Maria A. Sullivan, M.D., Ph.D.
Dr. Maria Sullivan is an Associate Professor of Clinical Psychiatry at the New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons. Dr. Sullivan received her education at Harvard, the University of Chicago (Ph.D., Psychology) and the George Washington University College of Medicine (1992). She completed her internship and residency training in Psychiatry at Columbia-Presbyterian Hospital and the NYSPI. Dr. Sullivan joined the Division on Substance Abuse in 1996, first as an addiction research fellow and later as a research psychiatrist. She received training in pre-clinical drug self-administration studies and clinical research under the mentorship of Drs. Marian Fischman and Herbert Kleber. Dr. Sullivan’s work has focused on the development of novel treatment strategies for nicotine dependence and opioid dependence.
Current Research Activities:
Combined pharmacotherapy and psychotherapy for opiate dependence
Opiate dependence is a serious pubic health problem, exacerbated by greater availability and purity of illicit heroin, and leading to substantial functional impairment and risks such as fatal overdose, progression to intravenous use, HIV, and viral hepatitis. For the past ten years the Division on Substance Abuse has had a very active research program to develop novel treatments for heroin dependence. Antagonist maintenance with naltrexone is a promising alternative to agonist therapy, since naltrexone blocks the reinforcing and intoxicating effects of opiates but carries no opiate-like effects. But the pharmacologic potential of naltrexone has been limited by poor compliance and high dropout rates. Dr. Sullivan and her colleagues have been working to improve the efficacy of naltrexone maintenance by developing a behavioral therapy to enhance adherence to naltrexone, and by conducting clinical trials of a long-acting depot naltrexone.
Results of an earlier trial suggested an association between depression and early dropout. Other predictors of poorer retention included greater daily quantity of heroin use at baseline and regular methadone use, as both of these factors resulted in a more severe opioid withdrawal syndrome during the transition to naltrexone. The need for flexibility in the length of detoxification and the aggressive use of medications to alleviate withdrawal discomfort, as well as the use of both antidepressant medications and cognitive-behavioral methods to address dysphoria, were important findings to emerge from this trial.
While more intensive behavioral therapy (e.g. involvement of significant other to monitor medication compliance, relapse prevention techniques, and use of abstinence-contingent vouchers) improved retention in treatment, poor compliance with oral naltrexone continued to predict early dropout in a recent controlled clinical trial. Dr. Sullivan and her colleagues are currently studying the safety and efficacy of a long-acting formulation of naltrexone, delivered by monthly intramuscular injection, to enhance retention in treatment. This approach appears to hold much promise for securing patients’ commitment to abstinence.
Development of human laboratory models to predict relapse to prescription opioid abuse among pain patients
The non-medical use and abuse of prescription opioids has risen dramatically over the past fifteen years, resulting in sharp recent rises in morbidity and mortality. In the Division on Substance Abuse, we have developed a laboratory model to evaluate potential medications for the treatment of opioid abuse, incorporating opioid self-administration with other more traditional measures of opioid effects. Currently, Dr. Sullivan and her colleagues are undertaking an investigation in which opioid-dependent chronic pain patients are transitioned to buprenorphine. These individuals’ opioid self-administration behavior, along with subjective and physiologic responses, are then examined in the laboratory setting. It is hoped that this work will provide important information about prescription opioid liability in pain patients and will yield a laboratory model for predicting likelihood to relapse to prescription opioid abuse.
Dr. Sullivan is a lecturer for Columbia College of Physicians and Surgeons and mentors residents in Psychiatry and research fellows through the postdoctoral fellowship in the Division on Substance Abuse.