The purpose of the study is to determine if the hormone progesterone affects marijuana users' stress response and marijuana use. Participation lasts approximately three weeks. During the first week, participants are randomly assigned to take either progesterone or placebo and remain abstinent from marijuana. They return at the end of the week to participate in a stress task. Throughout the three weeks, participants complete "CREMA" sessions (Cue Reactivity Ecologic Momentary Assessment) three times a day. These sessions include looking at stressful and neutral pictures and rating stress and craving.
The purpose of this study is to determine if the medication lofexidine, taken together with buprenorphine or methadone, is more effective at reducing opioid craving, use and stress response than buprenorphine or methadone alone, and to see if this effect is different for men and women. Participants are randomly assigned to add either lofexidine or placebo to their buprenorphine or methadone treatment for five weeks. They return at the end of five weeks to participate in an opioid imagery task and stress task. Throughout the study, participants complete "CREMA" sessions (Cue Reactivity Ecologic Momentary Assessment) using an iPhone app three times a day. These sessions include looking at stressful and neutral pictures and rating stress and craving.
Chronic pain is a serious public health problem with estimates as high as nearly half of the adult population experiencing some form of pain that lasts for more than 6 months. This issue negatively impacts quality of life, is financially burdensome, and has contributed to the opioid crisis in the United States. Therefore, a non-pharmacologic, non-invasive approach for alleviating chronic pain like prefrontal repetitive transcranial magnetic stimulation (rTMS) is an appealing avenue for research into chronic pain management. While rTMS has already been approved for use in treating depression, it has shown promise in treating chronic pain as well. However, there is a debate about which coil designs are most effective and which regions of the brain respond best to rTMS therapy. This study will examine the use of two novel coil designs the H1 coil which is designed to increase activity of the dorsolateral prefrontal cortex and the H7 coil which is designed to decrease activity of the medial prefrontal cortex. To evaluate the efficacy of the two treatment strategies, patients will undergo thermal pain testing before and after the rTMS interventions. The relative efficacy of these two treatment strategies will be useful for establishing rTMS as an effective strategy for chronic pain management and determining the direction for future rTMS research.
This research is taking place at the Ralph H. Johnson VAMC and surrounding Community-Based Outpatient Clinics (CBOCs). This study is examining the effectiveness of PE-PC in VHA primary care mental health integration (PCMHI) clinics. We will randomize Veterans presenting in VA PC with chronic PTSD who meet minimal inclusion/exclusion criteria to receive PE-PC (four, 30-minute weekly sessions) or PCMHI treatment as usual.
The purpose of this study is to develop transcranial magnetic stimulation (TMS) as a novel, non-pharmacologic approach to decreasing pain in individuals with chronic pain. This study will test whether rTMS over the prefrontal cortex can produce a reduction in your perception of pain, your desire to use opiates, and your brain's response to opiate cues. The results of this study will be used to design and develop a large clinical trial of rTMS as an innovative, new treatment option for chronic lower back pain in individuals that may have used chronic opiates.
This study will evaluate the effect of counseling plus Approach Bias Modification on cannabis use and craving in people with cannabis use disorder. The study consists of a screening visit, four treatment visits and two follow-up visits. Participants will have 3 sessions of counseling, 4 sessions of Approach Bias Modification, and 3 cue reactivity sessions.
Veterans who have prematurely dropped out of exposure therapy for PTSD will be contacted and offered the opportunity to return to treatment, this time with the assistance of a Veteran who has successfully completed this treatment in the past. Participants may receive a PE "Workout Buddy." This peer will meet them at the in vivo exposure therapy location and offer support and encouragement while the patient remains in that location. Participants may receive a PE general support peer. This peer will contact them once per week to check in about treatment progress and encourage session attendance, as well as discuss any life stresses. As the PTSD treatment standards in Charleston and other VA sites across the country increasingly include telemedicine delivered care, both in person and telemedicine based exposure therapy recipients will be included.
The first week after attempting to quite cigarette smoking is the hardest period to succeed. Research shows that individuals able to remain cigarette free for this first week are significantly more likely to quit the smoking habit. In this study, sponsored by the National Institutes of Health, we are evaluating a new tool to assist individuals with quitting cigarette smoking. Transcranial magnetic stimulation (TMS) is a non-invasive technique that uses magnetic pulses to temporarily stimulate specific brain areas (without the need for surgery, anesthetic, or other invasive procedures). This study will test whether 10 daily sessions of TMS over the forehead can help decrease smoking rates in treatment-seeking individuals.
Behavioral health problems among Veterans have raised awareness of the critical need for more reliable, effective, and accessible ways to recognize those in need, direct them to help, and ensure that they receive the best evidence-based care available. AboutFace is a novel peer education program that features the personal stories of Veterans and is designed to improve Veterans' likelihood of engaging in PTSD specialty care. Using a randomized controlled study design we propose to compare the efficacy of AboutFace relative to standard care for improving treatment engagement and outcomes. Additional data from VA providers will provide valuable information on wide scale implementation and dissemination of AboutFace. If AboutFace increases access of services, data will have broad implications for overcoming barriers to care for Veterans with PTSD and other stigmatized conditions.
The purpose of the study is to examine whether 60-minute sessions of Prolonged Exposure (PE) is as effective as the standard 90-minute sessions in reducing the symptoms of posttraumatic stress disorder (PTSD). PE is a well-researched, very effective individual (one-to-one) therapy that is designed to help people to deal with traumatic events they have suffered in the past, including combat. This study is being conducted at the Charleston VA Medical Center, surrounding Community-Based Outpatient Clinics (CBOCs), and in the community. It will involve approximately 200 active duty participants. This research is funded by the Department of Defense.