| Adam Bisaga, M.D.
Dr. Adam Bisaga is an Assistant Professor of Clinical Psychiatry in the Department of Psychiatry at the College of Physicians and Surgeons of Columbia University, and a Research Scientist at the New York State Psychiatric Institute. Dr. Bisaga received his medical degree in 1989 from Copernicus University School of Medicine in Krakow, Poland. Following a year of internship, Dr. Bisaga worked at the Institute of Psychiatry and Neurology in Warsaw where he trained in adult psychiatry and preclinical behavioral pharmacology of addictions. In 1992 Dr. Bisaga moved to the US and completed his psychiatric residency at the North Shore University Hospital in Manhasset, NY. In 1997 Dr. Bisaga began working at the Division of Substance Abuse at Columbia University, first as a research fellow in addiction psychiatry and later as a research psychiatrist. Here he received training in human preclinical studies and clinical research under the mentorship of Drs. Marian Fischman and Herbert Kleber. Since coming to Columbia, Dr. Bisaga has focused on the development of human laboratory models and testing novel pharmacotherapies for addictive disorders.
E-Mail: amb107@columbia.edu
Current Research Activities:
1. Cocaine dependence pharmacotherapy and methodology of early clinical trials. One of the major unmet needs in the treatment of addiction is the pharmacotherapy for cocaine dependence. The Division of Substance Abuse has a very active program to develop medications for this condition. Small N clinical trials can offer initial data on the efficacy and the mechanism of action of promising medications. Dr. Bisaga and his colleagues are interested in improving the design of clinical trials to test specific, laboratory-derived hypotheses about the potential spectrum of medication efficacy and to screen for new medication. This research group is particularly interested in the effectiveness of medication that acts on inhibitory and excitatory neurotransmission to modulate effects of cocaine.
Results of earlier studies have shown that inhibitory anticonvulsant medication gabapentin was no more effective than placebo in cocaine dependent individuals, though it may be beneficial in preventing relapse in a subpopulation of patients who achieve abstinence early in treatment. Pre-selection of patients based on the baseline level of cocaine use can predict the level of cocaine use during treatment and can identify patients more likely to experience a medication-specific effect.
Dr. Bisaga and colleagues are currently studying the effects of memantine on relapse in abstinent cocaine-dependent individuals: Effectiveness of Memantine in Treating Cocaine-Dependent Individuals. Initial abstinence is induced using a behavioral strategy of contingency reinforcement where decreases in cocaine use are reinforced early in treatment with high-value merchandise vouchers.
2. Effectiveness of Memantine in Treating Cocaine-Dependent Individuals. Improving treatment approaches for opioid dependence
The number of new problem users of heroin and prescription opioids has increased steadily over the past several years. While methadone maintenance remains the most effective treatment for opioid dependence, it has several limitations and is controversial. Alternate pharmacological strategies such as naltrexone maintenance are promising, but currently have limited usefulness due to poor patient compliance and low patient acceptability. Improved treatment approaches for naltrexone, including novel medication as well as pharmacological and behavioral augmentation strategies are greatly needed. There is strong support from preclinical studies and preliminary clinical observations suggesting that memantine, an NMDA-R antagonist may be effective in the treatment of opioid dependence.
Dr. Bisaga and colleagues are currently conducting a treatment trial of memantine as an adjunct to naltrexone maintenance in detoxified heroin-dependent individuals: Effectiveness of Memantine and Naltrexone Combination in Treating Heroin-Dependent Individuals.
3. Development of human laboratory models of addictive disorders and testing novel compounds using these models. Laboratory models of addictive disorders can offer unique opportunity to study mechanisms of disease and to screen for potential pharmacotherapies. Medications that block subjective effects, withdrawal symptoms, drug craving, or drug self-administration in the non-treatment-seeking volunteers who participate in the laboratory study may be effective in the treatment of addictive disorders. Currently Dr. Bisaga and colleagues are developing laboratory models of alcohol and nicotine dependence. These models will then serve to evaluate the contribution of glutamatergic neurotransmission. Memantine, medication that blocks NMDA receptor neurotransmission was found to reduce alcohol craving in moderate alcohol drinkers. Current studies will determine effects of memantine on cigarette self-administration, cue-induced craving, and relapse to smoking following a period of abstinence: Effect of Memantine Versus Bupropion on Smoking Relapse in Nicotine-Dependent Individuals.
Training Opportunities:
Dr. Bisaga has mentored postdoctoral research fellows through Dr. Herbert Kleber’s Postdoctoral Fellowship.
Selected Peer-reviewed Publications:
Bisaga A, Comer SD, Ward AS, Popik P, Kleber HD, Fischman MW. The NMDA antagonist memantine attenuates the expression of opioid physical dependence in humans. Psychopharmacology 157 (2001) 1-10.
Bisaga A, Evans SM. The acute effects of memantine in combination with alcohol in moderate drinkers. Psychopharmacology, 172, (2004) 16-24.
Bisaga A, Xie S, Laposata M, Evans SM. Comparison of serum fatty acid ethyl esters and urinary 5-hydroxytryptophol as markers of recent ethanol consumption. Alcohol Alcohol, 40, (2005) 214-8
Bisaga A, Aharonovich E, Garawi F, Levin FR, Rubin E, Raby WN, Nunes
EV. A randomized placebo controlled trial of gabapentin for cocaine
dependence. Drug Alcohol Depend, 81, (2006) 267-274.
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