John J. Mariani, M.D.
Dr. John Mariani is an Assistant Professor of Clinical Psychiatry at the College of Physicians and Surgeons of Columbia University and a Research Psychiatrist II at the New York State Psychiatric Institute. Dr. Mariani received his undergraduate degree in Biology at the State University of New York at Albany (1989) and received his medical degree from the New York University School of Medicine (1993). After completing his psychiatry residency training at the Beth Israel Medical Center, the Manhattan campus for the Albert Einstein College of Medicine, where he served as Chief Resident, Dr. Mariani began a two-year addiction psychiatry research fellowship at Columbia University. In 2005, he joined the faculty of the Division on Substance Abuse. Dr. Mariani's primary focus is clinical research and he is the recipient of a K-23 Mentored Patient-Oriented Research Career Development Award from the National Institute on Drug Abuse (NIDA) for which Dr. Frances Levin serves as his research mentor. Currently, Dr. Mariani is the Director of Columbia University's Substance Treatment and Research Service (STARS) and the Associate Director of Columbia University's Addiction Psychiatry Research Fellowship. In addition, he supervises clinical and didactic education in addictions for Columbia University PGY1 and PGY3 general psychiatry residents. Dr. Mariani's research is primarily focused on investigating novel pharmacotherapies for addictive disorders, especially the utilization of anticonvulsant treatment for alcohol and sedative-hypnotic dependence.
Current Research Activities:
A Randomized, Double-Blind, Placebo-Controlled, Pilot Trial of Gabapentin in the Treatment of Benzodiazepine Abuse in Methadone Maintenance Patients
Illicit drug use is a serious clinical problem in the methadone maintenance population. Benzodiazepine abuse in particular is problematic given that methadone maintenance patients who use these drugs have less favorable outcomes. The reported rates of current benzodiazepine abuse among methadone maintenance patients, usually defined as unauthorized use during the past month, range from 18% to 68.5% with most studies showing a prevalence of approximately 35%. Patients in a methadone maintenance treatment who die accidentally are likely to have been using benzodiazepines. Potential treatment strategies that have been investigated, including contingency management and benzodiazepine maintenance, have not been accepted into clinical practice. As a treatment for alcohol dependence, anticonvulsant agents have been shown to reduce drinking and promote abstinence, and reduce relapse drinking in abstinent alcoholics. There is evidence that certain anticonvulsant agents may help alleviate the symptoms of benzodiazepine withdrawal. Given the similar mechanisms of actions of alcohol and benzodiazepines, anticonvulsant agents should be investigated as a potential pharmacotherapy for benzodiazepine abuse. Gabapentin is an anticonvulsant agent that has no known drug interactions, lacks abuse potential, and has evidence of efficacy in the treatment of alcohol withdrawal and insomnia related to discontinuing alcohol.
The aim of this project is to study the use of gabapentin in reducing benzodiazepine abuse in methadone maintenance patients. A second aim is to study the effects of gabapentin on craving, mood, anxiety, and sleep disturbance in methadone maintenance patients abusing benzodiazepines. The protocol is a randomized, double-blind, placebo-controlled pilot outpatient trial of gabapentin in the treatment of benzodiazepine abuse in methadone maintenance patients. All subjects receive weekly manual-guided psychotherapy directed at achieving abstinence and improving current functioning. The primary outcome measure, benzodiazepine use, is assessed weekly by a combination of self-report (time line follow-back method) and urine toxicology. Associated psychological symptoms of craving, mood, anxiety, and sleep disturbance, is assessed by a combination of clinician and self-rated instruments.
Dr. Mariani serves as a clinical supervisor to fellows in the addiction psychiatry research fellowship and to Columbia University general psychiatry residents and medical students.
Mariani JJ. Alcohol-Related Disorders. In Gabbard's Treatments of Psychiatric Disorders, Fourth Edition. Glen O. Gabbard, editor in chief.—4th edition.2007 APA Psychiatric Publishing, Inc. Arlington VA P 199-216.
Mariani JJ and Levin FR. Substance Abuse and Adult Attention Deficit Hyperactivity Disorder. Substance Dependence and Co-Occurring Psychiatric Disorders: Best Practices for Diagnosis and Treatment. (in press)