Degree: Ph.D., 2005, Bowling Green State University, Clinical Psychology and Behavioral Medicine
I would describe my primary research interests as the application of public health and behavioral medicine to the treatment of illicit substance use. My main interests fall into several domains:
- Risk/harm reduction and disease prevention among out-of-treatment substance users
- Substance abuse intervention development and treatment effectiveness
- Ecological momentary assessment (EMA)
Medical Consequences associated with Injection Drug Use
Much of my work over the last several years has focused on health consequences associated with injection drug use. Injection drug users (IDUs) engage in a number of substance use practices that put them at high risk for viral disease (e.g., HIV, Hepatitis C), bacterial infections (e.g., skin abscesses, endocarditis), and overdose. Past studies have shown that specific practices, such as sharing needles, frequent injection, and not cleaning one’s skin before injecting, all pose risk for infection. Much of my recent work (Phillips, Anderson, & Stein, 2008; Phillips & Stein, 2010) has focused on establishing the range of high-risk practices (e.g., frequent injection, intramuscular injection) that put injectors at risk for bacterial infections, a very under-studied, yet common host of infections. Findings from these studies helped guide the development of a new risk reduction intervention with IDUs aimed at reducing both bacterial and viral infections. The project itself was a collaboration between myself (PI) and researchers at Brown University (Co-I: Michael Stein) and the University of Colorado – Denver Medical School (Project Safe, Co-I: Karen Corsi). The primary goals of this NIDA-funded (R21 DA026773) trial were to create a treatment manual, demonstrate feasibility of enrollment and follow-up assessment, determine the incidence of skin abscesses, and prove the practicality and initial efficacy of the intervention.
We utilized a stage model of behavioral therapy to develop the “Skin and Needle Hygiene Intervention (Skin).” In the first phase of this study, qualitative data was collected from focus groups with 32 active IDUs (Phillips, Altman, Corsi, & Stein, 2012). Participant responses guided the development of the new intervention, which combines psychoeducation, skill-building, and motivational interviewing. The RCT of the final, two-session intervention (Phillips, Stein, Anderson, & Corsi, 2012) included baseline, one-month, and six-month follow-ups with 48 active IDUs. Participants were randomized to either the: 1) risk reduction intervention or 2) an assessment-only control group. The primary outcome was skin- and needle-cleaning behavioral skills measured by videotaped demonstration. Secondary outcomes were high-risk injection practices, intramuscular injection, and bacterial infections. Intervention participants had greater improvements on the skin (d = 1.00) and needle cleaning demonstrations (d = .52) and larger reductions in high-risk injection practices (d = .32) and intramuscular injection (d = .29), with a lower incidence rate of bacterial infections (hazard ratio = .80), at six months compared with the assessment-only group.
Overall, the new Skin intervention appears very promising as a brief intervention to reduce bacterial and viral risks associated with IDU. The R21 study demonstrated that it is feasible to recruit IDUs for an intervention focused on bacterial infections. A large number of participants (98%) completed both Skin sessions, and 85% returned for their six-month follow-up. Importantly, we demonstrated sustained moderate to large intervention effects on skin and needle cleaning skills, the core of our intervention, as well as lower bacterial infection risk among intervention group participants. Due to the promise of the Skin intervention, my collaborator Michael Stein and I hope to test this new intervention on a larger number of participants (n = 350) in a hospital setting, where the prevalence of injection drug use is high, patients who otherwise might not seek care are accessible, and the presence of a drug-related illness can set the stage for patients to be more receptive to interventions.
Ecological Momentary Assessment with Marijuana Users
Marijuana use is a substantial problem among young adults in the U.S. and can lead to a number of health-related and cognitive outcomes. Prior studies have found high co-morbidity between cannabis disorders and psychological problems such as mood, anxiety, and psychotic disorders, as well as certain personality traits (e.g., impulsivity). When considering young adults, it is not clear whether marijuana use impacts college success or how complex substance use dynamics may operate to impact success. Most recently I have begun working with collaborators in education and statistics/methodology to assess the relationship between marijuana use, craving, and academic motivation among college student marijuana users using ecological momentary assessment (EMA). EMA is a type of methodology that allows researchers to learn about participants “in the moment,” often incorporating novel technologies (e.g., cell phones, PDAs) to gather information.
The primary goals of this ongoing pilot study are to establish the feasibility of using text messaging as a form of EMA and to examine the relationship between marijuana use, craving, and academic motivation in the moment. Participants include daily marijuana users. Preliminary data analyses using multilevel linear modeling suggest that craving for marijuana at one time point predicts marijuana use at the subsequent time point. Greater craving for marijuana was highly related to decreased academic motivation in the moment. Compliance rates for the two-week EMA are exceptional, with an overall 89% response rate, thus establishing that the study is feasible. We are still exploring much of the data, as the study is ongoing. Several variables that we did not assess during our pilot study that have important implications for intervention include affect (mood/anxiety) and psychological impairment. I hope to secure external funding to conduct a larger study that will further assess marijuana use and craving, psychological distress, and academic concerns among a college student population. We recently used our pilot data to inform a recent NIH grant submission. The long-term objective of this program of research is to reduce marijuana use and psychological symptoms, as well as improve academic outcomes, among college student marijuana users by developing and establishing the efficacy of a new intervention. Considering the promise of technology-based approaches with this population, I am very interested in pursuing a technology-enhanced intervention that incorporates mHealth (mobile health).
Courses Taught at UNC
Abnormal Psychology, Clinical Psychology, Introduction to Counseling Theories, Health Psychology, Theories of Counseling (graduate), Psychology of Addiction (graduate and undergraduate)
My approach to teaching psychology has evolved substantially over time and I feel that I continually strive to re-evaluate the content and manner in which I teach in order to best meet the needs of my students. I have learned, much like in psychotherapy, that different teaching strategies are needed for different objectives and outcomes. I have become more accustomed to using multiple teaching strategies in my courses to engage students and often incorporate collaborative learning and facilitated small group discussions, demonstrations, traditional lecture, guest speakers, in-class case studies, essay exams, and film to facilitate learning. I enjoy working with students at many different levels, including both undergraduate and graduate students, in and outside of the classroom. First and foremost, I believe that learning is an active and collaborative process and students need opportunities to engage with the material and to reflect on its utility outside of the classroom and to their lives. My approach to teaching often varies depending on the experience and knowledge of my students, though I feel there are a number of key principles I adhere to, including a focus on active learning, development of critical thinking skills, peer collaboration, and a focus on learning basic research principles.
Although much of what students learn come from various courses they take, I strongly feel that engaging students in research is an extremely valuable way to educate them about the field of Psychology. For this reason, I often work with a number of students each semester outside of the classroom. I currently run a Motivation and Addiction Research Group with Dr. Michael Phillips and graduate/undergraduate students. Students in my lab are involved in all phases of research, including reviewing the research literature, developing study questions and hypotheses, operationalizing variables, choosing measures, running participants, analyzing data, and summarizing findings. A large group of students recently presented some of our preliminary data at APA in August. I feel that this type of experience is a culmination of many of the topics/skills our students have learned while completing their degree and think it is a great way to help them apply their knowledge to a specific content-area.
Students interested in gaining research experience in the area of addiction or disease prevention should contact me by email (email@example.com).
Recent Grant Support and Submissions
Reduction of Medical Complications Associated With Injection Drug Use
R21 DA026773 (6/15/09 – 9/30/11)
Investigators: Kristina Phillips (PI), Michael Stein (Co-I), and Karen Corsi (Co-I)
National Institute on Drug Abuse (NIDA) / NIH
Preventing Bacterial and Viral Infections among Injection Drug Users
Re-submission (under review)
Investigators: Michael Stein (PI), Kristina Phillips (Co-I), and Jane Liebschutz (Co-I)
Submitted to the National Institute on Drug Abuse (NIDA) / NIH
Understanding the Dynamics of College Student Marijuana Use: A Study using EMA
New submission (under review)
Investigators: Kristina Phillips (PI), Michael Phillips (PI), and Trent Lalonde (Co-I)
Submitted to the National Institute on Drug Abuse (NIDA) / NIH
My Latest Professional Activity
Phillips, K.T., Altman, J.K., Corsi, K.F., & Stein, M.D. (2012). Development of a risk
reduction intervention to reduce bacterial and viral infections for injection drug users. Substance Use & Misuse. Advance online publication.
Phillips, K.T., Stein, M.D., Anderson, B.J., & Corsi, K.F. (2012). Skin and needle hygiene intervention for injection drug users: Results from a randomized, controlled Stage I pilot trial. Journal of Substance Abuse Treatment, 43, 313-321.
Phillips, K.T., & Stein, M.D. (2010). Risk practices associated with bacterial infections among injection drug users in Denver, CO. The American Journal of Drug and Alcohol Abuse, 36, 92-97.
Phillips, K.T., Anderson, B.J., & Stein, M.D. (2008). Predictors of bacterial infections
among HCV-negative injection drug users in Rhode Island. The American Journal of Drug and Alcohol Abuse, 34, 203-210.