University of Vermont

College of Medicine

Department of Psychiatry

Bio for John Hughes, M.D.
John Hughes, M.D.

John Hughes, M.D.

Professor
Department of Psychiatry


Contact Information
E-mail: John.Hughes@uvm.edu
Office Location:
UVM Department of Psychiatry, Mail Stop 482OH3, 1 South Prospect Street, Burlington, VT 05401

Education

1975 MD – University of Mississippi
1979 Psychiatry Residency – University of Pittsburgh
1981 Research Fellow – University of Minnesota

Academic Appointments

1985 Professor, University of Vermont, Departments of Psychiatry, Psychology, and Family Medicine

Research Grants

John Hughes, M.D.  Research Grants
R01DA024691 (9/30/08-9/30/12)
(Hughes, John R., P.I.)
Agency: NIDA
Attempts to Stop/Reduce Marijuana Among Dependent Users
The major aim of this study is to provide a detailed understanding of attempts to stop or reduce marijuana use that can be used to develop better behavioral treatments for marijuana dependence. The application will provide a prospective description of attempts by dependent adult marijuana users to stop or reduce their marijuana use in a real-world setting. Although prospective, natural history studies describing attempts to stop or reduce alcohol, heroin and tobacco use have proved useful, we know of no such study among adult marijuana users. A pilot study will develop measures and assess compliance with our procedures. The main study will recruit 200 daily, adult marijuana smokers who plan to quit or reduce in the near future. Participants will call an Interactive Voice Recording (IVR) system daily for 3 months to report marijuana use, intentions to change marijuana use, quit/reduction attempts, and events that might increase or decrease the probability of initiating a quit/reduction attempt or the success of an attempt. Participants will be called weekly to obtain more detailed measures such as other drug use, self-efficacy, psychiatric/medical symptoms, and treatment seeking. Phone follow-ups at 4, 5 and 6 months will track marijuana and other drug use and dependence/abuse.
R01DA031687 (8/15/11-4/30/14)
(Hughes, John R., P.I.)
Agency: NIDA
Does smoking cessation cause anhedonia? A test of pre-clinical findings
Recent animal research indicates acute nicotine increases the reinforcing effects of other rewards; however, chronic use of nicotine recruits an opponent process that counteracts the acute effects of nicotine and decreases sensitivity to rewards.  When nicotine is discontinued in animals, this opponent process persists and the resultant decreased sensitivity to rewards may be a cause of nicotine withdrawal symptoms such as depression and a cause of relapse back to smoking.  Although this animal model is widely cited, whether decreased reward sensitivity occurs when smokers stop smoking is unclear.  We propose an experimental test that focuses on whether abstinent smokers a) are less sensitive to monetary rewards during an operant task and/or b) report anhedonia (less pleasure from rewards) and apathy (less motivation to seek rewards).  We will recruit 120 current smokers who plan to quit smoking for good to smoke their usual amount for one week and then will abstain for 4 weeks.  To insure an adequate number of continuously abstinent smokers and to decrease selection bias, we will use monetary contingencies to encourage abstinence.  We anticipate this will produce > 70 smokers who remain abstinent for all 4 weeks.  To assist in interpretation of results, we will also recruit a comparison group of 70 long-abstinent former smokers to be measured on the same schedule.  We will measure reward sensitivity three times each week using a) progressive ratio (PR) responding for monetary rewards and b) self-report measures of anhedonia and apathy scales.  If reward sensitivity changes with abstinence, secondary aims will be to determine a) its magnitude, incidence and time course; b) whether it exhibits the time course expected of a withdrawal effect, c) whether reward sensitivity becomes similar to the level among long-abstinent smokers and c) whether decreased reward sensitivity could be the basis for much of withdrawal discomfort.  The results of this study will be an important translational test of the leading animal model of nicotine withdrawal.  If we find decreased reward sensitivity, this would suggest revisions in clinical descriptions of nicotine withdrawal, new targets for behavioral and pharmacological interventions and new treatments for smoking cessation (e.g., increased exposure to rewarding events).  If reward sensitivity does not change with abstinence, then (given the adequacy of our test) this would suggest a widely-cited animal model of abstinence effects may not be generalizable to human attempts to stop smoking.
R01DA025601 (1/1/12-12/31/14)
(Hughes, John R., P.I.).
Agency: NIDA
Treatment for Smoking Lapses and Relapses
Over-the-counter nicotine replacement therapy (OTC NRT) is, by far, the most common treatment for smoking cessation in the US.  Over 80% of those using NRT will lapse and return to smoking.  One possible reason for this high rate of treatment failure is that smokers are instructed to stop medication when they lapse (in contrast to recommendations to increase medication dose when heroin users lapse).  Recent indirect evidence suggests that, in fact, a lapse is the most important time to continue NRT.  We propose a randomized controlled trial of continued NRT post-lapse vs. stopping NRT post-lapse.  Smokers who want to quit will receive, counseling, stop abruptly and begin NRT.  All psychosocial treatment will occur via phone and medications via mail.  Instructions and rationales for continuing or stopping NRT during a lapse episode will be delivered via written material, Interactive Voice Response (IVR) phone messages and reinforced during phone counseling.  We will enter 1000 smokers and anticipate observing 580 lapse while using NRT. We hypothesize our intervention to continue NRT use upon a lapse will increase 6 month point prevalent abstinence with an OR of 2.0.  We will also examine compliance with instructions and possible behavioral mechanisms of efficacy (e.g. does continued NRT reduce nicotine reward from cigarettes) as well as the incidence of serious adverse events when participants are concurrently smoking and using NRT after a lapse.  This study will be the first direct experimental test of whether continuing NRT after a relapse increases abstinence and is safe.  Positive results would suggest the package instructions for NRT, treatment guidelines and training programs should change to explicitly encourage smokers to continue NRT treatment after a lapse.

R01CA163176 (9/1/12-8/31/15)
(Hughes, John R., P.I.)
Agency: NCI
A Test of Two Clinical Treatments for Ambivalent Smokers  Despite tobacco control interventions, the incidence of quitting among US smokers has not increased in the last decade.  One way to increase quitting is to increase quit attempts and the most common clinical methods to do so are brief advice to quit and provision of information about treatments.  Newer clinical methods to prompt quit attempts that have empirical support are smoking reduction and motivational counseling.  In a prior randomized controlled trial (RCT), we found that three brief phone calls advising reduction in cigs/day aided by nicotine replacement therapy (NRT), or the USPHS 5 R’s motivational intervention, both increased quit attempts (ORs = 4.2 and 5.6) and point-prevalent abstinence (ORs = 4.5 and 6.3) compared to no treatment.  We now propose a conceptual replication and extension test of these results for several reasons: 1) many smokers are reluctant to use NRT, thus we wish to see if reduction unaided by NRT can be effective, 2) our prior study is the only test of the widely-cited USPHS 5 R’s intervention and obtained a much larger effect size than prior motivational interventions (OR = 1.3-1.5); thus, we believe a replication important, and 3) we wished to increase methodological rigor by employing a usual care (rather than a no treatment) control group.  Our methods will be similar to our prior trial.  We will proactively contact adult, daily smokers to recruit 850 smokers who wish to quit at some point but have no plans to quit in the next month.  We will randomize them to a) reduction counseling without the aid of NRT, b) counseling guided by the USPHS 5 R’s, or c) usual care. The first two conditions will be delivered via brief counseling calls at study onset and then 2 and 4 weeks later (total = 35 min).  The usual care condition will consist of three newsletters advising smoker to quit and providing information on quitting sent at these same times.  Our major hypothesis is that the incidence of quit attempts over the 6 months of the study will be greater in both the 5 Rs and the reduction conditions than in the usual care condition.   A secondary hypothesis is that the increase in quit attempts will lead to increased abstinence.  Another secondary hypothesis is that beneficial effects of both treatments will be mediated by increases in self-efficacy and intentions to quit.  We hypothesize that decreases in cigs/day and nicotine dependence will mediate the efficacy of the reduction treatment but not the 5 Rs treatment and, conversely, we hypothesize that a shift in decisional balance will mediate the efficacy of the 5 Rs treatment but not of the reduction treatment.  The significance of our proposal is described in the narrative.

Awards and Honors

1994 Ove Ferno Award for Clinical Research in Nicotine and Tobacco
1996 Council on Addiction Psychiatry, American Psychiatric Association
1998 Best Doctors in America
1999 Advisory Council, Center for Substance Abuse Treatment
2002 America's Top Psychiatrists
2002 Board of Directors, College on Problems of Drug Dependence
2007 Top 25 Most Cited Tobacco Researcher

Publications

To view Dr. Hughes' publications, please visit Pub Med
Additional Publication Information