Dr. Guydish received his PhD in Clinical Psychology from Washington State University in 1987, completed a clinical internship in Behavioral Medicine at the University of California, San Francisco (UCSF), and received 3 years of postdoctoral research training, also at UCSF, with emphasis on HIV prevention and substance abuse treatment. Dr. Guydish joined the faculty in the UCSF Department of Medicine in 1992 and is currently Professor in Residence of Medicine and Health Policy (UCSF).
Since 1986 Dr. Guydish’s research has focused on the needs of indigent persons with substance abuse problems. Dr. Guydish’s research team has studied HIV prevention strategies, drug abuse treatment outcomes, and efforts to improve treatment systems. Currently they are studying how treatment programs adopt new interventions, and how to address nicotine dependence in drug treatment settings.
Dr. Guydish’s work in HIV prevention began with Dr. Tom Coates in the UCSF Center for AIDS Prevention Studies. When local activists started an illegal needle exchange program (NEP), they studied potential impacts of NEPs. This work has continued into recent years, when the Dr. Guydish’s research team published (with Dr. Gibson, UC Davis) a longitudinal study showing decreased HIV risk associated with NEP use and (with Dr. Lum, UCSF) a study of risk behavior among women using NEP services.
Dr. Jim Sorensen and Dr. Guydish later proposed a randomized trial looking at drug abuse treatment outcomes, and comparing residential treatment to an intensive outpatient approach. That proposal was funded and led by Dr. David Werdegar, and it broadened the research team’s experience beyond HIV risk and into the area of treatment outcomes. They completed two additional randomized trials investigating, respectively, a probation case management intervention for drug-involved women offenders and a manualized group intervention for methamphetamine users. Building on their experience with clinical trials, also in collaboration with Dr. Sorensen, Dr. Guydish won a 5 year National Institute on Drug Abuse (NIDA) grant to lead a regional node of the Clinical Trials Network (CTN). The CTN tests promising treatments in multi-site effectiveness trials and, through the CTN, their work in treatment outcomes will continue into the foreseeable future.
In their work they have seen that even convincing demonstrations of effectiveness through clinical trials are often not sufficient to change practice. Doing so may require system-level intervention, and they have collaborated with community agencies in the evaluating three such interventions. The first, the Target Cities Project, created a centralized intake system for clients seeking publicly-funded drug abuse treatment in San Francisco. The second was designed to improve access to community services for drug-involved women offenders, and the third was a NIH/NIDA award to study increasing treatment access through the San Francisco “Treatment on Demand” initiative.
Blending their experience with clinical trials research and their interest in modifying clinical practice, Dr. Guydish’s research team developed an R01 to explore adoption of interventions in the context of clinical trials. They asked whether a clinic is more likely to adopt an intervention after it has actively participated in testing that intervention. They have now focused this effort on one of the vexing problems in drug abuse treatment: increasing access to nicotine dependence treatment for persons entering drug abuse clinics, where 40% of staff and 80% of clients are current smokers. Extending prior work on adoption, and as a component of Dr. Sharon Hall’s NIH/NIDA P50 Center grant now underway, they developed a prospective study comparing change in nicotine dependence treatment practices in agencies that do and do not participate in nicotine-related clinical trials. As a next step, and also with NIH/NIDA funding, they are testing whether clinical practices related to nicotine dependence treatment can be directly modified through a manualized organizational change intervention. This extends the focus of their scientific work from individual client-level intervention and measurement to organizational and systemic intervention and measurement, offering the prospect of broader impact on clinical practice. |
