Meeting Addiction Where It Lives

Addiction has long been seen through a narrow lens—something to be hidden, stigmatized or explained away as a personal failing. But as the opioid epidemic, rising e-cigarette use and shifting cannabis laws prove, addiction is not only a medical condition but also a deeply complex public health issue. It’s a crisis that cuts across biology, psychology, law, economics and social policy, affecting people, their families, communities and populations alike.

School of Public Health and Health Professions (SPHHP) researchers are reframing how we understand addiction. Their work highlights a central idea: addiction isn’t just about abstinence or relapse. It’s about harm reduction, meeting people where they are and developing solutions that recognize the many factors—social, biological, political and more—that shape substance use.

Through collaborations that span disciplines like engineering, psychology, social work and more, SPHHP researchers are working to reduce stigma, understand recovery as more than just the absence of substance use, and build interventions that can change lives across diverse populations.

For Dennis Daniels, clinical assistant professor of health services, policy and practice, the stakes are personal and societal.

“Addiction-related outcomes devastate families, finances, and personal and public safety,” Daniels said. “As scholars and practitioners, we have a duty to collaborate in developing effective prevention and treatment strategies.”

This public health framing echoes across UB’s research community. Addiction is a chronic condition, yes, but also a product of biology, environment, economics and culture. It is shaped by forces as varied as marketing campaigns for vaping products, the availability of treatment resources or the social rituals of young adulthood.

Jessica Kulak, assistant professor of community health and health behavior, is preparing to analyze multi-year survey data to see how the rollout of legal cannabis affects young adults’ substance use. Those findings, she said, will be critical for shaping both policy and harm reduction education.

Kulak notes that addiction research must keep pace with how substance use itself is changing. "Drug use and misuse are becoming much more complicated,” she says. “Products are evolving, access is easier, and the ways people misuse substances are more sophisticated.” Her work underscores that research not only saves lives, but also informs public policy and equips clinicians with better tools.

Professor Gregory Homish, chair of the Department of Community Health and Health Behavior, asserts that it’s not just the research itself that’s significant. The research needs to help change the societal view of addiction.

"We need to reinforce the idea that people’s social network is sovery important,” he says. “Focusing only on the individual is noteffective. You need to focus on the broader peer network.”

What unites UB’s researchers is a commitment to collaboration—and to harm reduction. Whether studying how nicotine receptors drive cravings, examining how social networks support recovery, or testing interventions for chronic pain, they’re seeking approaches that make substance use less dangerous and more treatable.

Harm reduction challenges the notion that abstinence is the only path to recovery. Instead, it emphasizes minimizing risk and supporting people’s health where they are.

R. Lorraine Collins, associate dean for research and director of UB’s Center for Cannabis and Cannabinoid Research, has long advanced this perspective.

“Some people assert that if you have trouble with substance use, the only solution is to abstain. I disagree,” Collins said. “I help people to manage their use.”

Her work—whether focused on malt liquor and cannabis among young adults or cannabis use among older adults—highlights the role of self-control and behavioral strategies. For Collins, moderation is key—encouraging young people to monitor their use or developing policy recommendations that regulate cannabis potency and marketing.

Although public awareness of addiction has more recently been on opioids and other drugs, Nicholas Felicione, assistant professor of community health and health behavior, reminds us that cigarette smoking remains the leading preventable cause of disease, disability and death in the United States. Even though rates of smoking have decreased over the years, it’s still “one of the most harmful behaviors we can engage in,” Felicione says. He looks for the connections between biology (how substances affect receptors in the brain, for instance) and behavior that produce and reinforce use.

Jessica Kulak’s research also highlights how new cannabis products are shaping risk, particularly among young people. By surveying young adults as the cannabis marketplace expands in New York, she hopes to identify emerging patterns that can guide healthier engagement and prevention strategies.

The harm reduction lens resonates in the classroom, too. “We teach students that it’s not just about categorizing someone, but asking, how do we meet people where they are?” says Sarah Heavey, clinical associate professor in Community Health and Health Behavior. “It’s a person-centered approach.”

As addiction research evolves, so do its tools. UB researchers are increasingly taking advantage of ever-evolving technology to identify patterns in behavior and improve treatment.

Collins is collaborating with project lead and Assistant Professor of Community Health and Health Behavior Alison Haney, on proposed research to use artificial intelligence (AI), machine learning and other sophisticated techniques to examine acute tolerance to alcohol.

Similarly, Kyler Knapp, assistant professor of community health and health behavior, is exploring how AI can analyze “ecological momentary assessments”—the method of gathering in-the-moment data from people in the context of their natural environment—from people in recovery. A pilot study he has proposed involves getting data from people in their own words about their current moods, experiences and other factors, and using AI to find patterns in what they say. Those patterns, he believes, could show how the process of recovery changes over time and reveal ways to better help people early in their recovery.

Addiction research at UB is moving into new and timely directions, shaped by emerging trends in substance use and the need for more effective interventions and policy.

Lorraine Collins’ long-term vision is getting to policy that treats cannabis like alcohol or tobacco, with age restrictions and strict marketing controls. Nick Felicione is tracking the constantly shifting landscape of nicotine products, from synthetic compounds designed to sidestep regulation to new combinations of tobacco and cannabis that may worsen dependence. Sarah Heavey is pressing forward on work that examines rising overdose deaths among older adults and exploring culturally appropriate interventions for diverse populations.

Kyler Knapp is developing longer-term studies to understand which factors sustain recovery for years, not just months, and wants to broaden understanding of how researchers’ and community partners’ reciprocal relationships might better inform research and get vital data back to the community. Dennis Daniels is planning deeper dives into how vaping is marketed and perceived, with the goal of shifting electronic nicotine delivery systems (e-cigs) back toward their intended role as cessation tools. And Gregory Homish is embarking on a new study of health care workers’ stress and substance use, motivated by the extraordinary pressures revealed during COVID-19.

Together, these projects point to a future in which UB researchers are not only responding to today’s challenges but also anticipating tomorrow’s: new products, new populations at risk, and new opportunities to bring science and community together. As Collins noted, the goal is not simply to eliminate substance use but to help people live healthier lives. “We have this perception as a society that substance use is horrible at the same time we’re using substances. I hope that with better regulation and lessening of harm and negative consequences, we can lessen the stigma that can get in the way of people who need help.”

Daniels’ work focuses on harm perception of electronic nicotine delivery systems (ENDS), marketing of ENDS and consumer behaviors. With collaborators at UB and Roswell Park Comprehensive Cancer Center, he studies how exposure to ENDS marketing affects perceptions of harm, particularly among tobacco consumers and non-smokers. He mentors Master of Public Health (MPH) students researching generational differences in how e-cigarettes are understood, with findings to be presented nationally. His goal: reducing ENDS use to their intended purpose—helping people quit smoking—rather than fueling new addictions.

Kulak examines how evolving drug markets—particularly for cannabis—shape young adults’ substance use. Funded by the New York State Office of Addiction Services and Supports, her current project surveys young adults to track how the rollout of the cannabis marketplace influences the prevalence of cannabis use and risk factors.

Homish brings a social and environmental lens to addiction research. His decade-long study of Army Reserve and National Guard members and their spouses showed how both deployment and non-deployment experiences their substance use. He is now studying stress, resilience and substance use among health care workers post-COVID. A central theme of his work: the importance of social networks in recovery. “A person’s social network can be a powerful source of influence, which can mitigate or exacerbate substance use,” he says.

Collins’ current research is expanding into cannabis use among older adults, a population with unique risks such as falls, cognitive decline and complex health conditions. She continues to advocate for moderation, evidence-based regulation and reducing stigma around substance use.

Felicione studies tobacco use, particularly the intersection of product design and behavior. His lab investigates how factors like flavoring, nicotine levels or co-use with cannabis affect dependence and exposure to harmful substances. He works closely in the field of regulatory science to inform FDA policy on emerging products, from e-cigarettes to synthetic nicotine alternatives. He also partners with colleagues to address health disparities in smoking cessation, asking how financial and social barriers affect people’s ability to quit.

Heavey bridges epidemiology and community health practice. She analyzes millions of death records to distinguish between unintentional overdoses and suicides, with a focus on rising overdose rates among older adults. She also studies non-pharmaceutical interventions for chronic pain and collaborates with local agencies on suicide mortality. Her work underscores the idea that addiction and mental health are deeply intertwined—and that solutions must be culturally appropriate and system-wide.

Haney directs UB’s Buffalo Addiction Research (BAR) Lab, a simulated environment outfitted with cameras and sensors to study people’s behavior in an actual bar. Her work looks at acute tolerance—the phenomenon where people feel less impaired the longer they drink, even though their actual impairment remains. Because acute tolerance strongly predicts risky outcomes, Haney is testing ways to measure it in the lab and real-world settings. Her pilot project, in collaboration with UB emergency medicine, may lay the groundwork for adaptive interventions that help people recognize risk in the moment.

Knapp’s research emphasizes recovery as a dynamic, individualized process. By tracking people early in recovery through daily smartphone surveys, he seeks to understand moment-to-moment fluctuations in cravings and coping. His focus is on holistic well-being, not just substance use reduction.