We are saddened to hear of the passing of Kathy Carroll. Her contributions to the field of substance misuse will have a lasting impact on the work we do.
|In Memoriam: Kathleen M. Carroll, PhD
It is with profound sadness that we share the news that Kathleen (Kathy) M. Carroll, PhD, a clinical scientist who made seminal contributions to improving treatments for addiction, died unexpectedly after a brief illness on December 28, 2020. She was 62 years old. At the time of her death, Dr. Carroll was the Albert E. Kent Professor of Psychiatry, Yale School of Medicine, and director of psychosocial research in the Division on Addictions.
Dr. Carroll possessed a rare blend of brilliance, generosity, and humility that propelled a career spanning over 30 years in addiction treatment research at Yale. She graduated summa cum laude from Duke University, received her PhD in clinical psychology and neuropsychology in 1988 from the University of Minnesota, and completed her predoctoral training at Yale School of Medicine’s Division of Substance Abuse. Following a brief stint as instructor in Neurology at Harvard Medical School, she joined the faculty at Yale in 1989 as assistant professor of psychiatry. Working closely with Dr. Bruce Rounsaville, she helped establish and subsequently led the Psychotherapy Development Center (PDC), the National Institute on Drug Abuse’s (NIDA’s) only funded Center of Excellence devoted to behavioral therapies research. Through Dr. Carroll’s leadership, the PDC became one of the most important sources of addiction treatment development and dissemination over the past 25 years, improving the methodological rigor of clinical trials research and leading to multiple clinical innovations that have impacted the lives of many struggling with addiction. Officially ending in 2020, the PDC produced over 1,500 peer-reviewed publications and launched the careers of dozens of independent investigators. Dr. Carroll also served as a principal investigator of NIDA’s Clinical Trials Network, a partnership between NIDA, treatment researchers, and community providers to work toward new treatment options in community-level clinical practice.
The depths of her contribution to the field of addiction are unparalleled. She has been a principal investigator on over 100 research projects funded through NIH, with funding amounts totaling over $76 million. She authored or co-authored over 330 articles in peer-reviewed publications, with over 50 chapters in major textbooks, along with several books and published manuals. Her Cognitive Behavioral Therapy (CBT) manual for cocaine use disorders has been translated to over 14 languages and implemented worldwide. Among the defining accomplishments of her career has been broader recognition of the efficacy, safety, and durability of behavioral therapies. She helped establish the Stage Model of Behavioral Therapies Development that facilitated important advances by defining stages of science for behavioral therapies development, from pilot testing of novel approaches translated from basic clinical science (“Stage 1”) to efficacy testing via randomized clinical trials (“Stage 2”) to effectiveness research based in community settings (“Stage 3”). This required a set of methodological advances (e.g., systemization of interventions in manuals, development of fidelity rating systems, therapist training strategies) to which she made multiple contributions. She received a NIH MERIT award for her work which led to the development of an effective web-based version of CBT (“CBT4CBT”), now validated in eight independent trials. CBT4CBT became one of the first evidence-based computerized interventions for a range of substance use disorders and is currently being adapted and implemented for various co-occurring conditions.
Dr. Carroll served on several journal editorial boards, advisory boards, and NIH scientific review panels, too numerous to list. Most recently, she was an invited member of the National Academy of Medicine’s committee on medications to treat opioid use disorders and was a major author of its influential consensus report Responding to the Opioid Crisis: Medications Save Lives.
Dr. Carroll received many prestigious awards, but being honored in September of this year at the 50th anniversary celebration of the APT Foundation, where she conducted much of her research, was among the most meaningful to her. This award highlighted not only her research contributions but her mentorship and relationships with others, to which she was truly committed. According to long-time collaborator, Charla Nich, “we were blessed to be able to give Kathy a message just 3 months ago about our gratitude for her scientific integrity, brilliance, courage, strength, radical acceptance, and love personified.” Ayana Jordan, MD, PhD, a current mentee noted, “Her ability to lead compassionately and lift others while climbing, is indeed a gift from the creator.” Brian Kiluk, PhD, another long-time mentee, described her as “the embodiment of a true mentor—someone who both teaches and guides others on their career path, but also serves as a shining example for what others aspire to be.”
Dr. Carroll’s tremendous academic and scientific accomplishments are dwarfed by her kind, generous, and playful spirit. She had an amazing ability to find joy in everyday situations, especially in life’s most difficult moments. She loved swimming, art history, architectural history, hiking, and reading. Kathy was an expert on the works of Shakespeare and opera. She also had a fine sense of humor and loved a good prank. She was a lifelong progressive with great compassion for social justice and coupled anti-racist principles with her recent academic work on identifying and addressing racial and ethnic disparities in substance use treatment outcomes.
Dr. Carroll has maintained a decades old relationship with Christian Community Action (CCA) in New Haven and contributed annually through efforts to provide for school clothing, Christmas gifts, and Easter baskets for children living in emergency housing. From her hospital bed one week prior to falling critically ill, she reached out to CCA caseworkers to make sure that all the homeless children were cared for—and donated electronically toward that effort.
Kathy is survived by her daughter, Kate, her brother, John and his two amazing sons, Dag and Dashiell, her mother Barbara, and her husband Geoffrey White and his daughters, Natalie, and Carla White as well as Matthew Chivian. Her Yale/APT team, too large to mention by name, embraced Kathy as family. Kathy was predeceased by her father John, and loving canine companions Trundo and Ernie.
In lieu of flowers, Kathy’s family is suggesting a donation to the Kathy Carroll Memorial Playground fund at Christian Community Action, 168 Davenport Ave., New Haven, CT 06519. CCA has agreed to set up a creative, safe, and fun outdoor play space for the children in emergency housing.
Memorial services have been postponed until the pandemic allows for a proper gathering and celebration of Kathy’s life.
2020 has been an unprecedented year in so many ways. Every day we see stories and news reports about COVID19 but that is not the only crisis we are facing. The Opioid Epidemic continues and has only worsened since the Pandemic began. Between March and May, 42 states and territories issued mandatory stay at home orders which led many Americans to begin work from home, virtual learning or unemployment. For those deemed “essential workers”, work continued under uncertainty, fear and increased use of Personal Protective Equipment (PPE).
The effects of the Coronavirus vary from individual to individual but common experiences include feelings of social stress, isolation, fear, grief, concerns about job security, finances and health. All these factors, plus countless others, have played a roll in what state officials predict will be a year of record overdose deaths in Connecticut. The Chief Medical Examiner predicts the total number of overdoses in the state in 2020 to exceed 1300, over 100 more than last year. Through October 2020, Connecticut reported a 13% increase in overdose deaths over the same period in 2019. Fatal and nonfatal overdoses nationwide spiked in May 2020 with a 42% increase compared to May 2019.
It is impossible to know all of the correlations between COVID19 and substance use but some things we know for sure. Alcohol and cannabis sales have both increased during the Pandemic as many individuals are reporting new or increased alcohol and drug use as a coping method. Alcohol sales were deemed essential during the Pandemic as alcohol withdraw can be deadly. So what do we know about why overdoses, especially fatal ones, have increased? Isolation is a key factor. Individuals who may have once used drugs with others were often isolated and using alone. If an overdose occurs while someone is alone, there is no one to call for help or administer the lifesaving overdose reversal, Naoloxone. Even if someone is present, the fear of going to the hospital during COVID19 may have prevented individuals from seeking help. The existing stigma around SUD can impact willingness to seek treatment that could prevent a future overdose.
While organizations such as Liberation Programs were deemed essential and not forced to close, fear of leaving the house and being around others became a new barrier to treatment. Fortunately, governmental mandates were changed to allow for an increase in take home medication such as Methadone which curbs opioid cravings. Additionally, telehealth services were able to be implemented to provide treatment and support from an individual’s residence. However, if someone has no access to a phone or internet, this was not an easy solution. We have adapted and made changes to provide lifesaving treatment during the Pandemic, but there is much work left to be done.
Individuals with Substance Use Disorders (SUD) often have co-morbidities that can worsen symptoms in those who contract COVID19 as well as make individuals more susceptible to the virus. Unfortunately, minorities have been disproportionately affected by COVID19 and Substance Use Disorders. A study by the National Institute of Drug Abuse (NIDA), found that African Americans with Substance Use Disorder and COVID19 had worse outcomes for hospitalizations and mortality. Another study showed that Black patients had a larger portion of Opioid overdoses during the Pandemic. This disparity in access and treatment must be addressed in order to save lives.
So what are we doing at Liberation Programs to address the Coronavirus Pandemic and Substance Misuse? We have never closed our doors to Recoverees and are fully utilizing allowances for take home medications and telehealth – something we hope to incorporate even once the Pandemic is behind us. Our Mobile Wellness Van continues to operate throughout Fairfield County 5 days per week providing life saving Narcan (Naloxone), syringe exchange, harm reduction supplies, education and referrals to those seeking support. We have trained all staff as well as many in the community and local government in Narcan, including providing Narcan kits, so that we can get as many people as possible equipped to save lives. We remain committed to meeting people where they are, saving lives and showing that Recovery is Possible.
It all began in March, COVID19’s first case in the USA creating a rollercoaster of emotions such as anxiety, fear, stress and uncertainty! Isolation was encouraged.
At a steady and rapid pace, the Coronavirus pandemic forced us into our homes to “Shelter in Place” while we were encouraged to do our part to “Flatten the Curve”. Cities and states started to shut down as cases increased hourly and daily. Closings took on a life of their own; schools, churches, restaurants, malls, and theatres all closed. However, liquor stores were considered essential and remained opened along with grocery stores. Alcohol sales in stores and online increased at an alarming rate. Uber Eats and Uber Drinks thrived! What happened to those already struggling with substance use disorders?
With a universal time out, ensuing State orders and CDC guidelines were followed; how would those experiencing anxiety, depressions and isolation and already on the cusp for potential alcohol/substance abuse fare? Did parents relax rules at home for alcohol use among teens in order to appease and bond with their child(ren) and/or over compensate for their uncertainty as to what to do? With the first summer in history where sports and other activities were not available, how were young people able to exert energy? While sheltering-in-place and seeing family members differently than they ever had, how does one cope? How does a parent, who feels unprepared to read to their child(ren), cook meals, provide homework help, and experience food insecurities cope with their day-to-day stress? How does an individual whose only escape from an abusive partner was to work outside the home now survive? What does one reach for to deal with life on its new terms; is it alcohol? Legal, accessible and stigma free alcohol potentially start to look good to those looking for relief, even better to those who relied on it already and the best of all to those who could not cope with the responsibilities of their life during the pandemic. Did they resort to drinking, increase alcohol intake or excessive drinking?
There was no longer any place to hide, no place to run to, no dropping kids at day-care, school, work, extra-curricular activities, baptism, birthdays, catechism, bar mitzvah; it all happened under one roof, at home. The positive aspect of COVID19 created room for bonding, worship, laughter, game night, meals, academic, games and family story time. The decision for the school year’s end was distant learning. Pre COVID19 we navigated through life moving quickly from one task to the next and seldom saw one another for long periods because school, work, worship and extra-curricular activities were all outside of the home, oftentimes with people other than the nuclear family. The New Norm continues!
Waiting to exhale!
The August/September back-to-school plan for our precious young people had us hold our breath. Of course, young people deserve socialization, kinship, friendship, and the school experience – they also deserve protection and safety. How does the young person view the back-to-school decision and what does the parent/caregiver believe about their decision to send or not to send their child(ren) to school? Does that decision determine a “Good Parent” or “Bad Parent”? Hybrid/Virtual/Home Schooling, what is it to be? For the child(ren) headed to school, is it a bus or car ride or a walk? When students see their friends, how do they greet one another? Are they properly wearing their mask; fully covering their nose and mouth? How do parents focus in work or at home with the anxiety of if their child(ren) is safe? COVID19 (The Pandemic) has shifted our focus…..we question are we doing all we can, is there anything else we can do? While we consistently experience stress, anxiety and uncertainty, what is our retreat? Is alcohol a companion; is it one glass of wine, one cocktail or a few? Has a drink become what we reach for to calm our worry? Let us take a minute to exhale and assess how we made it through the past six (6) months, what was the “it factor” that offered a sense of sanity, what became your vice? How do you make it through safely day-by-day? Let us continue to do the best we can daily and be kind to one another by offering support and Love.
“Don’t wait for the storm to pass, learn to dance in the rain” (author unknown)
By: Maggie Young, Chief Recovery Officer