Department of Psychiatry Faculty

Marc I. Rosen, MD Associate Professor of Psychiatry VA Healthcare System Department of Psychiatry, 116A West Haven, CT 06516 Tel: 203-932-5711 X2112 Fax: 775-599-1511 Email: marc.rosen@yale.edu

Education

B.A., 1982, Columbia College
M.D., 1986, University of Pennsylvania
Psychiatry Residency, 1990, Yale

Research Interest

We develop and test the efficacy of behavioral interventions for clients with comorbid psychiatric and substance abuse.

One line of research considers the relationship between spending decisions by dually diagnosed clients and their substance use. This question has been approached with surveys, analysis of data from quasiexperimental studies, and clinical trials. In our research, we found that expenditures for illicit drugs were not increased after Social Security benefits were awarded, but that a high proportion of VA inpatients need money management assistance. In several surveys, we have described generally high client ratings of satisfaction with a variety of involuntary money management arrangements. In clinical trials, we have tested the efficacy of a money management-based intervention called ATM (Advisor Teller Money Manager). Clients in ATM are taught budgeting and planning. Clients in ATM are encouraged to use their money to achieve abstinence-related goals, thus dampening the temptation to spend loose cash on illicit drugs and alcohol.

A second line of research considers interventions targeting medication non-adherence. A difficulty in counseling clients concerning the need to take prescribed medication is the difficulty in knowing when the medications were taken. In a series of studies, our group has tested the efficacy of counseling in which clients are provided electronically-generated feedback and review the dates and times medications were taken as prescribed and when they were missed. In clinical trials, we have found this counseling to be effective among clients prescribed medication for diabetes but ineffective among clients prescribed antiretroviral medication. However, review of feedback has been effective among clients prescribed antiretroviral medication when feedback is coupled with material reinforcement, contingent on on-time bottle openings.

Survey, secondary data analysis, and clinical trials are ongoing.

Key Collaborators:

Bruce Rounsaville, Robert Rosenheck, Thomas McMahon, Kevin Dieckhaus, Margaret Bailey, Nancy Petry, John Beauvais.

Publications of Note:

Rigsby MO, Rosen MI, Beauvais JE, Cramer JA, Rainey PM, O’Malley SS, Dieckhaus KD, Rounsaville BJ: Cue-dose training with monetary reinforcement: pilot study of an antiretroviral adherence intervention. Journal of General Internal Medicine 2000; 15: 841-847.

Rosen MI, Desai R, Bailey M, Davidson L, Rosenheck R: Consumer experience with payeeship provided by a CMHC. Psychiatric Rehabilitation Journal 2001; 25 (2): 190-195.

Rosen MI, Rigsby MO, Dieckhaus KD, Cramer J: Effects of illicit drug use on adherence to prescribed antiretroviral medication. American Journal on Addiction 2003; 12 (5): 455-458.

Rosen MI, Rosenheck R, Shaner A, Eckman T, Gamache G, Krebs C: Veterans who may need a payee to prevent misuse of funds for drugs. Psychiatric Services 2002; 53 (8): 995-1000.

Rosen MI, Rosenheck R, Shaner A, Eckman T, Gamache G, Krebs C: Need for money management assistance among psychiatric inpatients. Drug and Alcohol Dependence 2002; 67 (3): 331-334.

Rosen MI, Rosenheck R, Shaner A, Eckman T, Gamache G, Krebs C: Payee relationships: institutional payees versus personal acquaintances. Psychiatric Rehabilitation Journal 2003; 26 (3): 262-267.

Rosen MI, Bailey M, Rosenheck RA: Principles of Money Management As a Therapy for Addiction. Psychiatric Services 2003; 54 (2): 171-173.

Rosen MI, Ryan C, Rigsby MO: Motivational Enhancement and MEMS Review to Improve Medication Adherence. Behaviour Change 2002; 19 (4): 183-190.

Rosen MI, Beauvais JE, Rigsby MO, Salahi J, Ryan C, Cramer JA: Neuropsychological correlates of sub-optimal adherence to metformin. Journal of Behavioral Medicine 2003; 26 (4): 349-360.

Rosen MI, Rosenheck R, Shaner A, Eckman T, Gamache G, Krebs C: Do patients who mismanage their funds use more health services?. Administration and Policy in Mental Health 2004; 31 (2): 131-140.

Rosen MI, Rigsby MO, Salahi JT, Ryan CE, Cramer JA: Electronic monitoring and counseling to improve medication adherence. Behaviour Research and Therapy 2004; 42 (4): 409-422.

Rosen MI, Bailey M, Dombrowski E, Ablondi K, Rosenheck RA: A comparison of satisfaction with clinician, family members/friends and attorneys as payees. Community Mental Health Journal 2005; 41 (3): 291-306.

Rosen M, McMahon T, Lin HQ, Rosenheck R: Effect of Social Security Payments on Substance Abuse in a Homeless Mentally Ill Cohort. Health Services Research (In Press).

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