Thomas Kosten has been fascinated by the mechanisms of addiction since his first year as a medical student. While working through the MD/PhD program at Cornell Medical School, Kosten became interested in the field of opioid dependence, working in the methadone program.
“It was a special program because it was designed to treat adolescents,” Kosten told U.S. Medicine. “Could you treat people under 21 years of age with methadone maintenance? Would it be damaging or dangerous? I was very excited about the clinical project. From that, I got interested in clinical addictions research.”
That interest took him to Yale University for psychiatry training, which is where he was first exposed to VA. As a resident and fellow at the VA Connecticut Healthcare System, he worked with soldiers returning from Vietnam with PTSD and opiate dependence. As the 1970s became the 1980s, Kosten turned his attention to the cocaine epidemic. “We were looking at those drug dependencies in veterans with PTSD,” Kosten said. “There was a lot of that at VA at the time.”
Through the 80s and 90s, Kosten made his way up the ranks at Yale and VA, eventually becoming a professor and chief of Psychiatry at Yale University and the Connecticut VAMC. He did research not only using methadone but also naltrexone and, later, buprenorphine for cocaine and opiate dependence. In the early 1990s, he turned his attention to the development of vaccines for addictions. For the past 20 years he has been working towards the end-goal of a successful vaccine for cocaine addiction.
During those years, he left Yale for warmer climates and a larger research facility. Kosten now makes his home at Houston’s Baylor University and the nearby Michael E DeBakey VAMC. He acts as the VAMC’s senior advisor on substance abuse and professor of psychiatry and behavioral sciences at Baylor. At one of the biggest VAMCs in the country, Kosten enjoys what he characterizes as an “incredible amount of lab space.” Helping him run that space is Therese Kosten, PhD, his wife and research partner.
Kosten and his wife have recently showed efficacy of an experimental cocaine vaccine and are now working on a multisite national study in collaboration with VA—an organization that has proved to be nothing but beneficial to Kosten. “They have been just a wonderfully supportive system,” Kosten said. “They have allowed outpatient studies that are NIH studies with veterans and non-veterans. The facility support that VA provides for academic investigators is just outstanding.”
Moving forward, one of Kosten’s goals is to convince other healthcare systems that they need to emulate the VA paradigm. “We are developing considerably better vaccines than the ones we had in the early 1990s, and we’re still spending a fair amount of time trying to convince people to treat substance abuse,” Kosten said. “The VA model of healthcare is so far ahead of where the rest of the healthcare system is in the US, especially in substance abuse.”
With VA, the success of a treatment modality for substance abuse can be tracked across the entire system using the electronic medical record. It can be evaluated, tweaked, and easily personalized from patient to patient.
His current goal is to implement a clinical /translational research initiative at the Houston VAMC.