About

James R. McKay, Ph.D., is a Professor of Psychiatry at the University of Pennsylvania. He serves as the Director of the Penn-TRI Center on the Continuum of Care in the Addictions and the Center of Excellence in Substance Abuse Treatment and Education at the Philadelphia Veterans Affairs Medical Center. His primary research interest is in developing and evaluating new clinical approaches to improve the long-term management of substance use disorders and related problems. Dr. McKay has conducted work on remote models of continuing care delivery, including the use of telephone, smartphone, and SMS technologies. He has expertise in adaptive approaches to treatment, including Sequential Multiple Assignment Randomized Trials (SMART) studies, and has authored the first book on this topic. Additionally, he provides behavioral treatments for substance use disorders, contributing significantly to clinical practice and research in addiction medicine.

Research topics

• Psychology
• Medicine
• Psychiatry
• Clinical psychology
• Political science

Selected publications

• Testing the Efficacy of an Adaptive Approach to Delivering Psychosocial Interventions in Office-based Buprenorphine Treatment

  Journal of Addiction Medicine · 2026-01-05

  article

  OBJECTIVES: Clinical guidelines recommend providing adjunctive psychosocial interventions with medications for opioid use disorder (MOUD); however, limited evidence exists regarding when and how to provide them. This 2-group unblinded randomized controlled trial evaluated the efficacy of an adaptive approach to providing cognitive behavioral therapy and peer support for individuals receiving office-based buprenorphine treatment. METHODS: Between September 2020 and May 2023, 125 patients who recently initiated office-based buprenorphine treatment at 2 federally qualified health centers in the Mid-Atlantic region and provided informed consent were randomly assigned (1:1) to treatment as usual (TAU; n = 63) or TAU plus adjunctive psychosocial treatment delivered using an adaptive algorithm informed by baseline characteristics, engagement, and responsiveness (TAU+Adaptive; n = 62). Assessments occurred at baseline and 3- and 6-month follow-ups. Primary outcomes were treatment retention and opioid use. RESULTS: No significant between-group differences were observed. Across conditions, about 30% tested positive for opioids at follow-up, and 40% remained in MOUD treatment at 6 months. Exploratory post hoc analyses indicated greater retention among participants prescribed a 24 mg baseline buprenorphine dose (46%) compared with those on 16 (24%) or 8 mg (26%). No serious study-related adverse events were reported. CONCLUSIONS: Although the efficacy of the adaptive approach was not supported, high rates of treatment discontinuation and polysubstance use highlight the need for additional support for some patients. Findings also suggest that dosing strategies may need to be tailored to the increasing potency of the illicit opioid supply.

  PublisherDOI

• The continuing care project: A multi-arm randomised controlled trial of a continuing care telephone intervention following residential substance use treatment

  Drug and Alcohol Dependence · 2025-04-07 · 1 citations

  articleOpen access

  BACKGROUND: Previous research suggests telephone-delivered continuing care interventions are effective in reducing rates of substance use. This study assessed the effectiveness of telephone-delivered continuing care for people who had stayed in a residential alcohol and other drug (AOD) treatment facility for at least 4-weeks. METHODS: Participants were 277 (20 - 71 years; M = 38 years, SD = 10.4; 58 % male) individuals attending residential AOD treatment. Following discharge participants were randomised to: i) 12 weekly telephone sessions; ii) 4 weekly telephone sessions; or iii) no telephone sessions (control group). A multi-centre prospective, randomised, open, blinded endpoint (PROBE) design compared three study arms with follow up at 3- and 6-months. Primary outcome was the odds of complete abstinence and the days of AOD use for those not completely abstinent at 6-months. RESULTS: At 6-months follow-up, the odds of being completely abstinent in the past month was not significantly different between the three study arms (p > 0.6) and the number of days abstinent was not significantly different (p > 0.4). Participants across all arms were more likely (p < 0.001) to be completely abstinent compared to baseline [12-session OR = 12.86 (5.4, 30.9); 4-session OR = 9.52 (4.0, 22.4); Control OR = 7.02, (3.4, 14.7)]. CONCLUSIONS: The results suggest that the residential programs are associated with positive long-term impacts among participants who complete at least 4 weeks of treatment. Further continuing care research should include those who do not remain in treatment for at least 4 weeks, as they may be likely to benefit the most.

  PublisherDOI

• How covid-19 was experienced to affect the development of substance use disorders among young adults

  Journal of Social Work Practice in the Addictions · 2025-04-16

  articleSenior author
  PublisherDOI

• Sensitivity analysis for constructing optimal regimes in the presence of treatment non-compliance and two active treatments

  Electronic Journal of Statistics · 2025-01-01

  articleOpen access
  PublisherDOI

• Contingency Management for Stimulant Use Disorder and Association With Mortality: A Cohort Study

  American Journal of Psychiatry · 2025-09-10 · 8 citations

  article

  OBJECTIVE: While opioid overdose has begun to decrease in recent years, stimulant overdose has continued to increase and has not been adequately addressed. Unlike opioid use disorder, there are no medications approved by the U.S. Food and Drug Administration to treat stimulant use disorder (StUD). The most effective treatment is contingency management (CM), a behavioral intervention that provides tangible rewards to reinforce target behaviors, such as biochemically verified abstinence. Despite the effectiveness of CM on near-term substance use behaviors, the long-term impact on key outcomes such as mortality are unclear. The objective of this work was to examine whether patients with StUD who receive CM have a decreased risk of mortality. METHODS: This was a retrospective cohort study of patients with StUD who received or did not receive CM, using linked electronic health records and death records in the largest integrated health system in the United States, the Veterans Health Administration (VHA), from July 2018 through December 2020. The primary outcome was mortality in the year following the index CM visit. All-cause mortality data were obtained from the National Death Index and linked to electronic health record data. Adjusted hazard ratios were estimated using stratified Cox proportional hazards models. RESULTS: A total of 1,481 patients with StUD who received CM were included alongside 1,481 matched control subjects. Over the 1-year follow-up period, those who received CM were 41% less likely to die (adjusted hazard ratio=0.59, 95% CI=0.36, 0.95) than those who did not receive CM. CONCLUSIONS: This study provides the first evidence that CM use in real-world health care settings is associated with reduced risk of mortality among patients with StUD.

  PublisherDOI

• ‘Freeing the Leopards’: role reversal

  Journal of Transatlantic Studies · 2025-10-25

  article1st authorCorresponding
  PublisherDOI

• Changes in the trajectories of drug-free friendships and substance use among a cohort of individuals with multiple substance use disorders

  Nordic Studies on Alcohol and Drugs · 2025-04-16 · 1 citations

  articleOpen access

  Aims: We used reports ( n = 208) of drug-free friendships and alcohol and drug use by people diagnosed with substance use disorder in order to investigate their annual change trajectories across 4 years after treatment and the association between these trajectories and debut age and gender. Methods: The participants were recruited from the Stavanger region, Norway. Using cross-sectional analysis, we first examined the relationship between “alcohol and drug use” and “drug-free friendships” across the five follow-ups. We tested whether these associations were significant using chisquare chi-squared tests. Second, we developed three latent growth curve models examining the association between “alcohol and drug use” and “drug-free friendships”. Results: Our analysis displays a stable drug-free friendships pattern across follow-ups. Only in the fourth follow-up was there a significant association between lower “alcohol and drug use” and having “drug-free friendships” (χ 2 = 18.27, df = 8, p &lt; .05). In model 1, we found no association between gender, debut age, and alcohol and drug use; model 2 had significant variance on intercept but not on slope; model 3 had good fit (χ 2 = 44.33, df = 39, comparative fit index = 0.98, root mean square error of approximation = 0.027). However, we did not find any significant regression path between the “alcohol and drug use” and “drug-free friendships” slopes. Conclusions: Drug-free relationships were in the studied cohort group found to have little influence on reducing alcohol and drug use, while debut age and gender were unrelated to use trajectories across 4 years. We suggest that future research should focus on the frequency and quality of drug-free friendships and participants’ friendship assessments because previous research has found such relationships to facilitate recovery.

  PublisherDOI

• Access to Firearms and Opioids Among Veterans at Risk for Suicide

  JAMA Network Open · 2025-01-28 · 2 citations

  articleOpen access

  Importance: Firearm injury and poisoning, often by drug or medication overdose, account for most suicides among the general population and US veterans. In the Veterans Health Administration, the largest integrated health care system in the US, firearm and opioid access is assessed among patients at risk for suicide who complete suicide safety plans. Objective: To describe self-reported, clinician-documented access to firearms and opioids, firearm storage practices, distribution of firearm cable locks and naloxone, and counseling on firearm storage and overdose among veterans at elevated risk for suicide who completed suicide safety plans. Design, Setting, and Participants: This cross-sectional study used electronic health record data from the Veterans Health Administration from December 2021 to February 2023. Participants were veterans identified as having elevated suicide risk through routine screening with the Columbia Suicide Severity Rating Scale Screener who completed a safety plan within 30 days. Data were analyzed from March 2023 to March 2024. Exposure: Completion of a safety plan, a brief, evidence-based intervention to help prevent or de-escalate suicidal crises. Main Outcomes and Measures: Firearm and opioid access, as well as firearm storage information, were assessed via the lethal means component of the standardized safety plan note template. Results: Among 38 454 veterans identified (32 310 [84.0%] male; 15 206 participants [39.5%] aged ≥55 years; 26 960 participants [70.1%] living in urban areas), 9969 (25.9%) were Black and 23 714 (61.7%) were White and 3426 (8.9%) were Hispanic/Latine and 28 892 (75.1%) were not Hispanic/Latine. A total of 10 855 (28.2%) reported access to firearms. Approximately one-third of veterans reported storing at least 1 firearm in each of the following ways: unlocked and loaded (insecure), outside of the home or locked and unloaded (secure), or locked and loaded. Younger and middle-aged veterans, White veterans, veterans who were not Hispanic/Latine, male veterans, and rural veterans were more likely to report firearm access. A total of 2021 veterans (5.3%) reported access to opioids; older veterans, White veterans, veterans who were not Hispanic/Latine, and rural veterans were more likely to report opioid access. Clinicians reported discussing firearm storage with 10 655 veterans (98.2%) and overdose with 1589 veterans (78.6%). Only 1837 veterans (16.9%) offered firearm cable locks and 536 veterans (26.5%) of veterans offered naloxone were documented as accepting them. Conclusions and Relevance: In this cross-sectional study of electronic health record data, the prevalence of reported access to firearms was lower than expected, suggesting underreporting or underdocumentation, or a lower true prevalence among this at-risk population. Completion of a note template may have encouraged routine discussion of firearm storage and overdose risk, but acceptance of gunlocks and naloxone was low. These findings suggest that White veterans, veterans who were not Hispanic/Latine, and rural veterans may be at particular risk of harm by firearms and opioids.

  PublisherDOI

• Feasibility and acceptability of a contingency management program for stimulant use disorder in a pallet shelter community for homeless-experienced veterans

  Journal of Substance Use and Addiction Treatment · 2025-07-31

  articleOpen access

  BACKGROUND: Stimulant use disorder (StUD) is a leading cause of overdose and death among homeless-experienced Veterans (HEVs). Contingency management (CM), a behavioral intervention offering rewards for stimulant abstinence, is the most effective psychosocial treatment for StUD. However, CM remains underutilized and understudied in homeless service settings. We piloted CM at a novel transitional pallet shelter community for HEVs and assessed the intervention's feasibility and acceptability. METHODS: We implemented a 12-week, on-site CM program at a pallet shelter community-comprised of locked, private "tiny homes" alongside on-site case management and health services-at the Veterans Affairs Greater Los Angeles. Veterans with a history of StUD were eligible to participate in twice-weekly urine drug screening (UDS), with voucher-based rewards for stimulant-negative results. Mixed methods were used to evaluate CM's feasibility and acceptability, including quantitative measures of attendance and abstinence and qualitative interviews with participating Veterans (n = 10) and staff (n = 6). RESULTS: Among 26 enrolled Veterans, average session attendance was 32 % and 49 % of UDS samples were negative for stimulants. Qualitative findings identified several factors that supported CM's acceptability, including perceptions that CM was accessible, structured, and supportive; helped meet immediate needs through monetary rewards; and enhanced engagement with health services. Reported barriers included concerns about privacy, stigma, and perceptions of insufficient rewards. CONCLUSION: This pilot showed initial Veteran engagement and positive Veteran and staff attitudes toward implementing CM at CTRS, though feasibility and acceptability may be enhanced by addressing concerns regarding privacy, stigma, accessibility, rewards, and integrated psychotherapeutic support.

  PublisherDOI

• Examining cocaine use reductions and long-term outcomes in two clinical trials of continuing care for cocaine dependence

  Journal of Substance Use and Addiction Treatment · 2024-05-11 · 4 citations

  articleOpen access
  PublisherOA PDFDOI

Recent grants

• NIH Grant R01DA014059

  NIH · $2.2M · 2007

• NIH Grant R29DA008399

  NIH · $515k · 1998

• NIH Grant R01DA010262

  NIH · $1.9M · 2003

• NIH Grant R01DA020623

  NIH · $3.6M · 2013

• NIH Grant R01AA014850

  NIH · $2.9M · 2009

Frequent coauthors

• Arthur I. Alterman

  112 shared

• John S. Cacciola

  Treatment Research Institute

  84 shared

• Paula P. Schnurr

  National Center for Post Traumatic Stress Disorder

  81 shared

• Quyên Q. Tiêt

  Alliant International University

  81 shared

• William M. Moore

  Health Services Research & Development

  81 shared

• Craig S. Rosen

  Stanford University

  81 shared

• Alex H. S. Harris

  Stanford University

  81 shared

• Susan Rogers

  University of Massachusetts Amherst

  81 shared

Labs

• James R. McKay LabPI

Education

• Ph.D., Psychology

  Harvard University

  1987

Awards & honors

• Director, Penn-TRI Center on the Continuum of Care in the Ad…
• Director, Center of Excellance in Substance Abuse Treatment…