Structured Clinical Interview for the DSM-5-TR (SCID-5-R) (2021-present)—Consultant and Co-Author. Sponsored by Columbia University and the American Psychiatry Association (APA), the objective of the project is to revise and the Structured Clinical Interview for the DSM-5 (SCID-5) according to updates to the DSM-5-TR (APA, 2022). Responsible for developing three versions of the SCID instrument (Research Version, Clinical Version, and Clinical Trials Version, and the Clinical Version in any foreign languages), seeking feedback from subject experts, and incorporating changes from expert feedback into the SCID-5-R.

National Study of Mental Health (2019-2021)—Consultant, Lead Clinical Supervisor, and Co-Author. Sponsored by SAMSHA, the objective of this study is to collect the best estimates of mental illness among adults in the US that have been calculated to date because we are not only going into households like most epidemiology studies – we’re also going into state hospitals, prisons, and homeless shelters. Responsible for hiring, training, and supervising all the clinical supervisors and clinical interviewers.

Structured Clinical Interview for the DSM-5 (SCID-5) (2013 to 2018)—Consultant and Co-Author. Sponsored by Columbia University and the American Psychiatry Association (APA), the objective of the project is to revise and the Structured Clinical Interview for the DSM-5 (SCID-5) according to updates to the DSM-5 (APA, 2013). Responsible for developing twelve versions of the SCID instrument (Research Version, Clinician Version, Clinical Trials Version, and the Clinician Version in 14 foreign languages), seeking feedback from subject experts, and incorporating changes from expert feedback into the SCID-5.

Training Materials for the Structured Clinical Interview for the DSM-5 (SCID-5) (2013 to date)—Consultant and Co-author. Sponsored by Columbia University and the American Psychiatry Association, the objective of the project is to create and produce the training materials for the Structured Clinical Interview for the DSM-5 (SCID-5) to include the User’s Guide for the SCID-5 Research Version, the User’s Guide for SCID-5 Clinician Version, the User’s Guide for SCID-5 Clinical Trials Version, and the User’s Guide for SCID-5 Personality Disorders Version, and the SCID-5 Training Videos. Responsible for producing first drafts and revisions of the training materials and serving as the lead actor in the video training tapes and webinars.

Effectiveness and Patient Acceptability of Stellate Ganglion Block (SGB) for Treatment of Posttraumatic Stress Disorder (PTSD) Symptoms among Active Duty Military Members. (2013 to date)— Consultant, Clinical Supervisor, and Co-Author. The prevalence of PTSD in active duty service members has been rising steadily over the last decade, and current treatment modalities are often ineffective or delayed. There appears to be hypothalamic-pituitary-adrenal (HPA) axis involvement in the etiology of PTSD, where a traumatic event leads to a release of norepinephrine in the insular cortex, amygdala, and hypothalamus. Stellate Ganglion Block (SGB) is theorized to cause a down regulation of nerve growth factor and decrease sprouting of sympathetic nerves, allowing a break in the chronic sympathetic arousal. The SGB is a routinely employed, safe, and minimally invasive procedure that has shown promise for near immediate relief of PTSD symptoms. This study’s aims are to (1) determine the effectiveness of SGB compared with saline placebo in treating symptoms of PTSD; (2) establish the duration of SGB effectiveness in treating PTSD symptoms; (3) determine whether any categories of PTSD symptoms (re-experiencing, avoidance, arousal) are more effectively impacted by SGB; and (4) describe the degree to which patients are accepting of the procedure.  The proposed research entails a randomized, double-blind, placebo-controlled trial with participants in the placebo group crossed over to active treatment at 2 months. Inclusion criteria include diagnosis of PTSD via a trained behavioral health clinician using the Clinician-Administered PTSD Scale (CAPS) and active duty status. Primary responsibilities include consultation on the design, clinical supervision and quality control of CAPS data, and co-authoring reports and manuscripts. Findings from the pilot study demons

Integrating New Measures of Trauma into SAMHSA’s Data Collection Programs (2014-2015) – Trauma Expert, Steering Committee Member, Speaker. Sponsored by the National Academies of Sciences, Engineering, and Medicine, the workshop was organized as part of an effort to assist SAMHSA and the Office of the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services in their responsibilities to expand the collection of behavioral health data in several areas. The workshop was structured to bring together experts in the measurement of exposure to traumatic events, the measurement of posttraumatic stress disorder (PTSD), and health survey methods and mechanisms most promising for expanding SAMHSA’s data collection in this area. Steering committee members included Dr. Karg, Dean Kilpatrick, Neil Russell, Robert Ursano, Terrence Keane, Terry Schell, Robert Pynoos, Evelyn Bromet, and Benjamin Saunders.

Screening, Brief Interventions, and Referral to Treatment for Youth at Durham Public Schools (2013 to date)—Consultant. Sponsored by Substance Abuse and Mental Health Services Administration, the objective of this project is to design, implement, and evaluate a Screening, Brief Intervention, and Referral to Treatment (SBIRT) pilot study among youth in Durham Public Schools. The intervention is designed to target youth at-risk for substance use, mental illness, and suicidal behavior. Primary responsibilities are to design the logic model, create the assessment of risk, conduct statistical analyses on the dataset, and co-present the findings with Ms. Wanda Boone.

DSM-5 Redesign Study for the National Survey on Drug Use and Health (2013 to 2016)—Project Co-Director, Co-Author, and Task Leader. Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), the objective of the project is to revise the National Survey on Drug Use and Health according to updates to the Diagnostic Statistical Manual, Fifth Edition (DSM-5), which was published by the American Psychiatric Association in May, 2013. Responsible for project oversight of a six-task project documenting the changes between the DSM-IV (1994) and DSM-5 (APA, 2013), exploring potential impact of these changes on the NSDUH data, seeking feedback from subject experts, incorporating changes from expert feedback into the NSDUH, and co-authoring deliverables. Also serves as the Task Leader for conducting cognitive testing of the revised NSDUH instrument.

Estimates and Correlates of Exposure to Trauma and Symptoms of Posttraumatic Stress. (2014 to 2016)— Project Director, Lead Analyst, and Co-Author. The Substance Abuse and Mental Health Services Administration (SAMHSA), sponsor of the National Survey on Drug Use and Health (NSDUH), formerly the National Household Survey on Drug Abuse, has awarded a contract to RTI to conduct a study of the direct estimates of mental disorders in the U.S. using the 2008-2012 NSDUH MHSS data. Responsible for leading the proposal and project, analyzing data from the Structured Clinical Interview for the DSM-IV (SCID) on the correlates of exposure to trauma and symptoms of posttraumatic stress, and serving as a co-author for the summary reports for SAMHSA based on these activities.

Direct Estimates of Mental Disorders Among Adults: National Survey on Drug Use and Health Mental Health Surveillance Study (2013 to 2014)— Project Leader and Lead Author. The Substance Abuse and Mental Health Services Administration (SAMHSA), sponsor of the National Survey on Drug Use and Health (NSDUH), formerly the National Household Survey on Drug Abuse, awarded a contract to RTI to conduct a study of the direct estimates of mental disorders in the U.S. using the 2008-2012 NSDUH MHSS data. Responsible for analyzing data from the Structured Clinical Interview for the DSM-IV (SCID-IV) compared to the NCS-R, and serving as the lead author for summary reports for SAMHSA based on these activities.

Follow-up of Patients Enrolled in the Combining Medications and Behavioral Interventions (COMBINE) Study and Other Treatment Cohorts (2009 to 2014)—Task Leader, Qualitative Data Collection Task Leader, Assistant Project Director. Sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the objective of the study was to understand the long-term outcomes of patients who have received treatment for alcoholism and identify factors affecting these outcomes. Two questionnaires will be used to conduct the data collection: a quantitative questionnaire including both an interviewer-administered portion and a self-administered portion using telephone audio computer-administered self-interviewing (T-ACASI); and a qualitative interview to collect information on subtle decision-making processes around treatment and recovery. Responsible for development and testing of the quantitative survey instrument, training and supervision of the clinical interviewers, and analyzing and reporting findings from the qualitative interview component.

Revision and Clinical Validation of the Substance Abuse and Dependence Module of the National Survey on Drug Use and Health (NSDUH)—Phase 2 (2008 to 2014)—Director. The NSDUH is the former National Household Survey on Drug Abuse (NHSDA), the major, ongoing epidemiologic study of substance use and abuse in this country. As part of this task, we conducted a clinical validation study of the NSDUH 2001 substance abuse and dependence module. In Phase I, we interviewed nearly 300 adult and adolescent subjects to examine the correspondence between the NSDUH module and a structured clinical interview and revised the module based on the results of the comparisons. Based on results from Phase 1, in Phase 2 we will revise the NSDUH module and will conduct a clinical validation of the revised instrument.

National Survey on Drug Use and Health: Mental Health Surveillance Study (2007 to 2014)—Project Manager (2011), Research Clinical Psychologist (2007 to 2014). The Substance Abuse and Mental Health Services Administration (SAMHSA), sponsor of the National Survey on Drug Use and Health (NSDUH), formerly the National Household Survey on Drug Abuse, awarded a contract to RTI to conduct a clinical validation and calibration study of the mental health modules of the NSDUH interview. Primary tasks for this study included recruiting, training, and supervising clinical interviewers on use of the Structured Clinical Interview for the DSM-IV (SCID), data editing and coding, and co-writing summary reports for SAMHSA based on these activities. She was also the point of contact for handling distressed respondents.

Children’s Mental Health Surveillance Study (2010-2013). Task Leader.  The National Institute of Health (NIH) and Center for Disease Control (CDC) awarded a contract to RTI to conduct a clinical validation and calibration study of the SDQ to assess mental health in adolescents for use in a national survey, the NHIS. Responsible for developing the distressed respondent protocol, working with the IRBs and ERBs to revise the distressed respondent protocol, and training clinical interviewers on use of the protocol. Dr. Karg was also the point of contact for handling distressed respondents.

Motivational Intervention for Methamphetamine-Using Men Who Have Sex with Men HIV Prevention Project (2006 to 2012)—Task Leader, Intervention. The purpose of this Centers for Disease Control (CDC)-funded cooperative study was to develop and pilot test a brief intervention to reduce HIV risk among methamphetamine-using men who have sex with men. The intervention for this site was based on the motivational interviewing to reduce methamphetamine use and unprotected anal sex with other men. Responsible for designing the intervention, designing the manual and protocol, analyzing the quantitative data, revising the intervention and protocol, and authoring manuscripts and presentations.

Pregnant Women’s Health CoOp (2004 to 2008)—Project Director. The purpose of this National Institute on Drug Abuse (NIDA)-funded study was to design, implement, and evaluate a randomized clinical trial to test a woman-focused intervention designed to reduce substance use and HIV risk for treatment-seeking drug-using pregnant African American women compared to treatment as usual. The intervention uses a personal, contextually relevant, and tailored perspective to strengthen social support and linkages to needed services following drug treatment. Responsible for assisting with developing the intervention, implementing the intervention in the field, providing consultation for clinical issues and incidents, conducting data analysis, and quality monitoring.

Technical Assistance for the SAMHSA Center for Substance Abuse Treatment (CSAT) Co-occurring and Homeless Activities Branch (CHAB) Grantees (2004 to 2008)—Clinical Expert for Technical Assistance. The CHAB grantees are funded to help their programs address the unmet and emerging needs of communities for substance abuse treatment and bridging the gap between research and practice in substance abuse treatment for vulnerable groups. Responsible for providing designated CHAB grantees with technical assistance in the areas of assessment and treatment of substance abuse for populations that have co-occurring mental illness and substance abuse treatment needs. Responsibilities include determining technical assistance needs, developing recommendations for improving the program, providing training to grantee staff members, coordinating and conducing site visits, evaluating the clinical services and outreach efforts provided by the grantee, and producing written reports and training materials.

Women’s Health CoOp-Pretoria, South Africa (2004 to 2007)—Associate Project Director. The purpose of this NIAAA-funded study was to evaluate randomized clinical trial of a woman-focused intervention designed to address substance abuse and HIV risk through a personal, contextually relevant, and tailored perspective compared to the standard NIDA intervention. The intervention includes strengthening social support and linkages to needed services including drug treatment. Also led Qualitative Substudy examining the heterogeneity of treatment outcomes among women who completed the study. Responsible for assisting with developing the intervention, implementing the intervention in the field, providing consultation for clinical issues and incidents, conducting data analysis, and quality monitoring.

SAMHSA OAS Short Reports on Data from National Household Survey on Drug Abuse (NHSDA) and National Survey on Drug Use and Health (NSDUH) (2004 to 2007)—Author. Working with RTI’s National Analytic Center, Dr. Karg was a Lead Author on policy-focused short reports that examine substance-related trends in the United States. The reports were based on secondary analyses of the data from the National Household Survey on Drug Abuse (NHSDA) and National Survey on Drug Use and Health (NSDUH) and are prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Applied Studies (OAS). The reports can be accessed at SAMHSA’s website (www.samhsa.gov/oas/facts.cfm) and are distributed to congressional staff, federal and state agencies, universities, and National Public Radio. Dr. Karg conceptualized analyses, wrote the reports, and developed graphic data diagrams.

Women’s Health CoOp-Cape Town, South Africa (2004 to 2007)—Health Analyst and Qualitative Task Leader. The purpose of this NIAAA-funded study was to evaluate a women-focused intervention designed to address substance abuse and HIV risk through a personal, contextually relevant, and tailored perspective. The intervention includes strengthening social support and linkages to needed services including drug treatment. Responsible for assisting with developing the intervention, implementing the intervention in the field, providing consultation for clinical issues and incidents, conducting data analysis, and quality monitoring.

Motivational Interventions to Reduce Alcohol Use in a College Population (2004 to 2006)–Co-Investigator. This RTI study, funded by NIAAA, was a large-scale, clinical trial designed to examine the relative efficacy of two motivational interviewing interventions for reducing alcohol use in a college population. Responsible for helping to develop the treatment protocols, training and supervising the therapists in the interventions, ensuring treatment integrity and quality control, and providing consultation for clinical issues and incidents.

Program Evaluation of the SAMHSA Center for Substance Abuse Treatment (CSAT) Co-occurring and Homeless Activities Branch (CHAB) Grantees (2004 to 2006)—Clinical Evaluator. Was a Program Evaluator and Team Leader for program evaluations conducted with CHAB grantees. Responsibilities included coordinating and conducting 2-day site visits, evaluating the clinical services and outreach efforts provided by the grantee, developing recommendations for improving the program, determining technical assistance needs, and producing written and oral reports of these findings.

Motivational Interventions to Reduce Alcohol Use in a Military Population (2004 to 2006)—Co-Investigator. This RTI study, funded by the Department of Defense, was a large-scaled clinical trial designed to examine the relative efficacy of two motivational interviewing interventions (individual and group) for reducing alcohol use in a military population. Responsible for helping to develop the treatment protocols, training and supervising the therapists in the interventions, providing consultation for clinical issues and incidents, and quality monitoring.

Revision and Clinical Validation of the Substance Abuse and Dependence Module of the National Survey on Drug Use and Health (NSDUH) (2001 to 2006)—Associate Director. The NSDUH is the former National Household Survey on Drug Abuse (NHSDA), the major, ongoing epidemiologic study of substance use and abuse in this country. As part of this task, we conducted a clinical validation study of the NSDUH 2001 substance abuse and dependence module. We interviewed nearly 300 adult and adolescent subjects to examine the correspondence between the NSDUH module and a structured clinical interview and revised the module based on the results of the comparisons. Responsible for recruiting, training, and supervising clinical interviewers in administration of the Structured Clinical Interview for the DSM-IV (SCID) Substance Use Disorders Module and the PAARC-SCID (for adolescents), providing consultation for clinical issues and incidents, conducting data analysis, quality monitoring, and writing reports describing the results.

SAMHSA OAS Monograph on Trends in Adolescents’ Marijuana Use in the US: Results from the National Household Surveys on Drug Abuse (2004)—Lead Author. Working with RTI’s National Analytic Center, Dr. Karg was the Lead Author on a 7-chapter monograph for the Office of Applied Studies (OAS) at the Substance Abuse and Mental Health Services Administration (SAMHSA) examining trends in adolescents’ marijuana use and reasons for the increase in youths’ drug use from 1992 to 1997. Data were from the National Household Survey on Drug Abuse (NHSDA) and National Survey on Drug Use and Health (NSDUH). In addition to writing the chapters, oversaw data analysis, coordinated research activities with other staff, helped develop timelines and budgets, and performed final report editing and preparation.

National Vietnam Veterans Longitudinal Study (NVVLS) (2002 to 2004)—Associate Task Leader, Psychological Well-Being Component. The Department of Veterans Affairs (DVA) awarded a contract to RTI to support a 4-year study to follow up the cohort of Vietnam veterans that RTI assessed during the mid-1980s in the National Vietnam Veterans Readjustment Study (NVVRS). Mandated by Congress (P.L. 106-419), this follow-up study will focus on the course of posttraumatic stress disorder (PTSD) among Vietnam veterans and on the association of PTSD with other health outcomes, particularly cardiovascular disease. Primary tasks for this study included recruiting, training, and supervising clinical interviewers on use of the Structured Clinical Interview for the DSM-IV (SCID), the Clinical Assessment of PTSD (CAPS), ensuring quality control, and serving as the point of contact for handling distressed respondents.

Effectiveness of Group Cognitive Behavioral Therapy for Treatment of Aggression Among Veterans with PTSD (2002)—Therapist. This study, conducted at the Durham VA Medical Center/Duke, was designed to examine the relative efficacy of a group cognitive behavioral therapy for improving anger management skills compared to a similar group intervention for improving anxiety management skills. Responsible for conducting the manualized intervention, providing consultation for clinical issues and incidents, and quality monitoring.

Scaling the Reinforcing Value of Cigarette Smoke (2001 to 2002)—Research Analyst. This investigation (NIDA-funded research project 2R01DA002665-19, conducted at the Durham VA Medical Center/Duke University Medical Center Nicotine Research Program, was designed to determine how the pharmacologic actions of nicotine and the sensory/behavioral aspects of cigarette smoking contribute to tobacco dependence. Tasks included assisting with study designs, creating stimuli for the cue reactivity substudy, designing and implementing the research protocol, and conducting experimental trials.

The Effects of Stress- and Smoking-Related Cues on Craving to Smoke (2000 to 2001)—Principal Investigator. Conducted at Auburn University, the purpose of this cue-reactivity experiment was to examine the effects of stress- and smoking-related cues on craving to smoke among abstinent and non-abstinent cigarette smokers. Craving was assessed by measuring the emotional, physiological, and behavioral reactivity among smoking- and stress-related cues. Responsibilities included all aspects of research design, implementation, data management, data analyses, writing and presenting papers, and writing manuscripts.

Efficacy of a Brief Intervention for Alcohol Problems with College Students (1998 to 2000)—Co-Investigator. This study, funded by the Department of Education, examined the relative efficacy of a brief intervention (motivational intervention) for alcohol problems with college students. Tasks included assisting with the study design, training and supervising interventionists, ensuring treatment integrity and quality control, collecting data, conducting data analyses, and coauthoring manuscripts.

Environmental Factors in Help-seeking and Natural Recovery (1999 to 2000)—Research Analyst. This project, funded by NIAAA (1-R01-AA08972) was designed to examine environmental factors that affect help-seeking and natural recovery among adults with alcohol dependence. Conducted clinical interviews with participant and collaterals and managed data collection tasks for a federally funded research project examining how people resolve drinking problems with and without formal treatment.

Short- and Long-Term Effects of Traumatic Exposure (2000)—Clinical Interviewer. This study, funded by the Veterans Administration and conducted at Auburn University, was designed to short- and long-term effects of traumatic exposure in a community sample. Responsibilities included conducting clinical interviews with participants, assisting with quality control tasks, providing consultation for clinical issues and incidents, and attending weekly research meetings.

Situational Antecedents to Substance Use (1998 to 1999)—Co-Investigator.  Designed, implemented, and analyzed data from a study conducted at Auburn University to examine the situational antecedents of substance use among “heavy” and “light” consumers of alcohol, marijuana, and nicotine. Tasks included instrumentation, data management, conducting and interpreting all statistical analyses, and authoring manuscript.

Anxiety Sensitivity and Situational Antecedents to Substance Use (1998 to 1999)—Co-Investigator. Conducted at Auburn University, the goal of this study was to examine the relation of anxiety sensitivity and situational antecedents of substance use. Responsibilities included designing and implementing study, data management tasks, conducting and interpreting all statistical analyses, and co-authoring manuscript.

Risky Behaviors Among Adolescents in a Rural Setting (1997 to 1999)—Co-Investigator. Conducted by Auburn University, the goal of this large-scale longitudinal study was to examine the prevalence of engaging in various acts of risky behavior (e.g., substance use, unprotected sex, driving under the influence) among adolescents in a rural setting. Tasks included study design, instrumentation, overseeing all data collection and data management, writing and presenting papers to regional authorities, local policy makers, and the scientific community.