David S. Fink, PhD, MPH

Applying a multi-level life course perspective, coupled with causal inference methodologies, to understand the causes of addiction and mental illness and inform interventions for improving health and well-being.

MOTIVATION | "Reduce suffering from psychiatric and substance use disorders through public policy"

The US has become a curious outlier among its peers. In nations that are free of war, famine, and disease outbreak, the increase in life expectancy overtimes has been described as “so extraordinarily linear that it may be the most remarkable regularity of mass endeavor ever observed.” However, in the 1990s, life expectancy growth in the US was slowing relative to other high income nations and absolute survival rates were declining for socioeconomically disadvantaged White women. The longterm stagnation in life expectancy culminated in a multiyear absolute decline in life expectancy in the US from 2015-2018. The unprecedented rise in suicide deaths and ongoing drug overdose crisis are two key drivers of this disturbing trend.

I use epidemiology to understand the etiology of psychiatric and substance use disorders. Health and longevity, as well as illness and death, arise from a complex interaction of factors that occur and accumulate across the life course. My research applies a cells-to-society approach to identify the causes of psychiatric and substance use disorders, with a particular focus on how state and national policy shape the consequences of these disorders. 

RESEARCH FOCUS | "How do factors, from cells to society and across the life course, cause addiction and drug-related harms?"

My primary research focus is on describing psychiatric and substance use disorders and their trajectories over the life course; modeling mechanisms linking exposures across multiple levels, including individual characteristics to environmental exposures, to subsequent psychiatric and substance use outcomes; and the effects of interventions on psychiatric and substance use-related morbidity and mortality. 

My scientific research philosophy on drug use is grounded in the principles of harm reduction: (1) drug use has always existed and will continue to exist in society; (2) drug use occurs on a continuum from nonproblematic use to highly problematic use with dependence; (3) recognizes the realities of poverty, class, racism, social isolation, past trauma, and other social inequalities affects both people’s vulnerability to and capacity for using drugs and effectively dealing with drug-related harm; (4) people who use drugs are the primary agents of reducing the harms of their drug use; and (5) we must meet people “where they’re at” to provide strategies for safer use, managed use, and abstinence (if desired).

These principles are grounded in justice and human rights. It focuses on meeting people where they are at in their drug use, without judgment, coercion, or discrimination, to provide people with knowledge and tools to remain healthy and alive, and advance evidence-based interventions and policy for the improvement of individual and community health. 

Over the past decade, I transitioned from a harm reduction counselor on San Diego’s Safe Syringe Program, providing direct services to people who inject drugs, to a research epidemiologist, focused on producing the rigorous evidence needed to inform policies and interventions able to improve the health and well-being of those who use drugs as well as their families, communities, and society at large. During the time, I received an MPH in epidemiology/biostatistics from San Diego State University and a PhD in epidemiology from Columbia University. I’ve published more than 50 peer-reviewed articles and 4 book chapters on a number of these topics, and my work has been covered by the BBC, Reuters, Washington Post, U.S. New and World Reports, TIME magazine, CNN, among others. Currently, I’m a postdoctoral researcher at the New York State Psychiatric Institute, investigating the effects of more flexible telehealth guidelines for buprenorphine prescribing for opioid use disorder (OUD) (NIDA grant K99DA055724).  

"We are all responsible for everyone else."
The Brothers Karamazov