Dr. Vest is an Instructor in the Department of Psychiatry at the Stanford School of Medicine. As a formerly incarcerated scholar, he is a strong advocate for social justice issues and public policy concerning prison reentry. His research interests include the intersection of mental health, substance use disorders, poverty, social justice, addiction recovery, pain, and prison reentry. He was postdoctoral fellow in the Systems Neuroscience and Pain Lab at the Stanford School of Medicine and received his Masters and Doctoral Degrees in Experimental Psychology from Washington State University in Pullman, WA.

Academic Appointments

  • Instructor, Psychiatry and Behavioral Sciences

Professional Education

  • Postdoc, Stanford University, Department of Pain Medicine (2022)
  • PhD, Washington State University, Experimental Psychology (2019)
  • MSc, Washington State University, Experimental Psychology (2016)
  • Bachelor of Science, Washington State University - Tricities, Psychology (2013)
  • Associates of Arts, Columbia Basin College, Chemical Dependency Counseling (2011)

Graduate and Fellowship Programs

All Publications

  • Evidencing the Need to Screen for Social Determinants of Health Among Boys Entering a Juvenile Prison: A Latent Profile Analysis YOUTH VIOLENCE AND JUVENILE JUSTICE Fix, R. L., Vest, N., Thompson, K. R. 2022
  • Social networking site use and alcohol use behaviors among adolescents: A latent profile analysis. Addictive behaviors Russell, A. M., Vest, N. A., Litt, D. M. 1800; 129: 107261


    BACKGROUND: Adolescent exposure to alcohol-related social networking site (SNS) content is associated with their own alcohol use. However, there is a need to better understand the relationship between varying levels of adolescent SNS use and alcohol-related risks. In this study, we sought to identify distinct patterns of SNS use across multiple platforms (Facebook, Instagram, and Snapchat) and to assess associations between those patterns and alcohol use outcomes.METHODS: Data were collected as part of a baseline assessment for a larger longitudinal experimental study. Participants (N=306, age 15-20) completed measures of demographics, SNS use, and alcohol use.RESULTS: Using latent profile analysis (LPA), three SNS use profiles were empirically derived: low SNS users (27.5%), high frequency, low duration users (47.4%), and high frequency, high duration users (25.2%). Significant differences in daily drinking (F [2, 301]=3.39, p=0.035) and AUDIT scores (F [2, 289]=6.15, p=0.002) were observed for the three profiles, with members of the high frequency, high duration profile reporting significantly more weekly drinks and higher AUDIT scores when compared to the other two profiles.CONCLUSION: These findings imply that a combination of high frequency and high duration SNS use may place individuals at risk for potentially problematic drinking. Given many clinicians have limited opportunities to delve into their patients' SNS use patterns, results suggest that a simple understanding of frequency and duration of use may provide enough information to indicate who may be at risk.

    View details for DOI 10.1016/j.addbeh.2022.107261

    View details for PubMedID 35114629

  • Substance Use, PTSD Symptoms, and Suicidal Ideation Among Veteran Psychiatry Inpatients:A Latent Class Trajectory Analysis. Journal of studies on alcohol and drugs Vest, N. A., Rossi, F. S., Ilgen, M., Humphreys, K., Timko, C. 2021; 82 (6): 792-800


    OBJECTIVE: In this study, we aimed to inform clinical practice by identifying distinct subgroups of U.S. veteran psychiatry inpatients on their alcohol and drug use severity, posttraumatic stress disorder (PTSD) symptoms, and suicidal ideation over time.METHOD: Participants were 406 patients with co-occurring substance use and mental health disorders. A parallel latent growth trajectory model was used to characterize participants' symptom severity across 15 months posttreatment intake.RESULTS: Four distinct classes were identified: 47% "normative improvement," 32% "high PTSD," 11% "high drug use," and 9% "high alcohol use." Eighty percent of the sample had reduced their drinking and drug intake by half from baseline to 3 months, and those levels remained stable from 3 to 15 months. The High PTSD, High Drug Use, and High Alcohol Use classes all reported levels of PTSD symptomatology at baseline consistent with a clinical diagnosis, and symptom levels remained high and stable across all 15 months. The Normative Improvement class showed declining drug and alcohol intake and was the only class exhibiting reductions in PTSD symptomatology over time. High substance use classes showed initial declines in suicidal ideation, then an increase from 9 to 15 months.CONCLUSIONS: The reduction in frequency of drinking and drug use for 80% of the sample was substantial and supports the potential efficacy of current treatment approaches. However, the high and stable levels of PTSD for more than 50% of the sample, as well as the reemergence of suicidal ideation in a sizable subgroup, underscore the difficulty in finding and linking patients to effective interventions to decrease symptomatology over time.

    View details for PubMedID 34762039

  • Recovery Dharma: Exploration of a Buddhist-based mutual help organization for the treatment of addiction JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS LaBelle, O., Meeks, M., Vest, N., Hastings, M., Harding, T. 2021
  • Potential Value of the Insights and Lived Experiences of Addiction Researchers With Addiction. Journal of addiction medicine Stull, S. W., Smith, K. E., Vest, N. A., Effinger, D. P., Epstein, D. H. 2021


    People in remission from substance use disorders (SUDs) have a history of using their own experience (also referred to as "experiential knowledge" or "expertise") to support those in or seeking SUD remission. In recent years, people with this experiential knowledge are being incorporated into research protocols to better guide research questions and inform the real-world uptake of SUD treatments and recovery supports. In these research contexts, however, those with research expertise and addiction rarely speak freely about these overlapping perspectives. The aim of this commentary is to increase awareness regarding the existence of this group (addiction researchers with addiction) and to explore the possibility that their expertise may help advance addiction science while helping to reduce stigma.

    View details for DOI 10.1097/ADM.0000000000000867

    View details for PubMedID 33973924

  • College programming for students in addiction recovery: A PRISMA-guided scoping review. Addictive behaviors Vest, N., Reinstra, M., Timko, C., Kelly, J., Humphreys, K. 2021; 121: 106992


    The health and well-being of students in recovery from substance use disorder are increasingly being recognized as a priority on college campuses. This scoping review maps the state of the existing literature evaluating collegiate recovery programming to highlight research gaps and inform policy.We conducted a systematic search of articles related to collegiate recovery programming published before August 2020. The 15 extracted study characteristics included publication type, study design, primary outcomes, reporting of behavioral addictions, mutual-help group attendance, sample demographic information, school size, ownership, and funding source.The PRISMA-guided search strategy identified 357 articles for abstract review; of 113 articles retained for full-text review, 54 studies met criteria for inclusion. Primary outcomes were coded into four domains: clinical, recovery experience, program characterization, and stigma. Most (57%) used quantitative observational designs and 41% employed qualitative research designs. Government or foundation grants funded 11% of the studies.The domains identified offer a framework for healthcare providers, college administrators, and researchers to understand and improve programs, thereby better serving this vulnerable student group.

    View details for DOI 10.1016/j.addbeh.2021.106992

    View details for PubMedID 34087765

  • Depression, Alcoholics Anonymous Involvement, and Daily Drinking Among Patients with Cooccurring Conditions: A Longitudinal Parallel Growth Mixture Model. Alcoholism, clinical and experimental research Vest, N., Sox-Harris, A., Ilgen, M., Humphreys, K., Timko, C. 2020


    BACKGROUND: Patients with cooccurring mental health and substance use disorders often find it difficult to sustain long-term recovery. One predictor of recovery may be how depression symptoms and Alcoholics Anonymous (AA) involvement influence alcohol consumption during and after inpatient psychiatric treatment. This study utilized a parallel growth mixture model to characterize the course of alcohol use, depression, and AA involvement in patients with cooccurring diagnoses.METHODS: Participants were adults with cooccurring disorders (n=406) receiving inpatient psychiatric care as part of a telephone monitoring clinical trial. Participants were assessed at intake, 3-, 9-, and 15-month follow-up.RESULTS: A 3-class solution was the most parsimonious based upon fit indices and clinical relevance of the classes. The classes identified were high AA involvement with normative depression (27%), high stable depression with uneven AA involvement (11%), and low AA involvement with normative depression (62%). Both the low and high AA classes reduced their drinking across time and were drinking at less than half their baseline levels at all follow-ups. The high stable depression class reported an uneven pattern of AA involvement and drank at higher daily frequencies across the study timeline. Depression symptoms and alcohol use decreased substantially from intake to 3months and then stabilized for 90% of patients with cooccurring disorders following inpatient psychiatric treatment.CONCLUSIONS: These findings can inform future clinical interventions among patients with cooccurring mental health and substance use disorders. Specifically, patients with more severe symptoms of depression may benefit from increased AA involvement, whereas patients with less severe symptoms of depression may not.

    View details for DOI 10.1111/acer.14474

    View details for PubMedID 33104268

  • Steep increases in fentanyl-related mortality west of the Mississippi River: Recent evidence from county and state surveillance. Drug and alcohol dependence Shover, C. L., Falasinnu, T. O., Dwyer, C. L., Santos, N. B., Cunningham, N. J., Freedman, R. B., Vest, N. A., Humphreys, K. 2020; 216: 108314


    BACKGROUND: Overdose deaths from synthetic opioids (e.g., fentanyl) increased 10-fold in the United States from 2013 to 2018, despite such opioids being rare in illicit drug markets west of the Mississippi River. Public health professionals have feared a "fentanyl breakthrough" in western U.S. drug markets could further accelerate overdose mortality. We evaluated the number and nature of western U.S. fentanyl deaths using the most recent data available.METHODS: We systematically searched jurisdictions west of the Mississippi River for publicly available data on fentanyl-related deaths since 2018, the most recent Centers for Disease Control and Prevention (CDC) statistics. Using mortality data from 2019 and 2020, we identified changes in fentanyl-related mortality rate and proportion of fatal heroin-, stimulant, and prescription pill overdoses involving fentanyl.RESULTS: Seven jurisdictions had publicly available fentanyl death data through December 2019 or later: Arizona; California; Denver County, CO; Harris County, TX; King County, WA; Los Angeles County, CA; and Dallas-Fort Worth, TX (Denton, Johnson, Parker, and Tarrant counties). All reported increased fentanyl deaths over the study period. Their collective contribution to national synthetic narcotics mortality increased 371 % from 2017 to 2019. Available 2020 data shows a 63 % growth in fentanyl-mortality over 2019. Fentanyl-involvement in heroin, stimulant, and prescription pill deaths has substantially grown.DISCUSSION: Fentanyl has spread westward, increasing deaths in the short-term and threatening to dramatically worsen the nation's already severe opioid epidemic in the long-term. Increasing the standard dose of naloxone, expanding Medicaid, improving coverage of addiction treatment, and public health educational campaigns should be prioritized.

    View details for DOI 10.1016/j.drugalcdep.2020.108314

    View details for PubMedID 33038637

  • Association of State Policies Allowing Medical Cannabis for Opioid Use Disorder With Dispensary Marketing for This Indication. JAMA network open Shover, C. L., Vest, N. A., Chen, D., Stueber, A., Falasinnu, T. O., Hah, J. M., Kim, J., Mackey, I., Weber, K. A., Ziadni, M., Humphreys, K. 2020; 3 (7): e2010001


    Importance: Misinformation about cannabis and opioid use disorder (OUD) may increase morbidity and mortality if it leads individuals with OUD to forego evidence-based treatment. It has not been systematically evaluated whether officially designating OUD as a qualifying condition for medical cannabis is associated with cannabis dispensaries suggesting cannabis as a treatment for OUD.Objective: To examine whether state-level policies designating OUD a qualifying condition for medical cannabis are associated with more dispensaries claiming cannabis can treat OUD.Design, Setting, and Participants: This cross-sectional, mixed-methods study of 208 medical dispensary brands was conducted in 2019 using the brands' online content. The study included dispensaries operating in New Jersey, New York, and Pennsylvania, where OUD is a qualifying condition for medical cannabis, and in Connecticut, Delaware, Maryland, Ohio, and West Virginia, where this policy does not exist.Exposures: Presence of OUD on the list of qualifying conditions for a state's medical cannabis program.Main Outcomes and Measures: Binary indicators of whether online content from the brand said cannabis can treat OUD, can replace US Food and Drug Administration-approved medications for OUD, can be an adjunctive therapy to Food and Drug Administration-approved medications for OUD, or can be used as a substitute for opioids to treat other conditions (eg, chronic pain).Results: After excluding duplicates, listings for nonexistent dispensaries, and those without online content, 167 brands across 7 states were included in the analysis (44 [26.3%] in states where OUD was a qualifying condition and 123 [73.7%] in adjacent states). A dispensary listed in a directory for West Virginia was not operational; therefore, comparison states were Connecticut, Delaware, Maryland, and Ohio. In policy-exposed states, 39% (95% CI, 23%-55%) more dispensaries claimed cannabis could treat OUD compared with unexposed states (P<.001). For replacing medications for OUD and being an adjunctive therapy, the differences were 14% (95% CI, 2%-26%; P=.002) and 28% (95% CI, 14%-42%; P<.001), respectively. The suggestion that cannabis could substitute for opioids (eg, to treat chronic pain) was made by 25% (95% CI, 9%-41%) more brands in policy-exposed states than adjacent states (P=.002).Conclusions and Relevance: In this study, state-level policies designating OUD as a qualifying condition for medical cannabis were associated with more dispensaries claiming cannabis can treat OUD. In the current policy environment, in which medical claims by cannabis dispensaries are largely unregulated, these advertisements could harm patients. Future research linking these policies to patient outcomes is warranted.

    View details for DOI 10.1001/jamanetworkopen.2020.10001

    View details for PubMedID 32662844

  • Coping Motives Mediate the Relationship Between Borderline Personality Features and Alcohol, Cannabis, and Prescription Opioid Use Disorder Symptomatology in a Substance Use Disorder Treatment Sample PERSONALITY DISORDERS-THEORY RESEARCH AND TREATMENT Vest, N. A., Tragesser, S. 2020; 11 (3): 230–36


    Borderline personality disorder and substance use disorder co-occur at a high rate. However, little is known about the mechanisms driving this association. This study examined substance use motives for 3 common substance use disorders among 193 individuals in substance use disorder treatment. We found that the coping motive consistently mediated the relationship between borderline personality and alcohol, cannabis, and prescription opioid use disorders. For this substance use disorder treatment sample, our findings support the self-medication model of substance use, and that interventions aimed at coping-related substance use would be helpful among these patients. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

    View details for DOI 10.1037/per0000385

    View details for Web of Science ID 000526037300008

    View details for PubMedID 31815505

    View details for PubMedCentralID PMC7156315

  • Parallel modeling of pain and depression in prediction of relapse during buprenorphine and naloxone treatment: A finite mixture model. Drug and alcohol dependence Vest, N. A., McPherson, S., Burns, G. L., Tragesser, S. 2020; 209: 107940


    BACKGROUND: Relapse is common in treatment for opioid use disorders (OUDs). Pain and depression often co-occur during OUD treatment, yet little is known about how they influence relapse among patients with a primary diagnosis of prescription opioid use disorder (POUD). Advanced statistical analyses that can simultaneously model these two conditions may lead to targeted clinical interventions.METHOD: The objective of this study was to utilize a discrete survival analysis with a growth mixture model to test time to prescription opioid relapse, predicted by parallel growth trajectories of depression and pain, in a clinical sample of patients in buprenorphine/naloxone treatment. The latent class analysis characterized heterogeneity with data collected from the National Institute of Drug Abuse Clinical Trials Network project (CTN-0030).RESULTS: Results suggested that a 4-class solution was the most parsimonious based on global fit indices and clinical relevance. The 4 classes identified were: 1) low relapse, 2) high depression and moderate pain, 3) high pain, and 4) high relapse. Odds ratios for time-to-first use indicated no statistically significant difference in time to relapse between the high pain and the high depression classes, but all other classes differed significantly.CONCLUSION: This is the first longitudinal study to characterize the influence of pain, depression, and relapse in patients receiving buprenorphine and naloxone treatment. These results emphasize the need to monitor the influence of pain and depression during stabilization on buprenorphine and naloxone. Future work may identify appropriate interventions that can be introduced to extend time-to-first prescription opioid use among patients.

    View details for DOI 10.1016/j.drugalcdep.2020.107940

    View details for PubMedID 32135429

  • Prison Population Reductions and COVID-19: A Latent Profile Analysis Synthesizing Recent Evidence From the Texas State Prison System. Journal of urban health : bulletin of the New York Academy of Medicine Vest, N. n., Johnson, O. n., Nowotny, K. n., Brinkley-Rubinstein, L. n. 2020


    People in prison are particularly vulnerable to infectious disease due to close living conditions and the lack of protective equipment. As a result, public health professionals and prison administrators seek information to guide best practices and policy recommendations during the COVID-19 pandemic. Using latent profile analysis, we sought to characterize Texas prisons on levels of COVID-19 cases and deaths among incarcerated residents, and COVID-19 cases among prison staff. This observational study was a secondary data analysis of publicly available data from the Texas Department of Criminal Justice (TBDJ) collected from March 1, 2020, until July 24, 2020. This project was completed in collaboration with the COVID Prison Project. We identified relevant profiles from the data: a low-outbreak profile, a high-outbreak profile, and a high-death profile. Additionally, current prison population and level of employee staffing predicted membership in the high-outbreak and high-death profiles when compared with the low-outbreak profile. Housing persons at 85% of prison capacity was associated with lower risk of COVID-19 infection and death. Implementing this 85% standard as an absolute minimum should be prioritized at prisons across the USA.

    View details for DOI 10.1007/s11524-020-00504-z

    View details for PubMedID 33337529

  • Borderline Personality Disorder Features and Risk for Prescription Opioid Misuse in a Chronic Pain Sample: Roles for Identity Disturbances and Impulsivity. Journal of personality disorders Reynolds, C. J., Vest, N., Tragesser, S. L. 2019: 1-18


    Although borderline personality disorder (BPD) is associated with both chronic pain and substance abuse, little research examines how BPD features in chronic pain patients may constitute a risk factor for misuse of prescription opioids, and no prior research has examined which particular component(s) of BPD might put chronic pain patients at risk-an oversight that undermines prevention and treatment of such problematic opioid use. In a cross-sectional study of patients in treatment for chronic pain (N = 147), BPD features were associated with several measures of prescription opioid misuse, even controlling for pain severity and interference. Specifically, the identity disturbances and self-harmful impulsivity facets of BPD were most consistently associated with opioid misuse, and exploratory analyses suggested that these factors may be interactive in their effects. Together, these results suggest that BPD features-especially unstable identity and self-harmful impulsivity-play a unique role in problematic prescription opioid use in chronic pain settings.

    View details for DOI 10.1521/pedi_2019_33_440

    View details for PubMedID 31609188

  • Do We Know Enough to Prescribe Opioid-Agonist Therapies to Adolescents With Problematic Opioid Use? A Commentary on Camenga et al. (2019) JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Vest, N., Humphreys, K. N. 2019; 80 (4): 406–7
  • Borderline personality disorder features and drinking, cannabis, and prescription opioid motives: Differential associations across substance and sex. Addictive behaviors Vest, N. A., Murphy, K. T., Tragesser, S. L. 2018; 87: 46-54


    Drinking motives have shown meaningful associations with borderline personality disorder (BPD) features. However, it is unknown whether other common substances of abuse (namely cannabis and prescription opioids) have the same associations with BPD features. In the present study, we tested associations between BPD features and motives across three substances: alcohol, cannabis, and prescription opioids. The purpose of the study was to determine whether BPD showed similar patterns of associations across drugs, or whether some substances serve particular functions for individuals with BPD features, and whether this also varies by sex in a college student sample.Five-hundred ninety-four college students completed online questionnaires measuring demographics, borderline personality disorder features, substance use, and substance specific motives for alcohol, cannabis, and prescription opioid use.BPD was most strongly associated with coping motives across all substances. For both alcohol and cannabis, this was true for both males and females, along with conformity motives. For prescription opioids, coping, social, enhancement, and pain motives were only significantly related to BPD features for females. When compared statistically, it was found that the associations with coping drinking motives and opioid pain motives were higher among females.This pattern of results suggests that negatively reinforcing motives (coping and conformity) play a similar functional role in borderline personality and substance use disorder pathology for alcohol and cannabis, but for prescription opioids the negative reinforcement motives (coping and pain) were only evident in females.

    View details for DOI 10.1016/j.addbeh.2018.06.015

    View details for PubMedID 29945027

  • Borderline Features and Prescription Opioid Misuse in a Substance Use Disorder Treatment Sample. Substance use & misuse Vest, N., Tragesser, S. 2018; 54 (1): 166-175


    An association between borderline personality disorder (BPD) and substance use disorders has been well established. However, very little is known about the relationship between BPD and prescription opioid misuse, specifically.The relationship between borderline personality disorder features and prescription opioid misuse was examined in a sample of 208 substance use disorder treatment patients in the outpatient level of care.Controlling for use of alcohol and cannabis, as well as other relevant covariates, we found that BPD features were associated with age of first use of prescription opioids, prescription opioid use disorder symptom count, lifetime use, past 12-month use, problem use, and cravings. Additionally, we found that BPD features were not associated with greater use of medically necessary opioid pain killers as prescribed by a physician; rather the association with BPD was in the greater likelihood of misuse (non-prescribed) of prescription opioid pain killers. The self-harm/impulsivity facet of BPD was most strongly associated with prescription opioid-related variables. Conclusions/Importance: These findings suggest that BPD is related to prescription opioid misuse, above and beyond the tendency to use other drugs of abuse, and that the self-harm impulsivity facet appears to be driving this relationship.

    View details for DOI 10.1080/10826084.2018.1512626

    View details for PubMedID 30375912

  • Impulsivity and risk for prescription opioid misuse in a chronic pain patient sample. Addictive behaviors Vest, N., Reynolds, C. J., Tragesser, S. L. 2016; 60: 184-90


    Misuse of, and addiction to, prescription opioid pain relievers is a growing concern, in both non-clinical samples and chronic pain patients receiving opioid analgesic therapy. Research is needed to identify which patients may be more prone to misuse or dependence on opioids in a chronic pain treatment setting. Based on literature showing the role of impulsivity in substance use disorders generally, we predicted that impulsivity may also be important to understanding which individuals may be at risk for opioid misuse when opioids are prescribed for pain. The present study examined associations between impulsivity facets and measures of prescription opioid misuse and symptoms. Four facets of impulsivity were examined: urgency, sensation seeking, lack of premeditation, and lack of perseverance. 143 patients receiving treatment for chronic pain at a regional pain clinic completed a series of questionnaires including the UPPS and measures of opioid risk and misuse. Consistent with predictions, urgency was associated with risk for future misuse (β=0.246, p<0.05), current misuse (β=0.253, p<0.01), and symptoms of current opioid use disorder (OUD; β=0.206, p<0.05). Sensation seeking was also associated with current misuse (β=0.279, p<0.01). These results suggest that identifying facets of impulsivity is important to understanding and assessing for risk of prescription opioid misuse in the context of chronic pain treatment. These data indicate that patients who react impulsively to negative mood states and cravings may be especially prone to developing aberrant use patterns when taking prescription opioids. This is the first known study to identify the role of urgency in predicting risk for OUDs in chronic pain patients.

    View details for DOI 10.1016/j.addbeh.2016.04.015

    View details for PubMedID 27156219