Rachel Winograd’s research interests within her work at MIMH include substance use, mental health integration, medication-assisted treatment, public health and harm reduction, among others. (Photo by August Jennewein)

Rachel Winograd was in an internet café in Central America when she found out that she got accepted into the University of Missouri–Columbia’s graduate program for clinical psychology. The San Francisco Bay Area native, who studied both psychology and theater at Emory University in Atlanta, was working on a farm while waiting to see where tentative future plans for graduate school might take her.

Fast forward through seven years of research, study and clinical experiences, and those plans have brought her to another UM System campus – the University of Missouri­–St. Louis, where she’s an assistant research professor and primary investigator for the Missouri Institute of Mental Health.

The new position allows her to do every day what she did back then when she was just deciding to pursue her PhD: follow her curiosity.

“I knew I wanted to be able to have a profession where I could be intrinsically motivated to learn more about it and feel like the work I was doing was going to have a tangible impact,” she explains. “The way I described it then, when I was trying to figure out what direction to go in, was, if I would walk into a bookstore, what section did I gravitate towards? Or if I was looking for something to watch on TV, what kind of shows would I watch?”

There was one subject in particular, Winograd realized, that consistently got her attention: addiction. She was drawn to books and articles on the topic, and always interested in its profound and deep effects on every aspect of peoples’ lives.

Ultimately, a brief time working as a counselor in a women’s rehab facility after her undergraduate years helped convince her that the study of substance use needed to be part of her life’s work.

Now it is.

Winograd is MIMH’s primary investigator for two hugely collaborative efforts: the Emergency Room Enhancement Program and the Missouri Opioid/Heroin Overdose Prevention and Education Project. Both initiatives have implications for and connections to people who struggle with substance use.

The latter focuses specifically on issues related to opioid use, which is a somewhat newfound and still evolving area of expertise for Winograd. It’s one she cares deeply about and one that came about – like many things in her life – because she followed both her interests and the opportunities that arose.

While at Mizzou, Winograd’s research centered mainly around a different substance: alcohol. A National Institute of Health grant allowed her to develop a series of studies that investigated drunkenness through the framework of personality. She even wrote a book about alcohol use disorder treatment for young adults.

As interesting as the work was, she often felt like there was still more she could be doing – something else that could hopefully, one day, directly impact people’s lives for the better.

Then came her pre-doctoral clinical internship with the VA St. Louis healthcare system. It was there, last year, that she began working with veterans who were struggling specifically with the use of opioids.

Like other veteran treatment populations, these patients weren’t part of a small or isolated group. Opioid use in America, along with the risk of overdose, has risen at an alarming rate in recent years. As the drugs, which refer not just to heroin, but also the prescription medications that many people rely on for chronic pain management, have become more widely available and consumable in different ways, a greater population than ever before has been put at risk. Quite literally, people are dying.

Having a deeper understanding of this very real and complex issue left its mark on Winograd.

“It was a really impactful year in a lot of ways. I learned a lot about the field in a short time and then lost a patient to overdose. It shifted the trajectory and course of my career. I went from focusing on alcohol – both clinical and research-wise – to opioids and program development and specifically overdose prevention, which has its own place in treatment and public health. It’s sort of a merging of clinical implementation with public health and harm reduction angles.”

She set out to expand the reach and impact of education and prevention programs and protocols within the VA, and she also began to seek out other people who she thought might be as passionately interested in the same kind of work.

“Part of what makes pursuing the overdose work so interesting,” she explains, “is that we all have deep feelings about it whether we realize it or not. If pushed, we can express them and say where we stand. It becomes a question about human life – a philosophical, ethical and moral question about us as human beings. We see this in all arenas of health care, including addiction. How far do we go with our duty to keep people alive?”

Ultimately, Winograd’s endeavors at the VA laid the groundwork for her position at MIMH, where she gets to collaborate on the kind of aforementioned projects that aim ultimately – through careful inquiry and evaluation – to save and improve lives.

And really, Winograd says, that’s what research is all about.

“I’m a champion of improving the state of affairs for mental health and substance use treatment, and a good way to do that is through empirical testing and evaluation. In fact, it’s the only way to do that, because if we don’t see if our new ideas and programs are working then no one can copy them; no one can share them. And then nobody gets the help.”

That concept of help – of ultimately being of service – is an especially important one for Winograd. It connects back to why she chose to pursue graduate school in the first place, and it’s also something she says she would advise any undergraduate student who’s interested in psychology to investigate.

“A lot of times people say they want to help people, which is great. But how can we be more specific? How do you want to help? What are your strengths? How are you most helpful in this world?”

Some other advice? Find the other helpers­ – and don’t take no for an answer.

“When you seek out people who are interested in making things better you’ll be surprised at the warm response you get,” she says. “It all works together. It’s a self-perpetuating phenomenon. If you find something that you’re really interested in, and you find people you admire who are doing good work, go connect with them. You can learn from their successes and then carve your own path to do whatever it is you want to do.”