Ryan S. Sultan, MD

Project 1: PAWS Digital Therapeutic

Grant: NIDA UG3/UH3 | Amount: $335,500 | Period: 2026-2027
Role: Principal Investigator

Full Title: PAWS: Personalized Adaptive Wellness System - An LLM-Based Digital Companion for Cannabis Use Disorder Treatment in Youth

Overview

PAWS is an innovative digital therapeutic that uses large language model (LLM) technology to create a personalized AI companion for adolescents and young adults (ages 13-24) struggling with cannabis use disorder. Unlike traditional apps, PAWS uses advanced conversational AI to provide dynamic, contextually-aware support.

Key Innovation

The digital pet companion adapts to each user's unique situation, providing 24/7 therapeutic support and crisis intervention, personalized coping strategies based on user behavior patterns, gamification elements to increase engagement, evidence-based CBT and motivational interviewing techniques, and real-time progress tracking and relapse prevention.

Research Objectives

UG3 Phase (Development): Develop and refine the PAWS AI system, conduct usability testing with target population (n=50), establish safety protocols and monitoring systems, optimize therapeutic content and conversation flows.

UH3 Phase (Efficacy Trial): Large-scale randomized controlled trial (n=300), measure reduction in cannabis use frequency and quantity, assess user engagement and therapeutic alliance with AI, evaluate cost-effectiveness vs. traditional treatment.

Clinical Significance

Cannabis use disorder affects millions of young people, yet traditional treatment engagement remains extremely low. PAWS addresses critical barriers including stigma, accessibility, cost, and appeal to youth populations. If successful, this could represent a paradigm shift in substance use disorder treatment delivery.

Project 2: Cannabis Use and New-Onset Psychotic Disorders

Grant: Research Grant | Amount: $335,500 | Period: 2025-2026
Role: Principal Investigator

Full Title: Examining the Relationship Between Cannabis Use and New-Onset Psychotic Disorders: A Large-Scale Epidemiological Analysis of State Legalization Impacts

Study Overview

This comprehensive epidemiological study examines the relationship between cannabis use and the development of new-onset psychotic disorders, with particular attention to the impact of state-level cannabis legalization policies on psychosis incidence rates.

Research Questions

What is the magnitude of association between cannabis use and new-onset psychosis? How do cannabis potency (THC %) and frequency of use affect psychosis risk? What is the impact of state legalization on ED visits for cannabis-induced psychosis? Are there vulnerable populations at higher risk? What are long-term outcomes for individuals with cannabis-induced psychotic disorder?

Methodology

Data Sources: Large administrative claims databases (n > 500,000 patients), electronic health records from multiple hospital systems, state-level cannabis policy and sales data, emergency department visit records.

Statistical Approaches: Propensity score matching to control for confounders, interrupted time series analysis for policy impacts, difference-in-differences designs, survival analysis for time-to-onset of psychosis, sensitivity analyses for unmeasured confounding.

Public Health Implications

As cannabis legalization expands across the United States, understanding the mental health consequences—particularly psychosis risk—is critical for evidence-based policy making, clinical practice guidelines, and public health messaging. This research will inform prevention strategies, clinical screening protocols, and regulatory frameworks.

Research Interests & Expertise

Psychopharmacoepidemiology: Medication utilization patterns, safety signal detection, comparative effectiveness

ADHD Research: Treatment patterns, comorbidities, long-term outcomes, medication safety
→ For comprehensive ADHD information, see my Complete Evidence-Based ADHD Guide (25,000+ words)

Cannabis Use Disorders: Treatment interventions, psychosis risks, legalization impacts
→ For evidence-based cannabis information, see my Cannabis & Mental Health Guide (6,000 words)

Digital Therapeutics: AI/LLM-based interventions, mobile health, digital phenotyping
→ See the PAWS Digital Therapeutic project page

Digital Mental Health: Social media impacts, screen time effects, youth mental health, telepsychiatry integration

Methodological Expertise

Large-Scale Database Analysis: Claims data (Medicare, Medicaid, commercial insurance), electronic health records (EHR) systems, national registries and surveillance data

Causal Inference Methods: Propensity score matching and weighting, instrumental variables analysis, difference-in-differences designs, interrupted time series analysis, regression discontinuity designs

Pharmacoepidemiology: New user cohort designs, active comparator studies, self-controlled case series, signal detection and safety surveillance

Recent Publications (2025-2026)

• Pediatrics (2026): Cannabis Use Among U.S. Adolescents — examining mental health outcomes in teens with nondisordered cannabis use (blog summary)
• JAMA Psychiatry (2025): Protective Effects of ADHD Medication on Real-World Outcomes — stimulant medications linked with 30-50% lower rates of accidents and arrests (blog summary)
• Am J Prev Med (2025): Labeling of Cannabis Products from Licensed and Unlicensed Retailers in New York City (blog summary)

Research Project Pages

• IQVIA Stimulant Prescribing Patterns — National analysis of ADHD stimulant prescribing trends
• ADHD in Females (MarketScan) — ADHD diagnosis and substance use in females
• CASNY Cannabis Study — Cannabis access and safety in New York
• PAWS Digital Therapeutic — AI-based intervention for cannabis use disorder
• NLP in Mental Health — Natural language processing for electronic health records
• Evolutionary Psychiatry — Understanding psychiatric conditions through an evolutionary lens

View Publications | Complete CV | Research Collaboration