About

Dr. Tibor P. A. Palfai is a Professor in the Department of Psychological & Brain Sciences at Boston University. He completed his PhD in Clinical Psychology from Yale University and undertook a postdoctoral fellowship at the Center for Alcohol and Addiction Studies at Brown University. His primary research interests focus on understanding the cognitive-motivational processes underlying health risk behaviors, such as hazardous and harmful drinking, substance use, and risky sexual decisions. He is involved in developing psychological interventions aimed at reducing these risks, including web and mobile-based interventions to decrease hazardous drinking and substance use, laboratory studies on the effects of alcohol on self-control and decision-making related to health risks, screening and brief interventions to modify HIV-risk factors, and creating integrated behavioral interventions for patients in medical settings experiencing co-occurring conditions like chronic pain and heavy drinking.

Research topics

• Medicine
• Psychology
• Clinical psychology
• Nursing
• Family medicine
• Psychiatry
• Immunology
• Physical therapy
• Multimedia
• Social psychology
• Biology
• Internal medicine
• Environmental health

Selected publications

• Cocaine Use, Unhealthy Alcohol Use, and PainInterference Among People with HIV

  AIDS and Behavior · 2026-01-05

  articleOpen access

  Pain is prevalent among people with HIV (PWH), and many PWH who experience pain also use substances (illicit drug and/or unhealthy alcohol use). While cocaine use and cocaine and alcohol co-use are prevalent in this population, their effects on pain in PWH are unknown. This study aims to investigate the association of cocaine use and co-use of cocaine and alcohol with pain interference among PWH. We completed a secondary analysis of the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) study, a longitudinal cohort of PWH with a history of substance use. The outcome was pain interference (Brief Pain Inventory). Exposures were recent cocaine use (Addiction Severity Index) and recent unhealthy alcohol use (Timeline Follow Back). Generalized Estimating Equation (GEE) ordinal logistic regression models were employed, adjusted for demographic factors, illicit/non-medical opioid use and cannabis use. Among 251 participants, 22.3% reported unhealthy alcohol use only, 11.1% reported cocaine use only, and 13.2% reported use of both. Cocaine use was associated with greater pain interference (adjusted odds ratio [aOR]: 1.73, 95% confidence interval [CI]: 1.15-2.60), whether or not participants had unhealthy alcohol use (interaction term, p = 0.695). Participants reporting both cocaine and unhealthy alcohol use had greater pain interference than participants reporting neither (aOR: 2.27, 95%CI: 1.35-3.79). Cocaine use was associated with greater pain interference as was co-use of cocaine and unhealthy alcohol among PWH. Considering patterns of substance use can inform clinicians conversations with PWH who may be using substances for pain management.

  PublisherDOI

• Mobile App Engagement and Pain Outcomes Among Primary Care Chronic Pain Patients Who Engage in Hazardous Drinking: A Pilot Study

  Journal of Clinical Psychology in Medical Settings · 2026-01-28 · 1 citations

  articleSenior author
  PublisherDOI

• Assessing Motivation for Condom Use Among MSM: Effort Discounting as a Novel Measure of Sexual Risk

  AIDS and Behavior · 2026-02-19

  article
  PublisherDOI

• Lessons Learned Identifying and Controlling Fraudulent Participation in Online Randomized Trials (Preprint)

  2025-05-14

  articleOpen access

  <sec> <title>UNSTRUCTURED</title> Virtually conducted clinical trials have become an important tool for improving access to research. Online research gives rise to new avenues for potentially fraudulent actors to participate in studies to achieve monetary gain. We describe our experience of uncovering and removing fraudulent participants from a virtual research study and our methods to prevent fraudulent participants in the future. Fraudulent participation in the 2 linked online clinical trials was first uncovered in 2023, prompting our investigation and identification of additional fraudulent participants (falsified identity or information to meet eligibility criteria) who successfully enrolled in these trials. Our study team categorized indicators of suspicious activity at prescreening, screening, and baseline stages of study participation and implemented a manual checklist method to prevent fraudulent participation. We evaluate the effectiveness of our fraud prevention methods 6 months after the initial breach of the trials. Before initial detection, 10 fraudulent participants successfully enrolled in our trials. Following the implementation of new fraud prevention measures, 37 individuals were identified as fraudulent at the screening stage, and no new fraudulent participants were enrolled. We provide a comprehensive list of suspicious behaviors that may suggest the virtual research intrusion of persons using fake identities. For online clinical studies, manual methods of fraud prevention, used in conjunction with automated prevention methods, can equip researchers to detect evolving patterns of attempted fraudulent enrollment. </sec>

  PublisherDOI

• Lessons Learned Identifying and Controlling Fraudulent Participation in Online Randomized Trials

  Journal of Medical Internet Research · 2025-10-29

  articleOpen access

  Virtually conducted clinical trials have become an important tool for improving access to research. Online research gives rise to new avenues for potentially fraudulent actors to participate in studies to achieve monetary gain. We describe our experience of uncovering and removing fraudulent participants from a virtual research study and our methods to prevent fraudulent participants in the future. Fraudulent participation in the 2 linked online clinical trials was first uncovered in 2023, prompting our investigation and identification of additional fraudulent participants (falsified identity or information to meet eligibility criteria) who successfully enrolled in these trials. Our study team categorized indicators of suspicious activity at prescreening, screening, and baseline stages of study participation and implemented a manual checklist method to prevent fraudulent participation. We evaluate the effectiveness of our fraud prevention methods 6 months after the initial breach of the trials. Before initial detection, 10 fraudulent participants successfully enrolled in our trials. Following the implementation of new fraud prevention measures, 37 individuals were identified as fraudulent at the screening stage, and no new fraudulent participants were enrolled. We provide a comprehensive list of suspicious behaviors that may suggest the virtual research intrusion of persons using fake identities. For online clinical studies, manual methods of fraud prevention, used in conjunction with automated prevention methods, can equip researchers to detect evolving patterns of attempted fraudulent enrollment.

  PublisherDOI

• Pain and alcohol consumption among people living with HIV: examining the moderating roles of depression and social support

  Alcohol · 2025-07-23 · 1 citations

  articleOpen access

  Pain and heavy alcohol use are common among people living with HIV (PLWH), and influence one another, potentially exacerbating these conditions over time. This study examines the prospective association between pain and alcohol use among PLWH with a history of unhealthy drinking behaviors and/or substance use and tests whether depression and social support are moderators. A sample of 233 participants from the Boston Alcohol Research Collaborative on HIV/AIDS cohort completed measures of pain intensity (i.e., average severity of pain in the past week) and pain interference (i.e., average interference of pain in everyday life), heavy episodic drinking, number of drinks, social support and depression at baseline and 6 months later. Negative binomial regression analyses assessed whether pain at baseline predicted alcohol use at 6 months, and examined baseline social support and depression as moderators. Pain intensity was significantly associated with number of drinks (IRR= 1.80, 95% CI: 1.05, 3.08) but not number of heavy drinking days (IRR= 1.84, 95% CI: 0.83, 4.07), while pain interference was not associated with number of drinks (IRR= 1.63, 95% CI: 0.96, 2.75) nor heavy drinking days (IRR= 1.43, 95% CI: 0.64, 3.17) at six months. Neither social support, nor depression were significant moderators of the association between pain and 6-month alcohol use outcomes. Pain intensity is prospectively associated with more alcohol use, but not with heavy drinking among PLWH. We conclude that pain is an important factor to address when considering interventions to reduce alcohol use among PLWH. • Pain intensity was associated with number of alcoholic drinks, but not number of heavy drinking days 6 months later in people living with HIV. • Pain interference was not associated with number of alcoholic drinks, nor number of heavy drinking days 6 months later. • Social support and depression are not significant moderators between baseline pain and alcohol use 6 months later.

  PublisherDOI

• Oral vs Extended-Release Injectable Naltrexone for Hospitalized Patients With Alcohol Use Disorder

  JAMA Internal Medicine · 2025-04-21 · 13 citations

  letterOpen access

  Importance: Alcohol use disorder (AUD) is common in hospital patients. AUD medications are not typically initiated in that setting. The comparative effectiveness between initiation of oral naltrexone and extended-release injectable naltrexone in the hospital is not known. Objective: To compare the effectiveness of initiating oral naltrexone vs extended-release injectable naltrexone on reduction in alcohol use and health care utilization among medical inpatients with AUD. Design, Setting, and Participants: The Alcohol Disorder Hospital Treatment (ADOPT) study is a randomized clinical trial conducted at an urban teaching hospital in the US, with enrollment between June 2016 and March 2020. Inpatients were screened for eligibility, and those with AUD and recent heavy drinking (defined as 5 or more drinks for men and 4 or more drinks for women) were enrolled. Outcomes were assessed at 3-month follow-up; assessors were not blinded to treatment assignment. Data were analyzed from May 2021 to September 2023. Interventions: Participants received either daily oral naltrexone or monthly extended-release injectable naltrexone. All received medical management with a research nurse who specialized in addiction. Main Measures and Outcomes: The primary outcome was change in percentage of heavy drinking days (HDDs) over the past 30 days from baseline to 3-month follow-up, assessed by validated instrument. The secondary outcome was any acute health care utilization (emergency department or hospitalization) at 3-month follow-up over the past 90 days. Results: Of 248 participants, 199 (80.2%) were male, and the mean (SD) age was 49.4 (10.4) years. The baseline median (IQR) percentage of HDDs in the past 30 days was 80.0% (43.3-100). At 3-month follow-up, the mean percentage of HDDs in the past 30 days was reduced in both groups (oral naltrexone: baseline, 66.7% HDDs; 3-month follow-up, 27.4% HDDs; difference, -38.4 percentage points; 95% CI, -125.0 to 48.2; extended-release injectable naltrexone: baseline, 70.7% HDDs; 3-month follow-up, 23.8% HDDs; difference, -46.4 percentage points; 95% CI, -123.4 to 30.6; P = .14). At follow-up, 59 of 109 in the oral naltrexone arm (54.1%) and 66 of 108 in the extended-release injectable naltrexone arm (61.1%) reported acute health care utilization in the prior 3 months; the odds of this utilization were not significantly different between groups (adjusted odds ratio, 1.34; 95% CI, 0.77-2.33). Conclusions and Relevance: In this randomized clinical trial, when initiated at hospital discharge, oral and extended-release injectable naltrexone did not differ in effectiveness. Participants had substantial reductions in HDDs in both treatment groups; however, there was not a significant difference in the reduction of percentage of HDDs in the past 30 days or acute health care utilization between groups. Hospitalization represents an opportunity to start AUD pharmacotherapy; choice of oral naltrexone vs extended-release injectable naltrexone should be directed by factors such as patient preference and insurance. Trial Registration: ClinicalTrials.gov Identifier: NCT02478489.

  PublisherOA PDFDOI

• How Cannabis and Alcohol Use Influence Sexual Behavior Among Men Who Have Sex With Men (MSM): An Ecological Momentary Assessment Study

  Journal of Studies on Alcohol and Drugs · 2025-03-20 · 2 citations

  articleOpen access

  OBJECTIVE: Heavy drinking is common among men who have sex with men (MSM) and significantly increases HIV acquisition risk. MSM who report heavy drinking also report higher cannabis use, which has also been associated with sexual behaviors known to elevate HIV transmission risk. Despite evidence of associations at the between-subjects level, the effects of alcohol and cannabis use on sexual risk behavior among MSM who engage in heavy drinking are largely unknown. The current study used ecological momentary assessment to examine the between- and within-subject associations of heavy drinking, cannabis use, and sexual behavior. METHOD: This is a secondary data analysis of a study on alcohol intoxication and sexual decision making that included 115 MSM who reported cannabis use and were not using pre-exposure prophylaxis (PrEP) at baseline. Participants reported daily alcohol and cannabis use and sexual activities over 6 weeks. Multilevel multinomial regression was used to evaluate how alcohol and cannabis use were associated with sexual behaviors. RESULTS: Higher alcohol use was associated with higher rates of intercourse at the between-persons level and a higher likelihood of all sexual behaviors at the event level. In contrast, cannabis use at the between-person level was associated with an increased rate of condomless anal intercourse relative to both anal intercourse with a condom as well as no sex. At the within-person level, cannabis was associated with an increased likelihood of anal sex with or without a condom relative to no sex. CONCLUSIONS: Cannabis and alcohol may have independent effects on sexual risk behavior among MSM. Interventions addressing sexual health among MSM who engage in heavy drinking should also consider the additive risks of cannabis use.

  PublisherOA PDFDOI

• Addressing Pain and Heavy Drinking among Patients in HIV-Care: A Pilot Study of an Integrated Telehealth Intervention

  AIDS and Behavior · 2025-02-25 · 1 citations

  article1st authorCorresponding
  PublisherDOI

• Sexual Alcohol Expectancies, Alcohol Intoxication, and Sexual Behavior in MSM: An Experience Sampling Study

  AIDS and Behavior · 2024-09-04 · 3 citations

  article
  PublisherDOI

Recent grants

• NIH Grant R01AA011534

  NIH · $215k · 2004

• NIH Grant R34DA029227

  NIH · $692k · 2014

• Alcohol and implicit process in sexual risk behavior in MSM

  NIH · $2.4M · 2015–2021

• NIH Grant UH2AA026192

  NIH · $453k · 2019

• NIH Grant R29AA011534

  NIH · $366k · 2003

Frequent coauthors

• Richard Saitz

  130 shared

• Jeffrey H. Samet

  Boston Medical Center

  99 shared

• Debbie M. Cheng

  University of Kentucky

  95 shared

• Dena Davidson

  52 shared

• C. G. Bird

  Providence College

  50 shared

• Judith Bernstein

  40 shared

• Robert M. Swift

  Providence VA Medical Center

  37 shared

• Kevin L. Kraemer

  University of Pittsburgh

  33 shared

Education

• Ph.D.

  Yale University