This perspective article
explores the possibilities of precision in addiction care — even better
individually fitted or tailor-made care — and examines what changes we need to
make in order to realize sensible progress in epidemiological key figures.
The
first part gives a short review on the development of addiction care and tries
to answer the question of where we stand now and what has been achieved in
addiction science through the development and evaluation of interventions in
the past decades.
Following this analysis, attention will be paid to what lies
ahead. This second part focuses on the question of how addiction care can deal
with the consequences of the emerging paradigm of personalized or precision
medicine, which is based on the fundamental assumption that individual
differences matter.
Finally, some limitations and conditions as well as tasks
and goals for progress are raised. In conclusion, it is argued that integration
of addiction care in (mental) health care in the future is desirable.
...In general, addiction care and medicine share a lack of
treatment strategies that work for all individuals. Clinicians cannot be blamed
for this deficit; it only demonstrates the need to be more precise in our
clinical research and predictions. Evidence-based guidelines derived from the
results of clinical trials are still very limited. Trials mostly focus on
averages of groups of patients compared to groups that receive another
intervention or a placebo. In reality, however, we treat individuals, and
therefore it is possible that a less effective strategy (from a group
perspective) is an ideal strategy for a minority of patients. Some may even react
unfavorably to the “most effective” strategy. From this perspective, many
meta-analyses are misleading because they have been conducted to strictly
compare the numerous types of interventions. These analyses inform us about
average differences, but their predictive value for the outcome of a specific
patient with very particular characteristics is insufficient. This observation
does not disqualify the effectiveness of the aforementioned strategies as such.
For many people, the “most effective” treatment strategy can work excellently,
especially if we have additional information about dosage, timing (stage of the
disease process), and other proven predictors (e.g., age of onset, treatment
history) that can support clinical or therapeutic decisions.
In summary, we need evidence-based strategies and
predictive instruments that provide support to adequately select treatment
options or prevention programs. For example, genetic tests can aid
pharmacotherapy decision, and brain scans can be used to inform decisions about
specific forms of counseling or therapy. If these are at our disposal, the NNT
of specific interventions can become more favorable, the number of disappointed
patients and therapists can be reduced, costs can be reduced, and gradually the
results will increase. In the realm of addiction care, this sounds very
optimistic. Evidence-based treatment interventions have become available only
recently, and the rate of implementation is still rather low. From a
professional point of view, this is not satisfactory. However, the strategies
we have and can implement are not enough, and there are strong arguments to
pursue further steps...
Full article at:
By:
Professor of
Mental Health, University of Applied Sciences in Leiden; Senior Researcher at
GGZ inGeest, Amsterdam; and Strategic Advisor at Brijder-Parnassia, The
Netherlands
To whom all correspondence should be addressed: Jaap van der
Stel, GGZ inGeest, PO Box 5, 2120 BA Bennebroek, The Netherlands. Email:ln.tseegnizgg@letsrednav.j.
More at: https://twitter.com/hiv_insight
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