The Concept of Treatment-Refractory Addiction: Implications for Addiction Treatment Systems and Research.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI:10.1097/ADM.0000000000001350
Edward V Nunes, A Thomas McLellan
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Abstract

Abstract: The concept of treatment-refractory addiction, proposed by Eric Strain in this edition of the Journal, has the potential to invigorate the field of addiction treatment and research by focusing on a phenomenon that is familiar to any clinician treating patients with substance use disorders, namely, the patient who does not experience sufficient improvement from standard treatments. An analogy is drawn to the concept of treatment-resistant depression and the STAR*D study, which demonstrated an algorithmic approach to treatment, where if the first antidepressant medication tried did not result in remission from depression, subsequent trials of medications or cognitive behavioral therapy doubled the proportion of patients achieving remission. Recognizing treatment-refractory addiction challenges our field to develop analogous, stepwise, algorithmic approaches to treatment of substance use disorders, moving away from siloed treatment programs toward integrated treatment systems where alternative treatments are available, offering the kind of personalized, tailored forms of care used in the treatment of most other chronic illnesses. Like in STAR*D, research could focus on samples of patients who have not benefitted from initial trials of standard addiction treatments, addressing the key clinical question of what to do next when previous treatments fail.

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难治性成瘾的概念:对成瘾治疗系统和研究的影响。
摘要:埃里克-斯特恩(Eric Strain)在本期期刊中提出的 "难治性成瘾"(treatment-refractory addiction)概念,通过关注治疗药物使用障碍患者的临床医生所熟悉的一种现象,即患者在接受标准治疗后病情未得到充分改善,有可能为成瘾治疗和研究领域注入新的活力。该研究展示了一种算法治疗方法,即如果首次尝试的抗抑郁药物治疗未能使抑郁症得到缓解,那么后续的药物治疗或认知行为疗法试验可使获得缓解的患者比例增加一倍。认识到难治性成瘾对我们的领域提出了挑战,我们需要开发类似的、循序渐进的、算法化的方法来治疗药物使用障碍,从孤立的治疗方案转向综合治疗系统,在综合治疗系统中提供可供选择的治疗方法,提供用于治疗大多数其他慢性疾病的个性化、量身定制的护理形式。与 STAR*D 项目一样,研究也可以侧重于那些在标准成瘾治疗的初步试验中未能获益的患者样本,以解决临床上的一个关键问题,即当之前的治疗失败时,下一步该怎么做。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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