Developing adaptive treatment strategies in substance abuse research
Open accessAbstract
For many individuals, substance abuse possesses characteristics of chronic disorders in that individuals experience repeated cycles of cessation and relapse; hence viewing drug dependence as a chronic, relapsing disorder is increasingly accepted. The development of a treatment for a chronic disorder requires consideration of the ordering of treatments, the timing of changes in treatment, and the use of measures of response, burden and adherence collected during treatment to make further treatment decisions. Adaptive treatment strategies provide a vehicle through which these issues can be addressed and thus provide a means toward improving and informing the clinical management of chronic substance abuse disorders. The sequential multiple assignment randomized trial (SMART) is particularly useful in developing adaptive treatment strategies. Simple analyses that can be used with the SMART design are described. Furthermore, the SMART design is compared with standard experimental designs.
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Measurement-based care is an essential component of treatment for many chronic physical and mental health conditions, but it is not typically used in the treatment of substance use disorders.
“Measurement-based care (Valenstein et al., 2009) is an essential component of treatment for many chronic physical and mental health conditions, but it is not typically used in the treatment of substance use disorders (SUDs)”
From Development and initial evaluation of the Brief Addiction Monitor (BAM) (2013) · cites this paper as Murphy, Lynch, Oslin, McKay, & TenHave, 2007
The Abstract says that treating a chronic disorder requires measures of response, burden, and adherence to guide later treatment decisions, and §2 describes using such measures in adaptive substance-use treatment. The paper does not say that measurement-based care is typically used for other physical or mental health conditions, or that it is not typically used for substance use disorders. (LLM, conf=0.83)
Experimental — accuracy not yet measuredMany health disorders are managed through a sequential, individualized approach in which treatment is adapted and readapted over time according to the individual's needs and changing status.
“The management of many health disorders, such as obesity, substance use, or depression, often entails a sequential, individualized approach whereby treatment (e.g., behavioral or medical interventions, or a combination) is adapted and readapted over time in response to the specific needs and evolving status of the individual [1,2].”
From Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research (2014) · cites this paper as [1]
Running separate RCTs for each stage and then for the adaptive intervention as a whole is less cost-effective than using a SMART.
“it would be less cost-effective-both in terms of actual dollars spent and, importantly, the value of the scientific information gained”
From Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research (2014) · cites this paper as [1]
Recent methodological work on adaptive interventions includes development of the SMART Trial and exploration of applying engineering control algorithms to adaptive behavioral interventions.
“Recent methodological work on building and optimizing adaptive interventions has included development of the Sequential Multiple Assignment Randomized Trial (SMART Trial) (58) and exploration of the idea of applying control algorithms from engineering to adaptive behavioral interventions to improve their performance (38, 39).”
From The Multiphase Optimization Strategy for Engineering Effective Tobacco Use Interventions (2011) · cites this paper as [58]
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Cites
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- Authors
- Murphy, S. A., Lynch, K. G., Oslin, D., McKay, J. R., & TenHave, T.
- Affiliations
- University of Michigan (US)
- University of Pennsylvania (US)
- Corresponding author
- Murphy, Susan A.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2007-05
- Volume
- 88
- Pages
- S24-S30
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC1922034
- OpenAlex
- W2108782374
- Cited by
- 211
- References
- 4
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 9 · 2023: 5 · 2022: 12 · 2021: 9 · 2020: 7 · 2019: 10 · 2018: 17 · 2017: 9 · 2016: 20 · 2015: 7 · 2014: 11 · 2013: 20 · 2012: 14
- FWCI
- 8.14
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01aa014851-04, 5p60da005186-25)
- National Institute on Alcohol Abuse and Alcoholism (R01 AA-014851, R01AA14850, R01AA014850, 1R01AA014851)
- National Institute of Mental Health (R01-MH-61892, K08MH001599, P30MH052129, P30MH066270, R01MH061892, 5P30 MH 52129, K08 MH01599)
- National Institute on Drug Abuse (DA 005186, K02DA015674, K02-DA00361, P50-DA-10075, P50DA010075, R21DA019800, P50DA005186, P60-DA005186, K02-DA15674, K02DA000361)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- adaptive treatment strategies, substance abuse, relapse, chronic disease, sequential multiple assignment randomized trial, treatment sequencing, medication adherence, treatment burden, clinical management
- MeSH terms
- Algorithms, Humans, Research Design, Randomized Controlled Trials as Topic, Patient-Centered Care, Substance-Related Disorders
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