Applying methods for personalized medicine to the treatment of alcohol use disorder.

Abstract

Objective: Numerous behavioral treatments for alcohol use disorder (AUD) are effective, but there are substantial individual differences in treatment response. This study examines the potential use of new methods for personalized medicine to test for individual differences in the effects of cognitive behavioral therapy (CBT) versus motivational enhancement therapy (MET) and to provide predictions of which will work best for individuals with AUD. We highlight both the potential contribution and the limitations of these methods. Method: We performed secondary analyses of abstinence among 1,144 participants with AUD participating in either outpatient or aftercare treatment who were randomized to receive either CBT or MET in Project MATCH. We first obtained predicted individual treatment effects (PITEs), as a function of 19 baseline client characteristics identified a priori by MATCH investigators. Then, we tested for the significance of individual differences and examined the predicted individual differences in abstinence 1 year following treatment. Predictive intervals were estimated for each individual to determine if they were 80% more likely to achieve abstinence in one treatment versus the other. Results: Results indicated that individual differences in the likelihood of abstinence at 1 year following treatment were significant for those in the outpatient sample, but not for those in the aftercare sample. Individual predictive intervals showed that 37% had a better chance of abstinence with CBT than MET, and 16% had a better chance of abstinence with MET. Obtaining predictions for a new individual is demonstrated. Conclusions: Personalized medicine methods, and PITE in particular, have the potential to identify individuals most likely to benefit from one versus another intervention. New personalized medicine methods play an important role in putting together differential effects due to previously identified variables into one prediction designed to be useful to clinicians and clients choosing between treatment options.

Individual differences in the effects of the ACTION-PAC intervention: an application of personalized medicine in the prevention and treatment of obesity

“…However, the strength of personalized medicine methods is their potential for clinical application rather than the ability to test theory (Kuhlemeier et al, 2021). While the clinical utility of this example would have increased if effects had been found for the intensive intervention, Figure 2 shows how the method results in a prediction about the treatment effect for each individual.…”

“…The goal of this paper is to demonstrate the use and limitations of one of these methods, the PITE framework (Ballarini et al, 2018;Kuhlemeier et al, 2021;Lamont et al, 2018), for examining the utility of personalized medicine methods in obesity research. PITE is especially relevant to obesity treatment because of its focus on individual predictions, rather than identifying subgroups, and its flexibility in which predictive method can be used.…”

New approaches to deep phenotyping in addictions.

“…NIDA PhAB and HiTOP have not yet been integrated. The present article outlines the interface between these two systems and argues that their integration can provide a broad and detailed characterization of people diagnosed with SUDs through deep phenotyping, which may ultimately illuminate treatment targets that maximize treatment effectiveness (Kuhlemeier et al, 2021).…”

New approaches to deep phenotyping in addictions

“…NIDA PhAB and HiTOP have not yet been integrated. The present paper outlines the interface between these two systems and argues that their integration can provide a broad and detailed characterization of people diagnosed with SUDs through deep phenotyping, which may ultimately illuminate treatment targets that maximize treatment effectiveness (Kuhlemeier et al, 2021).…”

“…Nevertheless, although NIDA PhAB and HiTOP stem from different conceptual backgrounds, existing evidence from nonhuman animal paradigms that influenced most modern models of addiction supports the viability of individual difference focused accounts of SUD and addiction, such as HiTOP. In fact, focusing on individual differences appears promising for precision medicine efforts in the treatment of alcohol use disorder (Kuhlemeier et al, 2021). Relatedly, critical yet largely unchartered territory for HiTOP and NIDA PhAB is their integration into experimental paradigms, which have also historically neglected individual differences.…”