Beyond drug use: a systematic consideration of other outcomes in evaluations of treatments for substance use disorders

Abstract

Across the addictions field, the primary outcome in treatment research has been reduction in drug consumption. A comprehensive view of the impact of substance use disorders on human functioning suggests that effective treatments should address the many consequences and features of addiction beyond drug use, a recommendation forwarded by multiple expert panels and review articles. Despite recurring proposals, and a compelling general rationale for moving beyond drug use as the sole standard for evaluating addiction treatment, the field has yet to adopt any core set of “other” measures that are routinely incorporated into treatment research. Among the many reasons for the limited impact of previous proposals has been the absence of a clear set of guidelines for selecting candidate outcomes. This paper is the result of the deliberations of a panel of substance abuse treatment and research experts convened by the National Institute on Drug Abuse to discuss appropriate outcome measures for clinical trials of substance abuse treatments. This paper provides an overview of previous recommendations and outlines specific guidelines for consideration of candidate outcomes. A list of outcomes meeting those guidelines is described and illustrated in detail with two outcomes: craving and quality of life. The paper concludes with specific recommendations for moving beyond the outcome listing offered in this paper to promote the programmatic incorporation of these outcomes into treatment research.

“There Are Things I Want to Say But You Do Not Ask”: a Comparison Between Standardised and Individualised Evaluations in Substance Use Treatment

“…To learn that patients who seek substance use treatment report problems beyond drug use is a major finding of our study. On the one hand, it confirms the importance of outcome evaluation protocols that include other aspects, such as psychosocial functioning or stress, which go beyond substance use (Tiffany et al 2012). Both domains suggested by Tiffany et al (2012) were also expressed by patients in our sample in individualised measures.…”

Does outcome measurement of treatment for substance use disorder reflect the personal concerns of patients? A scoping review of measures recommended in Europe

“…Most evaluation protocols focus on drug and/or alcohol use and related behaviours, e.g., injecting, criminal activities (Donavan et al, 2011;Tiffany et al, 2011), overlooking psychosocial variables that many authors believe to be highly relevant for patients' recovery (Table 1). These data could be used as markers to adjust the intervention according to treatment response (Tiffany et al, 2011), as well as allowing for a better understanding of the mechanisms underlying recovery.…”

Evaluation of medication-assisted treatment of opioid dependence—The physicians’ perspective

“…The overall "moderate" evaluation across the whole sample calls into mind the chronicity and complexity of the treatment of opioid dependence (McLellan et al, 2000). Our findings are of particular interest in light of the debate about which outcome parameters to apply in the assessment of substance use treatment (Bühringer, 2012;Donovan et al, 2012;Miller and Miller, 2009;Tiffany et al, 2012;Uchtenhagen, 2015). Some researchers have argued that substance use is the most suitable parameter for treatment success and should thus be the primary outcome of treatment evaluation (Donovan et al, 2012).…”

“…There has been intensive debate on suitable outcome parameters in the evaluation of substance use treatment in general, and MAT in particular (Bühringer, 2012;Donovan et al, 2012;Tiffany et al, 2012;Uchtenhagen, 2012). MAT is associated with a reduction in substance use, mortality, treatment dropouts, HIV infections, psychosocial symptom load and delinquency, and an overall increase in quality of life (Brugal et al, 2005;Cacciola, 2001;Deck et al, 2009;Feelemyer et al, 2014;MacArthur et al, 2012;Mattick et al, 2009).…”

“…Most treatment studies focused on putative objective parameters, while the subjective outcomes of MAT have received less attention. However, there is an increasing recognition that these constitute essential measures of MAT quality (Tiffany et al, 2012;Trujols et al, 2011;Uchtenhagen, 2015). Few studies have investigated subjective views of MAT episodes (Montagne, 2002;Stancliff, 2002), and, if so, mostly addressed patient satisfaction (Kelly et al, 2010;Marchand et al, 2011;Trujols et al, 2012).…”