Needed Relapse-Prevention Research on Novel Framework (ASPIRE Model) for Substance Use Disorders Treatment.

Abstract

According to a recent United States (U.S.) national survey on drug use and health, substance use disorders (SUDs) characterized by hazardous use of alcohol, non-prescribed drugs, and illicit drugs are common. In 2013, 22.7 million persons (8.6% of persons aged 12 years or older) needed treatment for an illicit drug or alcohol-use problem (1). Drug use disorders produce a wide variety of medical problems and are important contributors to years of life lost due to disability and preventable death (2). Yet, screening, intervening, and treating SUDs have not been embraced within general medical settings (3). In fact, even though untreated SUDs place individuals at substantially greater risk for a wide range of diseases and are a pervasive public health burden, only approximately one-tenth of Americans aged 12 years or older with SUDs received treatment in 2013 (1). A main obstacle to patient engagement in and initiation of SUDs treatment is lack of motivation to seek out follow-up care. Motivation to do so may be compromised by a lack of a personalized-medicine approach, in which patients are frequently only offered a single or narrow set of care options, which do not align with their individual needs. A gap exists in research in medical settings regarding how to effectively implement shared-decision making between patients and their providers, concerning how to tailor evidence-based care options to personalized needs and preferences of clients (4–6). Converging research over the past 30 years indicates that core features of SUDs comprise of a spectrum of neurobiological components, which in 2014, I distilled into a shared-decision-making and personalized/precision medicine framework for SUD treatment, the ASPIRE model (7). This integrative model stresses the need for translational research on how to most effectively optimize implementation of patient-centered care using this model in general medical settings and specialty SUD-treatment programs, in a manner whereby patients have an active role as partners in deciding with their providers on treatment strategies for evidence-based care tailored to their risk categories and values (7). This precision medicine approach should be customized to genetic, psychological, and physiological profiles and environmental events that patients experience as presenting an obstacle to their overall wellness and recovery (7). Accordingly, treatment and follow-up care plans should be matched with individual disease characteristics, which may enhance motivation of patients to cease hazardous substance use and associated health risk behaviors (7). Thus, the ASPIRE model uses as its foundational principle shared-decision-making between patients and healthcare providers to customize personalized medical care to particular neuroscience-research-grounded profiles, psychiatric comorbidities, readiness to change, risk categories, and problems that individual patients report as most distressing to their daily lives (7). Recent advances in genomic and health information technologies [for instance, meaningful use of electronic health record systems (EHRs), telemedicine, mobile-health technologies, EHRs-linked patient registries, EHRs-linked genomic data and lifestyle information, etc.] and bioinformatics methods for analyzing EHRs-linked biomedical big-data repositories should be leveraged to accelerate rigorous big-data science research on how to effectively implement such a personalized-medicine framework in general medical settings. In circumstances where individual patients are cognitively impaired and have limited insight, such a shared-decision-making approach to SUD treatment may actively involve patients’ caregivers or other family members, if patients consent to their involvement in their medical care (4–7). In such cases, family members may be recruited to help ensure patients follow through and adhere to their treatment plan mutually agreed upon with their medical provider. Systematic rigorous research is needed using a shared-decision-making approach to find more effective ways of reducing the burden of SUD and enhancing quality of lives not only for individual patients but also for their family members affected by an individual’s SUD.