Abstract
Modern health services now strive for individualized treatment. This approach has been enabled by the increase in knowledge derived from neuroscience and genomics. Substance use disorders are no exception to individualized treatment even though there are no gene-specific medications yet available. What is available is the ability to quickly and precisely assess and monitor biopsychosocial variables known to vary during addiction recovery and which place addicts at increased risk of relapse. Monitoring a broad spectrum of biopsychosocial health enables providers to address diverse genome-specific changes that might trigger withdrawal from treatment or recovery relapse in time to prevent that from occurring. This paper describes modern measurement tools contained in the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) and the NIH Toolbox and suggests how they might be applied to support recovery from alcohol and other substance use disorders in both pharmacological and abstinence-oriented modalities of care.
Highlights
Leaders in the substance use disorder (SUD) field have called for a shift from an acute care model of addiction treatment to a chronic care model in which recovery—not abstinence alone—is the goal [1,2]
Treatment programs have been moving toward a chronic care model, resources to sustain post-treatment recovery have been sparse, and relapse remains the norm [3]
By 2010, NIH PatientReported Outcomes Measurement Information System (PROMIS) had delivered on its promise to the field of healthcare by delivering a set of computerized patient-reported outcome (PRO) general health measures based on modern measurement theory (MMT) to monitor changes in biological, psychological, and social health status quickly and precisely
Summary
Leaders in the substance use disorder (SUD) field have called for a shift from an acute care model of addiction treatment to a chronic care model in which recovery—not abstinence alone—is the goal [1,2]. Many experts have called for routine monitoring as key to detecting symptoms early enough to re-intervene before a lapse into use or relapse into addiction occurs [4,5,6,7,8]. To add to the problem, most measures in common use for SUD monitoring are narrow in focus, and may fail to detect biological, psychological, and social adjustment factors that put recovery at risk. This paper describes an approach to comprehensive recovery monitoring that serves modern goals of precision medicine and individualized care. We describe barriers to comprehensive monitoring and weaknesses in commonly used measures, and we explain how modern measurement techniques can overcome those problems. We describe the development of two modern measurement systems for monitoring general medical recovery developed by the National Institutes of Health; The. Patient-Reported Outcomes Measurement Information System (PROMIS) and the NIH Toolbox. We explain how those measurement systems can be applied economically and effectively to enhancing SUD recovery success
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