What treatment for which patient?

Abstract

The field of addictions is a lively and exciting one in which controversy thrives. This is a healthy thing. It indicates that we are constantly thinking, growing and learning more about the processes involved in addictions and how best to manage at a biological, psychological and societal level. In this issue, several of the ‘growth’ areas in the addictions field are discussed. Marijuana abuse and dependence is a growing concern throughout the world, particularly in adolescent populations. In spite of this, we know little about efficacious treatment. Copeland (pp. 161–167) provides a thorough and scholarly review of the field, pointing out areas that are ripe for further investigation. In particular, there are currently no pharmacotherapeutic treatments that have demonstrated efficacy in the treatment of marijuana dependence. With the development of the cannabinoid antagonists, this is a new and exciting avenue for exploration. The area of replacement therapies versus abstinencebased therapies or the controlled use of substances is an area that has received much attention. In this issue, there are two articles discussing these issues. Waal and Kornor (pp. 169–174) discuss the use of abstinence-oriented therapies compared with replacement therapies for opiate addicts. In another article, Saladin and Santa Ana (pp. 175–187) discuss the use of controlled drinking strategies in the treatment of alcohol use disorders. Of interest is the fact that these two articles written by different groups of investigators viewing different addictive disorders come to largely the same conclusion. Abstinence-oriented, replacement therapies and controlled drinking strategies all have a place in the treatment of substance use disorders. Substance use disorders are an extraordinarily heterogeneous and complex set of disorders, and there are likely to be a number of efficacious treatments in which the utility of the treatment depends upon administering the treatment to the right patient at the right time in the course of their disorder. In other words, matching patients to treatments. Treatment matching is a construct that has been discussed for a long time. As we grow and develop our knowledge about addictions and new efficacious treatments emerge, this construct will become increasingly important in practice.