Precision Medicine in Alcohol Use Disorder: Mapping Etiologic and Maintenance Mechanisms to Mechanisms of Behavior Change to Improve Patient Outcomes
Precision Medicine in Alcohol Use Disorder: Mapping Etiologic and Maintenance Mechanisms to Mechanisms of Behavior Change to Improve Patient Outcomes
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DOI：
10.1037/pha0000613
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发表时间：
2022-11-10
影响因子：
2.3
通讯作者：
Witkiewitz, Katie
中科院分区：
文献类型：
--
作者：
Boness, Cassandra L.;Witkiewitz, Katie
精准医学已经被认为是解决酒精使用障碍异质性和适度酒精使用障碍治疗效果问题的潜在解决方案。精准医疗的成功在于我们能够首先确定特定人的病因和维持机制，然后选择最有可能解决这些机制的治疗方法。存在几种描述经验支持的物质使用障碍（SUD）病因学和维持机制的框架（例如，病因学、基于理论、个体发生学、层次[ETOH]框架）。也有大量的文献关于酒精使用障碍治疗中行为改变的机制。然而，关于酒精使用障碍治疗的行为改变文献的机制广泛地集中在改变的机制上，而不是更具体地集中在核心酒精使用障碍的病因和维持机制上。因此，这两类机制从未被整合或系统地评估其重叠之处。因此，本简要综述的目的是证明常用的酒精使用障碍治疗方法如何与某些酒精使用障碍病因学和维持机制（特别是ETOH框架所描述的机制）重叠并直接针对这些机制。我们描绘了经验上合理的重叠机制和理论上合理的重叠机制，值得更多的研究。最后，基于识别的经验和理论上合理的重叠机制，我们阐述了如何正在进行的工作与酒精使用障碍精准医学可能会测试具体的假设，就哪些治疗最适合whome.Public Health的意义这篇综述强调了重叠的过程，（一）导致和维持酒精使用障碍和（B）导致行为改变酒精使用障碍治疗。通过利用过程之间的这种重叠，我们可能能够更好地确定治疗目标并提高现有治疗方法的疗效。
Precision medicine has been advanced as a potential solution to the problem of alcohol use disorder heterogeneity and modest alcohol use disorder treatment efficacy. The success of precision medicine lies in our ability to first identify the etiologic and maintenance mechanisms at play for a given person and then choose the treatment that is most likely to address such mechanisms. There exist several frameworks that describe empirically supported substance use disorder (SUD) etiologic and maintenance mechanisms (e.g., the Etiologic, Theory-based, Ontogenetic, Hierarchical [ETOH] Framework). There also exists a large literature on mechanisms of behavior change in alcohol use disorder treatment. However, the mechanism of behavior change literature on alcohol use disorder treatments has focused broadly on mechanisms of change rather than more specifically on core alcohol use disorder etiologic and maintenance mechanisms. Thus, the two types of mechanisms have never been integrated or systematically evaluated for their overlap. As such, the aim of the present brief review is to demonstrate how commonly used alcohol use disorder treatments may overlap with and directly target certain alcohol use disorder etiologic and maintenance mechanisms (specifically those described by the ETOH framework). We delineate empirically plausible overlapping mechanisms and theoretically plausible overlapping mechanisms that warrant more research. Last, based on the identification of empirically and theoretically plausible overlapping mechanisms, we elaborate on how ongoing work related to alcohol use disorder precision medicine may test specific hypotheses regarding which treatments work best for whom.Public Health Significance This review highlights the overlap between processes that (a) cause and maintain an alcohol use disorder and (b) cause behavior change in alcohol use disorder treatment. By leveraging this overlap between processes, we may be able to better identify treatment targets and improve the efficacy of existing treatments.