Moving the Alcohol Addiction RDoC forward.
Moving the Alcohol Addiction RDoC forward.
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推动酒精成瘾 RDoC 向前发展。
DOI：
10.1111/acer.12661
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Sher,KennethJ
中科院分区：
文献类型：
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作者：
Sher,KennethJ
Litten等人(in Press）为推进酒精使用障碍（AUDs）的个性化治疗制定了重要的研究议程，扩展了RDoC框架（Cuthbert，2014）以解决酒精和成瘾问题。目前的诊断方法（例如，DSM-5，美国精神病学协会，2013年），告诉我们一个给定的个人的疾病的具体性质或在治疗中解决什么潜在的组件很少。通过确定导致或维持AUDs的特定机制，并通过旨在使这些机制正常化或稳定化的干预措施来靶向它们，我们应该能够开发新的治疗方法，并更有效地利用现有的治疗方法。正如Litten等人所指出的，提高对复杂综合征患者的识别能力，合理实施综合干预（例如，多药治疗，联合行为疗法）涉及多个目标，并告知我们对合并症及其治疗的理解。实现这一愿景需要基础研究，继续绘制可分离的药物之间的重叠和边界。（例如，别稳态、激励-敏化、习惯、反应抑制），但相互关联（例如，Lovic等人，2011）机制。最终，我们应该能够将这些机制转化为可指导临床决策的易处理的临床评估。这将需要在制定衡量标准方面做更多的工作。虽然在评估与成瘾相关的接近和抑制过程方面已经取得了很大进展（例如，斯泰西和Wiers，2010），但许多这些措施的心理测量表明，为了可靠和有效地应用，需要进一步改进。即使是古老的，“久经考验的”反应抑制措施（例如，去/不去，停止信号，反扫视任务）往往相互关联性很差，并且具有可疑的心理测量学（Fillmore & Weafer，2013）。因此，改善关键过程的基本客观测量（包括行为和生物标志物）将增加酒精成瘾RDoC倡议实现其推进成瘾研究和改善患者护理的巨大承诺的可能性。
Litten et al.(in press) lay out an important research agenda for advancing personalized treatment for alcohol use disorders (AUDs), extending the RDoC framework (Cuthbert, 2014) to address alcohol and addiction constructs. Current diagnostic approaches (eg, DSM-5, American Psychiatric Association, 2013), tell us little about the specific nature of a given individual's disorder or what underlying components to address in treatment. By identifying specific mechanisms that are causing or maintaining AUDs and by targeting them with interventions designed to normalize or stabilize those mechanisms, we should be able to develop novel treatments and to employ existing ones more effectively. As noted by Litten et al., it will also enhance our ability to identify patients with complex syndromes involving multiple dysfunctions and rationally implement combined interventions (eg, polypharmacy, combined behavioral therapies) involving multiple targets and inform our understanding of comorbidities and their treatment.Actualizing this vision requires basic research that continues to map the overlap and boundaries among dissociable (eg, allostasis, incentive-sensitization, habit, response inhibition) yet interrelated (eg, Lovic et al., 2011) mechanisms. Ultimately, we should be able to translate these mechanisms into tractable clinical assessments that can guide clinical decision-making. This will require considerably more work on measure development. Although much progress has been made in assessing both approach and inhibitory processes associated with addiction (eg, Stacy & Wiers, 2010), many of these measures’ psychometrics indicates further refinement is necessary for reliable and valid application. Even venerable,“tried and true” measures of response inhibition (eg, go/no-go, stop-signal, anti-saccade tasks) often correlate poorly with each other and have questionable psychometrics (Fillmore & Weafer, 2013). Consequently, improving basic, objective measurement (including both behavioral and biological markers) of key processes will increase the likelihood that the Alcohol Addiction RDoC initiative will fulfill its considerable promise for advancing addiction research and improving patient care.