Combating Drug Addiction with Personalized Care

The addiction epidemic is a largely neglected public health crisis in the United States. A study conducted by The National Center for Addiction and Substance Abuse at Columbia University found that 40 million Americans over the age of 12 suffer from addiction to alcohol, nicotine, and illicit substances. This figure greatly overshadows the 27 million Americans with heart disease, the 26 million with diabetes, and the 19 million with cancer. So why is such a prevalent problem receiving such little attention?

The way the current U.S. health system treats addiction is partly to blame. Current treatment methods, when and if a patient receives treatment, are either inconclusively effective or generalized. A scientific consensus on the effectiveness of popular 12-step therapy programs such as Alcoholics Anonymous or Narcotics Anonymous has yet to be reached, with different studies finding the programs beneficial, neutral, or even detrimental to recovery. In addition to therapy, medical professionals recommend medication be used to help facilitate recovery. However over 90% of medications properly function in only 30% to 50% of patients. For example, though methadone is useful in managing adult addiction, it is not suitable for teens. In addition, it is even harder to find the right medication for each patient in addiction treatment due to patient relapse and adherence. Yet most doctors are still treating addiction with a one-size-fits all approach and prescribing popular medications without really considering the individual characteristics of the patient at hand.

Personalization of care could be the answer to getting America’s drug addiction under control. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a new approach developed by the government’s Substance Abuse and Mental Health Services Administration that serves as a resource for health care centers looking to deliver early intervention. This could have enormous effects in preventing the onset of addiction with the 80 million risky drug users currently in the United States. Personalized medicine, which is providing “the right drug for the right patient at the right time,” is currently being applied to more effectively treat addiction after it has already appeared in a patient. By matching specific medication to certain genes, addiction can be effectively combated on the first try. The question of whether an alcoholic would respond better to naltrexone, acamprosate, or disulfiram or whether an opiate addict would respond better to naltrexone, methadone, or buprenorphine could soon be answered with a low cost blood test. Finally, due to the chronic nature of drug addiction, “a short-term, one-time treatment is usually not sufficient.” Personalized health planning is a potential strategy to ensure treatment regimens are being followed, to engage patients in combatting drug addiction to improve their health, and to alert providers if a different treatment approach is needed.

Risky drug use and drug addiction costs the U.S. government over $468 billion annually. However, only 10% of individuals with drug addiction receive treatment and few health care providers know how to treat addiction. What is needed now is a logical new approach to managing addiction that is both patient-centered and cost effective. An emphasis on early prevention and tailored treatment options could not only save billions of dollars, but also millions of lives. As personalized approaches to care are refined, it is of the utmost importance to ensure addiction treatment does not get left behind.

Wendy Ji is an intern for the Duke Center for Research on Personalized Health Care and a junior attending the University of North Carolina at Chapel Hill.