Scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have proposed the use of a new addiction assessment tool to improve the way people are diagnosed with substance use disorders.
The Addictions Neuroclinical Assessment (ANA) integrates clinical and behavioral information with brain imaging and genetic data to more precisely diagnose and treat addictive disorders. Specifically, the ANA can be used to better understand how addictive disorders develop, and to fine-tune classification of these disorders and their treatment.
In an article published online in Biological Psychiatry, the scientists review current methods of diagnosis and discuss the need for new neuroclinical measures to differentiate patients who meet clinical criteria for addiction while differing in etiology, prognosis, and treatment response.
The current classification of an addictive disorder, in which a person either has one or doesn’t, fails to take into account the complexity of these disorders and how they manifest differently in different people.
“We currently approach addiction diagnosis as a ‘yes or no’ proposition,” said first author Laura E. Kwako, Ph.D., a researcher in the Office of the NIAAA Clinical Director. “The Addictions Neuroclinical Assessment that we propose leverages knowledge of the neuroscience of addiction to identify a package of assessments that may be used to more precisely identify different subtypes of addictive disorders.”
The ANA incorporates the previous efforts of several other initiatives and would include behavioral assessment of three functional processes considered most relevant to addiction: altered perception of an object or event by drug-taking that makes it seem more attractive or important (incentive salience), increased negative emotional responses (negative emotionality) when drugs are no longer available, and deficits in organizing behavior toward future goals (executive functioning). The authors note that the selection of these processes is based on current understanding of the neuroscience of addiction.
The authors further note that part of the usefulness of the ANA would lie in the ability to integrate diverse information and tailor treatments to individual patients. This integration would be similar to what has been done in cancer research, where clinicians combine cellular, genetic, molecular, and imaging information with patients’ clinical history to make diagnoses and customize treatments based on the specific characteristics of the disease.
“It is evident that the current diagnostic categories are broad and encompass enormous clinical heterogeneity,” said Dr. John Krystal, editor of Biological Psychiatry. “The development of dimensional approaches to complement current diagnostic categories may help to provide more effective individualized treatments for addictions.”