Toward Individualized Treatment for Substance Abuse

Clinical observation and research discovery each can give rise to treatments that prove effective in clinical trials and, accordingly, are considered evidence-based. For example, motivational interviewing draws on, and addresses, clinicians’ recognition of patient ambivalence, and contingency management emerged from research on the effects of rewards on human behavior. Whether they originate in the clinic or the research setting, evidence-based treatments provide clinicians with tools to treat patients more effectively while still treating each as a unique individual. Thus, motivational interviewing, by moving clients past ambivalence, clears the way to addressing other issues that are particular to the individual. Contingency management, similarly, can increase clinicians’ ability to address clients’ individual issues by motivating attendance in sessions and other desirable behaviors. The future of substance abuse treatment is the development of an increasing array of evidence-based treatments that clinicians will use to address patients’ varied strengths, needs, and circumstances. We have already begun to see the emergence of evidence-based treatments for patients with certain co-dependencies and co-occurring disorders. Research reviewed in this issue of Addiction Science & Clinical Practice suggests that interventions might be developed for patients in specific stages of addiction, with different types and degrees of cognitive impairment, or with particular genotypes. Far from reducing the role of clinicians and the importance of the therapeutic relationship, evidence-based treatments rely heavily on clinical skills and empathy. Increasingly, clinicians will need to be familiar with the variety of available evidence-based treatments, to identify the right one—or combination or sequence—for each patient and to administer a range of assessments and interventions with fidelity. For substance abuse clinicians, the tools, the challenges, and the potential for success increase in concert.