Developing adaptive treatment strategies in substance abuse research

Received 30 March 2006; received in revised form 17 September 2006; accepted 18 September 2006.

Abstract

For many individuals, substance abuse possesses characteristics of chronic disorders in that individuals experience repeated cycles of cessation and relapse; hence viewing drug dependence as a chronic, relapsing disorder is increasingly accepted. The development of a treatment for a chronic disorder requires consideration of the ordering of treatments, the timing of changes in treatment, and the use of measures of response, burden and adherence collected during treatment to make further treatment decisions. Adaptive treatment strategies provide a vehicle through which these issues can be addressed and thus provide a means toward improving and informing the clinical management of chronic substance abuse disorders. The sequential multiple assignment randomized trial (SMART) is particularly useful in developing adaptive treatment strategies. Simple analyses that can be used with the SMART design are described. Furthermore, the SMART design is compared with standard experimental designs.

Keywords: Stepped care, Individualized care, Treatment algorithms, Dynamic treatment regimes, Experimental design

a University of Michigan, Institute for Social Research, 426 Thompson St., Ann Arbor, MI 48106-1248, USA

b University of Pennsylvania, 3900 Chestnut Street, Philadelphia, PA 19104-6178, USA

c University of Pennsylvania, Geriatric and Addiction Psychiatry, 3535 Market Street, Room 3002, Philadelphia, PA 19104, USA

d University of Pennsylvania, School of Medicine, 607 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA

Corresponding author. Tel.: +1 734 763 5046; fax: +1 734 763 4676.

PII: S0376-8716(06)00338-3

doi:10.1016/j.drugalcdep.2006.09.008

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