In a recent article published in Alcohol Drug Abuse Weekly, leaders of the National Institute of Health (NIH) in USA, in the field of substance use disorders (SUDs), have called for the evaluation of novel treatments, including rapid-acting psychotherapeutics such as psychedelics. They highlight the need to explore new approaches to improve the effectiveness and sustainability of treatments for individuals with mental illness and substance and alcohol use disorders.
The article discusses the research gap in various areas, including comorbidities and polysubstance use, objective metrics for measuring functional recovery, biomarkers for treatment decisions, and approaches to sustaining results from rapid treatments. They emphasize that addressing these areas will unlock the potential for more effective and sustainable treatments.
While there are pilot studies on the effectiveness of psychedelics like psilocybin, ketamine, and ibogaine for SUDs, the safety of these drugs in patients with SUDs still needs evaluation. The article also mentions the possibility of developing immunotherapies, such as vaccines or antibodies, to block the effects of drugs in the brain.
The article highlights the importance of combining different treatment approaches, such as neuromodulation techniques like transcranial direct current stimulation and deep brain stimulation, with medication or behavioral interventions. The authors suggest that combining treatments may accelerate responses and improve outcomes.
For alcohol use disorders (AUDs), the article mentions a few promising psychotherapeutics. Psylocibin treatment has shown effectiveness in reducing craving and increasing abstinence, while ketamine has shown potential when combined with motivational enhancement. Brain stimulation techniques have also shown some reduction in heavy drinking days and an increase in abstinence. Additional research is needed on hormones like ghrelin and oxytocin for AUD treatment.
The article proposes that reducing substance use, craving, and improvements in affect during withdrawal can be considered positive outcomes in addition to abstinence for all SUDs. The authors suggest that establishing more "harm reduction" endpoints, similar to those used in AUD clinical trials, would expand the toolbox of rapid treatments.
The need to modernize research is driven by the aim to use faster-acting treatments in real-world settings. The article emphasizes the potential of treatments that work in hours or days to significantly reduce morbidity and mortality and improve care. However, questions about the effective use, duration, and cost of these treatments need to be answered through further research.
It is important to note that not all rapid-acting approaches will work for everyone, and understanding which treatments are most likely to benefit specific individuals will require further innovation and experimentation. Prospective studies are needed to determine the specificity of different treatment approaches for individual patients.
While ketamine is already approved by the FDA, further research is needed to understand the role of context in treatment, including factors like "set and setting" parameters and psychotherapy elements.
In conclusion, the article highlights the potential of novel treatments, particularly psychedelics, and calls for further evaluation of these approaches. By addressing research gaps and exploring innovative treatment combinations, there is hope for more effective and sustainable interventions for individuals with SUDs and AUDs. ..... see article abstract.
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