Neuroscience biomarkers in assessment and treatment of substance use disorders

Neuroscience is the study of brain mechanisms, how they function, how they are constructed, and how they relate to behavior (Kuhn & Koob, 2010). Neuroscience is a broad field that scrutinizes these brain mechanisms at all levels from the molecular and genetic levels all the way to the higher-order psychological processes and even to the understanding of clinical conditions. Because of its scope and its relevance to all aspects of behavior, neuroscience offers several unique contributions to understanding issues like addiction from multiple levels of analysis.

John is a 60-year-old male with no prior history of addictive behavior or mental illness and no family history of substance abuse who developed a substance use disorder to alcohol and the benzodiazepine Valium. The clinical case of "John" is not unique; however, the case offers an example of how little science can help understand, assess, and treat addictions. In the treatment of addiction clinicians follow a three stage process: assessment, intervention, and treatment of the addictive behavior. Neuroscience can assist the process at all three levels.

Assessment

Neuroscientists are finding links to biological variations in the human brain that increase or even reduce the risk to develop a substance use disorder. Moreover, genetic neuroscience is finding associated genetic links that increase the risk for addictive behavior.

Typically the assessment of a substance use disorder is achieved via a clinical interview that includes the person's history, family history, self-report of the current problems, possible collaboration with friends or relatives, and possible adjunctive information such as reports from work, police reports, incarceration history, etc. (Samet, Waxman, Hatzenbuehler & Hasin, 2007). Clinicians may also administer paper and pencil assessment inventories that can be completed by the subject, the subject's friends or relatives, or others. The clinician will then develop a formulation based on self-reports, collaborative reports, and any other documentation available in the case. There is a need for -- clinical measures that can differentiate patients who meet the clinical criteria for substance use disorders for the same addictive agent while at the same time having different backgrounds, responses the prior treatment, and so forth.

Neuroscience has identified potential biomarkers that can be extremely useful in the assessment of a particular substance use disorder and help to understand the vulnerabilities and current neurobiological substrate of the person in question (Wilson, Thomas, & Iacono, 2015). Although still in their infancy, the techniques of neuro-imaging, EEG assessment, and biofeedback can be useful in differentiating these issues (Wilson et al., 2015). At this time it appears that using these instruments to help assess such things as the executive functioning ability of the individual, neural responses to certain types of incentives such as addictive substances or addictive activities, genetic associations that are associated with high probabilities to developing substance use disorders, and the valence of a person's emotional responses to specific types of stimuli can be useful in conjunction with the traditional assessment tools to help to assess the particular issues and etiology of an individual's problem as well as to outline specific types of treatment interventions, personal vulnerabilities, and specific goals of treatment for the individual in question (Wilson et al., 2015). Certain neuro-imaging techniques may be expensive; however, other techniques such as genetic testing, EEG analysis, biofeedback, etc. are less costly and offer the possibility of empirically validated neurological/biological assessment indicators.

In the case of John such techniques would have been useful in identifying particular vulnerabilities and biological indicators that suggest future risk factors.

Treatment

The current approach to treating addiction typically involves education, some type of therapeutic intervention, and unless the individual is also burdened by legal issues very little long-term follow-up. The treatments for substance use disorders are traditionally short-term and often not effective (Nutt et al., 2014). One of the advantages to evolving the research of neuroscientists in the treatment process could allow for a better understanding as to why the current treatment modalities are not consistently able to produce positive changes (see Carhart-Harris, Leech, Hellyer, Shanahan, Feilding, et al., 2014). Moreover, because the researcher neuroscience outlines the changes that occur in the brain and at the molecular level this research can help to emphasize the need for longer term interventions and long-term follow-up for individuals who have been victim to addiction. This research could also help identify changes and these traditional treatment modalities that could result in their being more efficacious.

Finally, one of the areas of treatment that is still underdeveloped is the development of medications that are appropriate to treat drug addiction. Currently are some types of medications such as opioid replacement therapy or medications such as Naltrexone or Antabuse that stop or interfere with use; however, medications are few, offer a restricted range of options, and certainly understanding the neural circuitry, biological substrates, and other physiological aspects of addiction can pave the way for more efficient medications that can assist in the treatment of addiction (Kuhn & Koob, 2010; Wilson et al., 2015). Neuroscience research can be crucial in the development of these medications which could potentially lower the rates of relapse in individuals attempting to recover from serious substance use disorders.

In the case of John, even though his treatment had been successful in the short-term, medications could have been used to make his treatment run more smoothly and to assist in the long-term to remain abstinent.