Treatment Failure Versus Failed Treatments: The Risks of Embracing Treatment Refractory Addiction.

IF 4.2 3区医学 Q1 SUBSTANCE ABUSE

Journal of Addiction Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-10 DOI:10.1097/ADM.0000000000001351

David A Fiellin

引用次数: 0

Abstract

Abstract: In this issue, Strain advocates for the field of addiction medicine to consider a new diagnostic signal-treatment-refractory addiction. Also in this issue, Nunes and McLellan support the concepts advanced by Strain. I provide an alternate view and propose that it is premature to create such a signal and that doing so could lead to unintended adverse consequences. My argument is based on 4 concerns: (1) the lack of neuroscientific correlates, (2) the profound impact that context has on what patients receive as "treatment," (3) the rare provision of sequentially stepped treatment, and (4) the potential for misuse of the signal. Addiction medicine should be cautious in introducing concepts such as treatment-refractory addiction to ensure that patients are not seen as "treatment failures." Our efforts should rather focus on the development of additional effective treatments, improving access to existing effective treatments and a creating a system that does not provide "failed treatments."

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治疗失败与治疗失败：接受难治性成瘾治疗的风险。

摘要：在本期杂志中，Strain 主张成瘾医学领域考虑一种新的诊断信号--治疗难治性成瘾。同样在本期中，Nunes 和 McLellan 支持 Strain 提出的概念。我提出了另一种观点，并认为现在设立这样一个信号还为时过早，而且这样做可能会导致意想不到的不良后果。我的论点基于以下四点：（1）缺乏神经科学相关性；（2）环境对患者所接受的 "治疗 "有着深远的影响；（3）很少提供有顺序的阶梯式治疗；（4）信号可能被滥用。成瘾医学在引入治疗难治性成瘾等概念时应谨慎从事，以确保患者不会被视为 "治疗失败者"。我们的工作重点应该是开发更多有效的治疗方法，改善现有有效治疗方法的可及性，并建立一个不提供 "失败治疗 "的系统。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Addiction Medicine 医学-药物滥用

CiteScore

6.10

自引率

9.10%

发文量

260

审稿时长

>12 weeks

期刊介绍： The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.