Neuroscience-based Framework for Addiction Diagnosis

Proposed by new review in Biological Psychiatry

Philadelphia, PA, August 2, 2016

When it comes to an addictive disorder, you either have it or you don’t. But this dichotomous nature of the diagnosis fails to recognize the complexity and diversity of addiction’s origins and manifestation in people. A new review in Biological Psychiatry proposes an Addictions Neuroclinical Assessment (ANA) to incorporate more clinical information into the diagnosis of addictive disorders.

According to first author Laura Kwako from the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Maryland, although treatment options exist, capitalizing on the burgeoning knowledge of the neurobiological origins of addiction could help find treatments that address the diversity within the addiction diagnosis. The ANA is an effort to meet the need for a neuroscience-based framework for diagnosis which the researchers hope will advance understanding of how addictive disorders emerge and how to classify them.

Past efforts have been made to categorize addictive disorders based on the substance of abuse, for example, alcohol versus cocaine. But differences and similarities between addictions are not constrained by the type of drug. In the review, the researchers propose a dimensional framework, incorporating behavioral measures with brain imaging and genetic data.

“It is evident that the current diagnostic categories are broad and encompass enormous clinical heterogeneity,” said Dr. John Krystal, Editor of Biological Psychiatry. “The development of dimensional approaches to complement current diagnostic categories may help to provide more effective individualized treatments for addictions.”

The ANA incorporates previous efforts of several other initiatives and adopts the framework from the National Institute of Mental Health’s Research Domain Criteria (RDoC), a research framework for studying psychiatric disorders. The researchers considered domains of RDoC that were most relevant to addiction and built a framework that can be used in a clinical setting. It assesses processes related to three areas of functioning: organizing behavior toward future goals (executive functioning), altered perception of an object or event that makes it seem more attractive or important (incentive salience), and increased negative emotional responses (negative emotionality).

In the review, the researchers emphasize the need to also collect brain imaging and genetic information from patients. Although they currently have little utility in the clinic, the researchers hope that the comprehensive measures will facilitate future understanding of the origin of addiction at a biological level.

“The proposed Addictions Neuroclinical Assessment described in our article leverages knowledge of the neuroscience of addiction to identify a package of assessments that may be used to more precisely identify different subtypes of addictive disorders,” said Kwako, adding that the effort will improve diagnosis of addictions and alleviate the enormous societal burden of addictive disorders.

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Notes for editors
The article is "Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders," by Laura E. Kwako, Reza Momenan, Raye Z. Litten, George F. Koob, and David Goldman (doi: 10.1016/j.biopsych.2015.10.024). It appears in Biological Psychiatry, volume 80, issue 3 (2016), published by Elsevier.

Copies of this paper are available to credentialed journalists upon request; please contact Rhiannon Bugno at +1 214 648 0880 or biol.psych@utsouthwestern.edu. Journalists wishing to interview the authors may contact Laura Kwako at laura.kwako@nih.gov.

The authors’ affiliations, and disclosures of financial and conflicts of interests are available in the article.

John H. Krystal, M.D., is Chairman of the Department of Psychiatry at the Yale University School of Medicine, Chief of Psychiatry at Yale-New Haven Hospital, and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial and conflicts of interests are available here.

About Biological Psychiatry
Biological Psychiatry is the official journal of the Society of Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal publishes both basic and clinical contributions from all disciplines and research areas relevant to the pathophysiology and treatment of major psychiatric disorders.

The journal publishes novel results of original research which represent an important new lead or significant impact on the field, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Reviews and commentaries that focus on topics of current research and interest are also encouraged.

Biological Psychiatry is one of the most selective and highly cited journals in the field of psychiatric neuroscience. It is ranked 5th out of 140 Psychiatry titles and 11th out of 256 Neurosciences titles in the Journal Citations Reports® published by Thomson Reuters. The 2015 Impact Factor score for Biological Psychiatry is 11.212.

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Media contact
Rhiannon Bugno
Editorial Office, Biological Psychiatry
+1 214 648 0880
biol.psych@utsouthwestern.edu