Personalized Medicine for Addiction

Better science may revolutionize treatment and help patients avoid the huge toll of addictions. Here's what you should know about personal medicine and addiction.

Listen deeply to anyone with an addiction and you’ll hear many threads to the story. The Rubik’s cube puzzle may seem to have far more than six faces, lining up in various ways.

All patients are individuals.

“It would be a miracle if standardized treatment strategies would work for everyone at every stage and that patients with the same diagnosis would respond in the same way," observes Jaap van der Stel, a professor emeritus of mental health at the University of Applied Sciences in Leiden, Germany. But that may be especially true for people struggling with addictions.

Personalized medicine therefore holds the promise of transforming the field. In his overview, “Precision in Addiction Care: Does It Make a Difference?” van der Stel goes on to say: “There are great opportunities for more precision in psychiatry and addiction care… [with a] targeted focus on the patient’s individual characteristics and a better selection of treatment strategies.”

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Resistance to oversimplification — “I’m different from other addicts.” — is one of the most common reasons people give for staying away from medical treatment.

That doesn't mean they are doomed: The common idea that addictions always get worse without professional treatment simply isn’t true. Many get better — on their own, over time. They escape bad circumstances, grow into other coping methods, or join addiction support programs and put in the work to get better.

The hope is that treatment can work faster, and that people will be more likely to overcome shame and other reasons for resisting help if they see options fine-tuned to their own needs. Ideally, everyone could choose among support groups, medication, specialized therapy, and other social services that make a difference.  

The most immediate applications of personalized medicine may be providing patients with the right medication at the right time. Many drugs, typically with other current uses — among them, naltrexone, acamprosate, topiramate, disulfiram, baclofen, N-acetylcysteine, and bupropion — all seem to have some power to reduce cravings.

Right now, many doctors prescribe those medicines with a one-size-fits all approach, and they don’t always work for everyone.

Naltrexone, for example, seems to prevent a relapse of drinking for up to 75 percent of people recovering from alcoholism who try it. You’re a good candidate if you have strong alcohol cravings, a family history of alcoholism — and it turns out, if you like spicy foods. Researchers have uncovered possible links between the effectiveness of naltrexone and specific gene variants, but results so far have been mixed.   

Similarly, genetic markers may be linked to success with acamprosate and topiramate. Another potential anti-craving drug, especially for smokers and drinkers, is varenicline; research into associated genetic markers is underway.

It would be helpful for U.S. drug research to include volunteers with a broader range of ethnicities and distinguish between them. For example, one study found a particular variant was linked to higher risk of alcohol use disorder in people of Asian descent but not in those with European ancestry. Women who abuse drugs after giving birth may need specialized medication.    

Meanwhile, researchers are on the trail of effective meds for behavioral addictions. The more healthcare providers know about the people most likely to benefit the better. The population that may have a habit deemed a behavioral addiction at any point in time is much bigger than you might guess.

One day, people may receive targeted therapy as well, instead of being sent to a group using a 12-step formula.

Some research, for example, suggests that younger teens with a marijuana problem and a rebellious streak do better with family therapy than cognitive behavioral therapy, which teaches them to think more clearly. On the other hand, 17- and 18-year-olds may do better with cognitive behavioral therapy.

It’s even possible that brain scans may one day help pinpoint the trait or skill that most needs a boost.

It will help to know each patient as well as possible. Many people with addictions are depressed or have other psychiatric issues. It’s a common (and self-defeating) scenario for drinkers to get a prescription for an antidepressant — and keep drinking.

Personalized medicine means addressing both the addiction and depression; antidepressants alone don’t stop substance abuse. One small study reported that depressed drinkers who received both sertraline and naltrexone did better than people treated with either drug alone or a placebo.

Patients in the end can free themselves, finding ways to avoid relapses, which may require both persistence and experimentation, twisting and turning that Rubik’s cube. Better, more personalized, treatment is essential.  

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