Exploring novel approaches to treatment and relapse prevention
Addiction is a multifactorial disease, influenced by biologic, environmental, and psychological factors. Our goal at the Fran and Doug Tieman Center for Research is to advance research in addiction medicine in a manner that will ultimately improve patient outcomes.
What are the risk factors for relapse?
Understanding the risk factors for relapse provides an opportunity to work proactively to mitigate the risk. Social and environmental cues (“people, places and things”) that are associated with a person’s substance use can serve as triggers for relapse. Lack of social support and peer pressure are also contributing factors. Trauma and other forms of stress can increase the likelihood of relapse significantly. The cumulative effect of experiencing stress early in life has an impact on the developing parts of the brain that can affect the ability to learn and adapt to stress later in life. The brain’s responses to stress can make people more vulnerable to unhealthy choices.
Why conduct research at a treatment center?
The presence of a research center within a treatment center means we are uniquely positioned to conduct research in an environment that approximates real world settings.
As an organization, Caron was initially involved in outcomes research, but we are now focused on medical research. This shift in focus was necessary because we need objectivity in the field of addiction medicine. Such objective data may provide us with the ability to predict a person’s risk of developing a substance use disorder if exposed to certain medications and their vulnerability to relapse after treatment. This will help determine the best treatment plan and duration for patients on an individual basis. The ultimate goal is to improve treatment outcomes.
We collaborate with our research partners in three broad areas: Predicting susceptibility by assessing genetic risk, repurposing of medications already in use for other conditions and predicting the likelihood of relapse.
Can we prevent addiction before it starts?
The ability to identify people who are at high risk of developing a substance use disorder when exposed to a specific substance will enable us to prevent addictions before they even start. For example, even though a personalized approach is recommended for treating post-surgical pain, few resources are available for this. A genetic risk assessment would provide objective data to guide decision making when it comes to prescribing opioids. We collaborated with SOLVD Health (formerly Prescient Medicine) on a research project that led to the development of a novel machine learning algorithm for assessing opioid use disorder, now under review by the FDA, using gene variants involved in the brain reward pathway. High-risk individuals were approximately sixteen times more likely to develop an opioid use disorder than those identified as low risk.
Can we predict relapse?
Caron is also studying the relationship between patterns of brain activity and the likelihood of relapse. One of our projects involves studying electroencephalograms (EEGs) to identify patterns of brain activity that may be associated with an increased risk for relapse. In separate project, we will be collaborating with colleagues at Penn State Hershey to study the use of neuroimaging techniques to predict relapse. Functional near infra- red spectroscopy (fNIRs) is a portable, noninvasive method of monitoring brain activity by measuring changes in oxygenation of the blood. Preliminary studies have shown that it may predict early relapse in patients with alcohol use disorder.
How will Caron’s research ultimately help patients?
In addition to providing a broader range of treatment options for our patients, the ability to make individual treatment recommendations based on risk could be a potential game changer. The ability to differentiate those who are at high versus low risk for developing opioid use disorder can guide treatment protocols for pain management.
As with other diseases, there are modifiable risk factors, and there are others, such as genetic risk, that cannot be modified. Our goal is to identify risk factors and then educate and empower patients to mitigate their risk. Ideally, we would like to prevent these disorders from developing in the first place. For those who have a substance use disorder, we want to empower them to avoid relapse after treatment. As we focus on advancing knowledge in the field, we continue to work towards empowering patients to understand their individual risk and make informed choices.
By Caron Staff
By Eric Webber, MA, CADC, CSAT/CMAT, CCS, CCPG