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Home  Research Areas Adaptive Treatment Strategies
In the treatment and prevention sciences it has been evident that there is individual heterogeneity in need for treatment in terms of disorder severity, background characteristics and co-occurring problems. Indeed the need for treatment may vary across time. For example, patients with mental illnesses (e.g. depression, drug-abuse, alcoholism, etc) often respond differently to treatment and also tend to experience repeated cycles of cessation and relapse. Therefore, the clinical management of mental illnesses requires that clinicians make a sequence of treatment decisions, where the first step is aimed at stabilizing the patient and the following steps are directed to preventing relapse in the long term. Adaptive treatment strategies operationalize this sequential decision making.
Adaptive treatment strategies (also known as “dynamic treatment regimes”) are individually tailored treatments; formally an adaptive treatment strategy is a sequence of decision rules that specify how the intensity or type of treatment should change depending on patient variables. These patient variables may include patient response, risk, burden, adherence and preference, collected during prior therapy. The goal of adaptive treatment strategies is to make decisions that result in optimal clinical outcomes. For example, in planning the treatment for alcohol dependent patients, researchers are faced with a sequence of decisions, such as what is the best initial treatment, what is the best time to alter treatment and what is the best subsequent treatment for improving patients and non-improving patients. In the context of this example, a simple adaptive treatment strategy is: treat patients with an opiate antagonist Naltrexone (NTX) first. If the patient is able to avoid more than one heavy drinking day during the ensuing 2 months then the patient is provided a prescription to NTX and Telephone Disease Management (TDM; Oslin et al. 2003). If, however, at anytime during the 2 months the patient incurs a second heavy drinking day, then the conclusion is that the patient's disorder is not responding to NTX. In this case, if the patient is experiencing minimal side effects to NTX, then the patient is provided NTX + Combined Behavioral Intervention (CBI; Pettinati et al., 2004). Conversely, if the nonresponding patient is experiencing moderate or severe side effects, the patient is provided CBI alone.
The development of optimal adaptive treatment strategies involves the consideration of many different issues. These include experimental designs for collecting suitable data, the construction of tailoring variables and a high quality outcome variable, derivation of decision rules, inference, etc. More information on the formulation of an efficient, evidence-based process of developing adaptive treatment strategies can be found at Dr. Susan A. Murphy’s website.
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