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Adaptive Interventions

Behavioral interventions for prevention and treatment are an important part of the fight against drug abuse and conditions such as HIV/AIDS and mental illness. Among the challenges faced by scientists is how and when to alter the course of treatment for participants in the intervention.



Sequential, Multiple Assignment, Randomized Trials (SMART)

Adaptive interventions (also known as "adaptive treatment strategies" or “dynamic treatment regimens”) are individually tailored treatments. Formally, an adaptive intervention is a sequence of decision rules that specify how the intensity or type of treatment should change depending on the patient's needs. We are developing sequential, multiple assignment, randomized trials (SMART) to enable scientists to build adaptive interventions.



SMART Designs in the Field

Despite the fact that SMART is a recent innovation, many SMART designs have been funded and conducted. We have compiled a list of SMARTs addressing a broad range of health problems from substance use to depression.

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Why Conduct a SMART to Build an Adaptive Intervention?

Interventions that adapt at the right times can improve participant outcomes (e.g., intensifying for people who do not respond to the initial treatment) while decreasing the cost and burden of the intervention (e.g., stepping down treatment for responsive participants). SMART designs provide the data needed to construct high-quality adaptive interventions.

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Introductory Example: Using Medication to Prevent Alcoholism Relapse

ExTEND SMART allows scientists to operationalize adaptive clinical decision making. In SMART interventions, scientists use data-based evidence to inform decision making about how and when to alter a patient's treatment.


In this example, researchers designed a trial to test how best to use the drug Naltrexone (NTX) in the treatment of alcoholism relapse. The trial tested how to classify relapse and what treatments best compliment NTX.

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Susan MurphyLead researcher: Susan Murphy


Other researchers:

Daniel Almirall

Linda Collins

Inbal Nahum-Shani

Center Collaborations

This work began as a collaboration between Susan Murphy and Linda Collins, which led to two projects: work on optimizing interventions and SMART.


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Our research on adaptive interventions is currently supported by the National Institute on Drug Abuse (NIDA) grant P50-DA10075.


Significant support was provided by NIDA grant K02 DA15674, Eunice Kennedy Shriver National Institute of Child Health & Human Development grant R01 HD073975, 

and National Institute of Mental Health grant R01 MH080015.

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