Beyond drug use: A systematic consideration of other outcomes in evaluations of treatments for substance use disorders.

Across the addiction field, the primary outcome in treatment research has been reduction in drug consumption. A comprehensive view of the impact of substance use disorders on human functioning suggests that effective treatments should address the many consequences and features of addiction beyond drug use, a recommendation forwarded by multiple expert panels and review papers. Despite recurring proposals, and a compelling general rationale for moving beyond drug use as the sole standard for evaluating addiction treatment, the field has yet to adopt any core set of “other” measures that are routinely incorporated into treatment research. Among the many reasons for the limited impact of previous proposals has been the absence of a clear set of guidelines for selecting candidate outcomes. This paper is the result of the deliberations of a panel of substance abuse treatment and research experts, including many members of the National Drug Abuse Treatment Clinical Trials Network (CTN), convened by the National Institute on Drug Abuse (NIDA) to discuss appropriate outcome measures for clinical trials of substance abuse treatments (a paper from a second panel at the same meeting concluded the primary outcome measure should be an indicator of drug-taking behavior, and that there is no single clinical metric that is appropriate for inclusion in most drug dependence treatment trials — see Donovan et al, 2012). This paper provides an overview of previous recommendations and outlines specific guidelines for consideration of candidate outcomes. A list of outcomes meeting those guidelines is described and illustrated in detail with two outcomes: craving and quality of life. The paper concludes with specific recommendations for moving beyond the outcome listing offered in this paper to promote the programmatic incorporation of these outcomes into treatment research.

Update: Commentary about this article and a related article by Dennis Donovan (see item 683), with responses from Drs. Tiffany and Donovan, was published in Addiction 2012;107(4):719-726.