Assessing Addiction From Multiple Perspectives

It’s time to change addiction assessment, and build on advances in neuroscience, say scientists at the National Institute on Alcohol Abuse and Alcoholism. They’ve proposed an assessment tool to diagnose addictive disorders that takes into account addiction-related behaviors, brain imaging, and genetic data. The Addictions Neuroclinical Assessment (ANA) could lead to more effective individualized treatments, they say.

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“We currently approach addiction diagnosis as a ‘yes or no’ proposition,” said Laura Kwako, PhD, lead author of a review article on the subject. Addictive disorders are typically classified by the substance of abuse and the presence or absence of symptoms, such as difficulty controlling consumption. By “leveraging knowledge of the neuroscience” to identify a “package of assessments,” the researchers hope to more precisely identify different subtypes of addictive disorders. They compare the new assessment tool to those used to tailor cancer diagnoses, which combine cellular, genetic, molecular, and imaging information with clinical history.

The behavioral assessment would include 3 functional processes most relevant to addiction: altered perception of an object or event, or “incentive salience” (where drug-taking makes something seem more attractive or important); negative emotionality (increased negative responses when drugs are no longer available); and executive functioning (e.g., deficits in organizing behavior toward goals).

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“The assessment framework that we describe recognizes the great advances that continue to be made in our understanding of the neuroscience of addiction,” said NIAAA director George Koob, PhD, a coauthor of the review. “These advances underscore how much we know about the core neurobiologcal manifestations of addiction in people.”