Developments in pharmacotherapy: personalised pharmacotherapy?
background Effect-sizes of pharmacological treatments for addictive disorders are limited and a substantial number of patients do not derive any benefit from these treatments.
aim To develop strategies that will enhance the effectivity of pharmacotherapy in the future.
method We reviewed the literature using a model of staging and profiling which matches pharmacological interventions to specific stages of addiction.
results Pharmacological interventions can be tailored to the specific stage of the disease. In the early stages of a disease, pharmacotherapy can be directed towards reducing impulsivity, craving and compulsive behaviour and controlling substance abuse. In later stages the aim is to reduce negative effects, craving and compulsive behaviour and bring the patient to the stage of total abstinence. Furthermore, if therapists opt for pharmacotherapy they must take specific characteristics of the patient into consideration. Currently, phenotypical (clinical) characteristics do not provide a firm enough basis for pharmacological interventions. Endophenotypical or genetic characteristics seem to be very promising. However, most findings still need to be replicated and validated.
conclusion The era of truly personalised medication for addiction has not yet arrived, but there are some very promising developments. In the short term, the prospects for pharmacogenetics seem to be the most favourable. A model of staging and profiling can provide a valuable framework for new developments in pharmacotherapy.