Research priorities for alcoholism treatment

The goals of the current NIAAA review process were to assess the breath, coverage, and balance of the treatment research portfolio and to identify areas for increased attention. Both alcoholism treatment experts and non-alcohol-related treatment experts were called upon to help with this task. Our group was encouraged by the fact that results from previous reviews have effectively been incorporated into the institute portfolio, particularly in the areas of the pharmacotherapy and psychotherapy development programs. The present review identified the five priority areas: mechanisms of action of treatment, combination and sequencing of treatments, health-seeking patterns and processes, concurrent disorders, and understanding help agent behaviors. In addition, several methodological and/or conceptual issues emerged that it was felt, crosscut these areas. These issues included greater emphasis on intervention testing in special populations, patient-treatment matching, measurement techniques, and technology transfer. Finally, several mechanisms of funding were outlined, including across-institute initiatives that could facilitate larger scale translational work such as comorbidity studies and/or studies of combined treatments. All the above were deemed important by the advisory committee, but an overarching emphasis was placed on understanding the mechanisms of action of treatment. For example, it is important to know that a particular pharmacotherapy reduces craving and also how this comes about. Similarly, it is key to the continued refinement of psychosocial treatments that the active components and their mechanisms of change be clarified. Such mechanism studies are crucial for the development of more heuristic and more accurate theoretical formulations that must guide our understanding of alcohol dependence if treatment, relapse, and recovery are to become more scientifically grounded.