Nora D. Volkow, MD: Advancing Clinical Research for Treating Use Disorders

The focuses of neurological-targeted treatment and patient-tailored care strategies are coming close to a merge in addiction medicine. What it may mean is greater assurance of positive outcomes for clinicians and patients alike.

In the second segment of an interview with HCPLive during the American Psychiatric Association (APA) 2022 Annual Meeting in New Orleans this week, National Institute on Drug Abuse (NIDA) director Nora D. Volkow, MD, highlighted the pharmacological pursuits of the National Institutes of Health (NIH) in better addressing substance use disorders (SUDs).

As Volkow explained, there is a growing understanding that poly-SUD may be adequately addressed in patients—those who may suffer from use disorders in both alcohol and opioids, or otherwise.

“Because we frequently see individuals that are taking multiple substances, and they may have a use disorder that goes for more than one of them,” Volkow said. “And yet at the same time, particularly from brain imaging studies, we have started to understand common neurocircuitry that is engaged whether you have an alcohol use disorder or you have a cocaine use disorder.”

As such, Volkow and colleagues are seeking strategies of care that benefit patients regardless of their use disorder. One such mean may be neuromodulation technology that may benefit the affected prefrontal cortex of patients with SUDs.

“To the extent that we can use neuromodulation to help the prefrontal cortex recover, then you are going to be able to improve the outcomes overall in individuals,” Volkow said.

Additionally, there is growing interest in targeting intervention of any present depression or insomnia—common comorbidites in patients with SUD—in order to improve the efficacy of disorder therapy as well.

“(It’s about) going beyond the notion of the target that we’re going for as being abstinence, to going for alternative outcomes that relate to improvement of wellbeing in the person with substance use disorder,” Volkow said. “Because if you can elevate them by making them feel better, you’re going to increase the chances that they’re going to achieve recovery.”

Lastly, Volkow emphasized the need to seek patient collaboration and buy-in with any current or future SUD care, noting that such an opportunity to involve patients in research decision-making in the past affected the field’s capability to treat behavior issues, which may impact clinical outcomes as well.

“We are modifying that so we have patient voices in the way that we tackle the problem,” she said. “It is true that bringing patients and families into forums…that one thing we’ve come to realize that the drive to take drugs is not strictly driven by cravings, but depression as well.”