Biomarkers to recent statistics , the US saw a -2% decline in reported drug deaths, along with a -14% decline in drug overdoses last year. While numbers are yet to be finalized for Sept – Dec 2024, the number of overdoses is expected to be down by 2-4% in 2024 compared to 2023.
Though there are a myriad of factors that influence such statistical fluctuations, it’s important to remember that advances in modern medicine and technology, coupled with a growing societal and social awareness of mental and behavioral disorders, have rapidly increased the understanding of these conditions on the whole.
Evidence to support multi-dimensional approaches towards psychiatric disorders is mounting. These new and dynamic strategies are transforming the ways we diagnose and ultimately treat substance use disorders.
By a dimensional approach, we mean that we assess the degree of symptoms a client with a psychological or behavioral disorder exhibits. This contrasts with the more categorical diagnostic approach traditionally used in such instances, which serves as more of a tick-box exercise of how many symptoms or traits the client exhibits to meet diagnostic criteria.
What Are Biomarkers of Addiction?
A 2014 paper on ‘Neuroimaging and Biomarkers in Addiction Treatment’1 discusses how neuroimaging studies have contributed to the identification of biomarkers in the treatment of addiction. It describes these biomarkers as necessary tools to ‘provide targets for treatment, detect treatment subgroups, predict treatment response, and broadly improve outcomes’.
In layman’s terms, these biomarkers act as indicators, providing further insight into clients’ vulnerabilities, their response to treatment, and more.
Biological vs Imaging Biomarkers
Biomarkers for addiction can be broken down into two distinctive types. Both are crucial tools that offer differing, though complementary approaches to understanding the disease of addiction. They can be used to monitor, diagnose, and even provide predictions for addiction treatment outcomes.
Biological biomarkers focus on physiological and molecular changes in blood and tissues, with symptoms like inflammatory markers and spikes in cortisol reflecting an individual’s predisposition to addictive behaviors. Further to this, biological markers can hone in at a cellular and molecular level, identifying proteins and genes present that can indicate a greater biological response to substance use.
Imaging-based biomarkers use tech like positron emission tomography (PET) and magnetic resonance imaging (MRI) scans to track and detect changes in brain chemistry, receptor availability, and neural activity patterns.
Biological biomarkers for things like blood samples are minimally invasive, and can vary in their accuracy due to a host of external and lifestyle variables. However, when conducted in a more controlled environment, they can lead to detailed, molecular-level insights.
Meanwhile, it can be argued that imaging biomarkers are less invasive, though techniques like PET scans require radiation exposure, which can pose additional and potentially unnecessary risk to clients. That being said, imaging biomarkers provide valuable and dynamic information about cerebral structure and brain function, which is said by some to be more precise.
Clinical Applications
The practical applications of both of these methods offer multiple benefits in the realm of addiction prevention, diagnosis, and treatment.
Imaging-based biomarkers, for example, can accurately diagnose different stages of addiction, while also predicting clients’ vulnerability before behavioral symptoms present. This can allow for the implementation of preventative measures, or early diagnosis and access to treatment.
For individuals already presenting with symptoms of addiction, a recent study of 4,837 young people with opioid use disorder found that, of those who received medication-assisted treatment (MAT) alongside behavioral care within three months of diagnosis, rates of treatment completion and success were higher than those who only received behavioral treatment.
These findings speak not only to the efficacy of MAT as part of a holistic approach to addiction recovery, but of the importance of early treatment in lessening the impact of substance abuse cases.
Imaging methods can also be used throughout MAT to keep tabs on brain changes while taking particular medications, and during periods of abstinence. It can also predict the severity of withdrawal symptoms in any given client from a range of different substances.
They can also help tailor treatment selections for more effective results based on biomarker profiles. This is compounded by the application of imaging biomarkers to predict which clients may be at higher risk of relapsing.
The Limitations and Challenges of These Methods
While it’s tempting to focus squarely on the pros of such tools, it’s important to take a rounded perspective. One of the more practical challenges of this current technology is the cost of advanced imaging, with many lower-income areas and poorly funded health facilities unable to implement it at this time. These technologies require significant investment, not only for the tools themselves, but in the hiring of trained staff that specialize in their methods.
There are also potential ethical concerns, insofar as predictive imaging and patient privacy are concerned. Predictive imaging is also not foolproof. It’s possible that clients identified as low-risk may, in fact, benefit from treatment, and be overlooked due to biomarker results, leading them to fall through the cracks and go untreated. That being said, this highlights the importance of integrating diagnostic methods to ensure teams are never solely reliant on one tool or approach.
With biomarkers being a relatively new approach within the field of addiction treatment, there remains a lack of standardization in their definitions across studies. This is an important factor to consider in ensuring their success going forwards, should biomarkers gain traction and become more widely used in addiction recovery.