Citation

Agniel D, Almirall D, Burkhart Q, Grant S, Hunter SB, Pedersen ER, Ramchand R, Griffin BA. Drug Alcohol Depend. 2020; 212: e107991.

Affiliation

RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202-5050, USA.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.drugalcdep.2020.107991

PMID

32408135

Abstract

BACKGROUND: Adolescents respond differentially to substance use treatment based on their individual needs and goals. Providers may benefit from guidance (via decision rules) for personalizing aspects of treatment, such as level-of-care (LOC) placements, like choosing between outpatient or inpatient care. The field lacks an empirically-supported foundation to inform the development of an adaptive LOC-placement protocol. This work begins to build the evidence base for adaptive protocols by estimating them from a large observational dataset.

METHODS: We estimated two-stage LOC-placement protocols adapted to individual adolescent characteristics collected from the Global Appraisal of Individual Needs assessment tool (n = 10,131 adolescents). We used a modified version of Q-learning, a regression-based method for estimating personalized treatment rules over time, to estimate four protocols, each targeting a potentially distinct treatment goal: one primary outcome (a composite of ten positive treatment outcomes) and three secondary (substance frequency, substance problems, and emotional problems). We compared the adaptive protocols to non-adaptive protocols using an independent dataset.

RESULTS: Intensive outpatient was recommended for all adolescents at intake for the primary outcome, while low-risk adolescents were recommended for no further treatment at followup while higher-risk patients were recommended to inpatient. Our adaptive protocols outperformed static protocols by an average of 0.4 standard deviations (95 % confidence interval 0.2-0.6) of the primary outcome.

CONCLUSIONS: Adaptive protocols provide a simple one-to-one guide between adolescents' needs and recommended treatment which can be used as decision support for clinicians making LOC-placement decisions.

Copyright © 2020 Elsevier B.V. All rights reserved.

Language: en

Keywords

Adaptive methods; Adolescent substance use; Clinical placement guidelines; Dynamic treatment regimes; Observational data