The future of translational research on alcohol use disorder

Abstract

In March 2019, a scientific meeting was held at the University of California, Los Angeles (UCLA) Luskin Center to discuss approaches to expedite the translation of neurobiological insights to advances in the treatment of alcohol use disorder (AUD). A guiding theme that emerged was that while translational research in AUD is clearly a challenge, it is also a field ripe with opportunities. Herein, we seek to summarize and disseminate the recommendations for the future of translational AUD research using four sections. First, we briefly review the current landscape of AUD treatment including the available evidence-based treatments and their uptake in clinical settings. Second, we discuss AUD treatment development efforts from a translational science viewpoint. We review current hurdles to treatment development as well as opportunities for mechanism-informed treatment. Third, we consider models of translational science and public health impact. Together, these critical insights serve as the bases for a series of recommendations and future directions. Towards the goal of improving clinical care and population health for AUD, scientists are tasked with bolstering the clinical applicability of their research findings so as to expedite the translation of knowledge into patient care.

Keywords: AUD; medications; research; translational; treatment; treatment gap.

Figure 1.

Models of Translational Research Four models of translational research reviewed in the manuscript are displayed to highlight their overlap and opportunities for translational and reverse translational research. The Institute of Medicine classifies research in two halves: Type 1 Translational Research (T1TR) which focuses on basic research to clinical efficacy, and Type 2 Translational Research (T2TR) emphasizes clinical efficacy, dissemination, implementation, and impact (Lam et al., 2013). The continuum of translational research includes four phases beginning with the identification of targets to candidate health application (T1) and ending with the evaluation of real-world health outcomes in the population (T4) (Khoury et al., 2007). The Science of Behavior Change proposed intervention pipeline highlights the identification of intervention targets, the development of appropriate assays, and the optimization of trial designs to measure target engagement (Nielsen et al., 2018). Finally, the Phases of Drug Development represents the pathway from drug discovery and pre-clinical animal research through translation to patient populations and safety monitoring of approved medications (Litten et al., 2012). Phases of preclinical research are colored in dark gray, phases which overlap preclinical and clinical research, termed translation, are colored in a gradient from dark to light gray, and clinical research phases are colored in light gray.