Neuroscience-informed classification of prevention interventions in substance use disorders: An RDoC-based approach

Abstract

Neuroscience has contributed to uncover the mechanisms underpinning substance use disorders (SUD). The next frontier is to leverage these mechanisms as active targets to create more effective interventions for SUD treatment and prevention. Recent large-scale cohort studies from early childhood are generating multiple levels of neuroscience-based information with the potential to inform the development and refinement of future preventive strategies. However, there are still no available well-recognized frameworks to guide the integration of these multi-level datasets into prevention interventions. The Research Domain Criteria (RDoC) provides a neuroscience-based multi-system framework that is well suited to facilitate translation of neurobiological mechanisms into behavioral domains amenable to preventative interventions. We propose a novel RDoC-based framework for prevention science and adapted the framework for the existing preventive interventions. From a systematic review of randomized controlled trials using a person-centered drug/alcohol preventive approach for adolescents, we identified 22 unique preventive interventions. By teasing apart these 22 interventions into the RDoC domains, we proposed distinct neurocognitive trajectories which have been recognized as precursors or risk factors for SUDs, to be targeted, engaged and modified for effective addiction prevention.

Keywords: Adolescence; Interventions; Neuroscience; Prevention; Research Domain Criteria; Substance use disorders.

Figure 1 –. RDoC based Addiction-related neurofunctional domains

a) The original RDoC framework includes five domains of Negative Valence System, Positive Valence System, Cognitive System, Social Processes, and Arousal and Regulatory Systems. b) The Alcohol and Addiction RDoC (AARDoC) model and the Addictions Neuroclinical Assessments (ANA) battery to assess the three-domain model, where neurofunctional abnormalities in SUDs are indexed by the three domains of Negative Emotionality, Incentive Salience, and Executive Function. c) The NIDA Phenotyping Assessment Battery (PhAB) that is designed to be administered as a set of tools to characterize “core” addiction-relevant domains in a harmonized way, for instance, across NIDA clinical trials. Interoception, Metacognition, and Sleep/circadian rhythm domains have been added to the three-domain model using a Delphi method. d) The updated NIDA Phenotyping battery comprises three transdiagnostic research domains with relevance for addiction: Appetitive motivational states (including the RDoC domain of incentive salience), Aversive motivational states (including the RDoC domain of negative emotionality), and the RDoC domain of Cognitive Executive function while includes precognition and social cognition domains.

Figure 2:

The five major RDoC domains could act as, (a) risk factors, or (b) protective factors for substance use disorders during adolescence.

Figure 3.. Integration of addiction preventive interventions in multiple domains and levels of analysis in RDoC.

While the majority of currently available interventions for addiction prevention are targeting (1) physiology, cognitive and behavioral processes and (2) environment, the RDoC framework provides an opportunity to connect these interventions to other units of analysis like neural circuits or molecular pathways and integrate/combine them with interventions in other levels of analysis. Considering a temporal dimension to the RDoC matrix can provide a developmental perspective to this matrix which is important, especially in preventive interventions for children and adolescents.

Figure 4:

PRISMA summary of identified studies/ interventions included in the review