The Profound Heterogeneity of Substance Use Disorders: Implications for Treatment Development

A single treatment approach will never be sufficient to address the diversity of individuals with substance use disorders (SUDs). SUDs have historically defied definition through simple characterizations or models, and no single characterization has led to the development of broadly effective interventions. The range of dimensions of heterogeneity among individuals with SUDs, including severity of the disorder, type of substance, and issues that frequently co-occur, underscores the need for highly tailored approaches. Personalized medicine for individuals with SUDs will require two major developments. First, given the diversity of individuals with SUDs, multivariate phenotyping is needed to identify the particular features driving addictive processes in a given individual. Second, a wider range of interventions that directly target core mechanisms of addiction and the problems that co-occur with them is needed. As clinicians cannot be expected to master the full range of interventions that may target these core processes, developing interventions that can be delivered easily, flexibly, and systematically via technology will facilitate the ability to truly tailor them to this highly complex and challenging population. One such technology-delivered intervention, Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT), is used as an example to illustrate a vision for the future of highly tailored interventions for individuals with SUDs.