40 ára afmælisráðstefna SÁÁ: What We Know & Don’t Know About Technology for Assessment, Pharmacotherapy and Contingency Management?
David R. Gastfriend, MD, DFASAM, Chief Architect, CONTINUUM – The ASAM Criteria Decision Engine™; Chief Medical Officer & Co-Founder, DynamiCare Health, Inc.; Scientific Advisor, Treatment Research Institute
Technology can enhance healthcare access and quality. Academic-entrepreneurial partnerships have generated innovations in: 1) triage and comprehensive assessment/placement, 2) medication in addiction treatment (MAT), and 3) contingency management (CM) and behavioral monitoring. Data indicate improved outcome efficacy with each of these. Despite many obstacles, including inertia, stigma and limited funding, systems are finding effective paths to large-scale adoption. Currently available examples include ASAM’s CONTINUUM assessment implementation of the ASAM Criteria for placement and payment reform, extended-release naltrexone for the treatment of alcohol and opioid use disorder, and the DynamiCare smartphone application for incentivizing rewards and monitoring behavior. Tools such as these are now being integrated into a unified approach, such as in PATH – Personalized Addiction Treatment-to-Health, a new $13 million study in U.S. primary care systems. Each of these innovations, however, creates new questions that need answers. How can we use standardized assessment data to individualize continuity of care for the patient and improve systems? Who is the right patient for the different pharmacotherapies, and when is the right time to start, switch and stop? What are the optimal parameters for contingency management rewards, such as the amount of incentives and duration of treatment? Finally, in a future in which technology serves addiction medicine to the extent it does elsewhere in modern medicine, how will treatment and recovery change?
Dr. Gastfriend is the lead researcher on the American Society of Addiction Medicine’s (ASAM) Criteria for patient treatment matching, and Chief Architect of its standard software implementation for patient assessment and managed care utilization review, CONTINUUM – The ASAM Criteria Decision Engine™.
An addiction psychiatrist, he completed his training at Massachusetts General Hospital (MGH). At Harvard Medical School and MGH over a 25-year span, he was Director of the MGH Addiction Research Program and founded the MGH/McLean Hospital Addiction Psychiatry Fellowship. His pharmacologic and behavioral research activities included serving as an investigator in the National Institute on Drug Abuse (NIDA) Cocaine Collaborative Study, and as investigator and committee chair in the National Institute on Alcohol Abuse and Alcoholism (NIAAA) COMBINE Study and the NIDA Clinical Trials Network.
His research operationalized and validated ASAM’s Criteria, and contributed to their endorsement by most U.S. states, the Veterans Administration and the Department of Defense. This research was funded by the NIDA and NIAAA, and CONTINUUM was developed with the support of the U.S. Substance Abuse and Mental Health Services Administration for nationwide release in 2015.
From 2004 – 2013, Dr. Gastfriend was Vice President for Scientific Communications at the pharmaceutical company Alkermes, Inc., where he supported gaining FDA approval of extended-release naltrexone (VIVITROL®) for the treatment of alcohol and opioid dependence, and directed scientific publications and presentations on clinical, justice systems, and health economic research in addiction.
In 2014 he served as CEO of the Treatment Research Institute (TRI), the international research and policy center based in Philadelphia, PA. He continues as Scientific Advisor at TRI, providing guidance to researchers on clinical trials and policy projects.
In 2016, he co-founded with his son, Eric Gastfriend MBA, DynamiCare Health, Inc., a technology start-up to provide a nationally scalable, turnkey, extramural platform to achieve adoption of Contingency Management into routine clinical care.
NIDA granted him a Mid-Career Investigator Award for Patient-Oriented Research in 2000. In 2007, he received the “Champion in Health Care – Innovator Award” from the Boston Business Journal for his research on Vivitrol. Among his 150 scientific publications are the books The ASAM Criteria and Addiction Treatment Matching. He is a Distinguished Fellow of the American Society of Addiction Medicine (DFASAM) and the 2012 recipient of ASAM’s McGovern Award and Lecture for contributions to addiction treatment and society. In 2017, he received a $13 million award from the U.S. Patient-Centered Outcomes Research Institute to design and study a new integrated treatment model for the opioid epidemic for primary care systems. He has advised the governments of Belgium, China, Iceland, Israel, Norway, Russia and the U.S. on advances in alcohol and drug addiction treatment.