Key Dates
March 13, 2023
None
The purpose of this Request for Information (RFI) is to invite input on the use of the term “preaddiction” for identifying and intervening in potentially clinically significant substance misuse and/or early-stage substance use disorder within healthcare settings.
Note: It is important to read this entire RFI notice to ensure how to submit adequate responses and to understand how the responses will be utilized.
Background:
Substance misuse and substance use disorders (SUD) continue to have a devastating impact on people in the United States, where fatal overdoses now exceed 100,000 annually and continue to increase. However, SUD and overdose are not the only adverse potential health outcomes of substance misuse: compromised physical and mental health, injuries, vehicle crashes, violence, infectious disease, lost productivity, and other negative effects are also risks. Despite the severity of the problem, fewer than 20% of people with SUD (including drug and alcohol use disorders) receive treatment. Given the urgency of the crisis, early intervention is increasingly crucial. Interventions should target preventing the escalation of substance misuse to SUD and of mild SUD into moderate or severe manifestations (colloquially, “addiction”).
Recently, the term “preaddiction” has been proposed as a way to: raise public awareness about potentially harmful patterns of substance use; spur greater utilization of screening and brief intervention in clinical settings; prevent overdose; and promote the development of new interventions for potentially clinically significant substance misuse and/or early-stage SUD. Although not always clinically well-defined, “addiction” to drugs or alcohol is well-understood by the public as a serious yet preventable condition. In this context, addiction is like other serious health conditions for which behavioral factors are understood to play a role and for which early screening or intervention may prevent adverse health outcomes. Since substance misuse is easier to modify through voluntary behavioral change or brief interventions before it progresses to addiction, this window is a promising target for early intervention if both patients and clinicians can be made aware of the potential health and safety implications of substance misuse. Conversely, applying a term like preaddiction to clinically significant substance misuse and/or early-stage SUD could have unintended negative consequences, such as further stigmatizing people who use substances. Thus, information is needed to ascertain the benefits and potential drawbacks of adopting a term like preaddiction when used for screening in healthcare settings.
Information Requested:
This RFI seeks input from people with lived experience of substance use, medical and scientific research communities, and other interested parties regarding the use of a term like preaddiction for identifying and intervening in potentially clinically significant substance misuse and/or early-stage SUD within healthcare settings. Input is sought both on the terminology to describe this concept and the concept itself. For simplicity, the concept is referred to as “preaddiction,” though input on the use of that specific term and its potential resonance with diverse patient populations is sought.
The NIH seeks comments on any of the following topics:
- How and whether to define preaddiction (or a similar term) across different classes of substances and across different age groups
- The potential impact, both positive and negative, of a concept like preaddiction on different populations and on treatment seeking and use of harm-reduction services
- The potential impact of the use of a term like preaddiction in clinical practice (e.g., screening, brief intervention, referral, and treatment)
- Other terminology that may resonate with patients to describe potentially clinically significant substance misuse and/or early-stage substance use disorder and motivate interventions
- Whether a term like preaddiction should be applied to mild SUD per the DSM-5 and/or to moderate SUD per the DSM-5
- Whether a term like preaddiction should be applied to any problematic substance use prior to meeting criteria for SUD per the DSM-5, such as substance use by adolescents, driving under the influence of drugs, or other potentially risky behaviors
- Optimal interventions and outcomes for people with preaddiction
- Barriers to the adoption of the concept of preaddiction in health care, research, the advocacy community, and general public
NIH is also seeking input on research that could be conducted to evaluate the utility of a term like preaddiction and, if appropriate, facilitate its adoption in healthcare settings, including research on:
- Development and validation of criteria for preaddiction
- The natural history of people who meet those criteria
- The proportion of people with preaddiction who self-correct versus escalate to more severe SUD
- The impact of social determinants of health on trajectories for people with pre-addiction
- The impact of co-occurring mental health conditions on trajectories for people with pre-addiction
- Appropriate screening tools to identify preaddiction and frequency of screening
- The development and testing of interventions for people meeting preaddiction criteria, including:
- Interventions to prevent substance use escalation
- Interventions to prevent overdose
- Guidelines for providers on how to intervene with patients who meet criteria for preaddiction (primary care physicians, emergency physicians, dentists, etc.)
- The impact of a term like preaddiction on the utilization of prevention services
- The impact of a term like preaddiction on substance use outcomes, including:
- Treatment seeking
- Referral to treatment
- SUD progression
- Overdose
- Use of harm-reduction services
- Ways to effectively integrate preaddiction screening and intervention into routine medical care, e.g., as part of annual primary care visits or during visits for medical concerns not specifically related to substance use
- Evidence needed to support insurance reimbursement of preaddiction screening and interventions
How to Submit a Response:
Responses to this RFI must be submitted electronically via: [email protected]
Responses must be received by: April 27, 2023
Responses to this RFI are voluntary. Do not include any proprietary, classified, confidential, trade secret, or sensitive information in your response. The responses will be reviewed by NIH staff, and individual feedback will not be provided to any responder. The Government will use the information submitted in response to this RFI at its discretion. The Government reserves the right to use any submitted information on public NIH websites, in reports, in summaries of the state of the science, in any possible resultant solicitation(s), grant(s), or cooperative agreement(s), or in the development of future funding opportunity announcements.
This RFI is for information and planning purposes only and shall not be construed as a solicitation, grant, or cooperative agreement, or as an obligation on the part of the Federal Government, the NIH, or individual NIH Institutes and Centers to provide support for any ideas identified in response to it. The Government will not pay for the preparation of any information submitted or for the Government’s use of such information. No basis for claims against the U.S. Government shall arise because of a response to this request for information or from the Government’s use of such information. NIH looks forward to your input and we hope that you will share this RFI document with your colleagues.
and Human Services (HHS)
