title: A SMART data analysis method for constructing adaptive treatment strategies for substance use disorders.
abstract: OBJECTIVE
  To demonstrate how Q-learning, a novel data analysis method, can be used with data from a sequential, multiple assignment, randomized trial (SMART) to construct empirically an adaptive treatment strategy (ATS) that is more tailored than the ATSs already embedded in a SMART.
  
  
  METHODS
  We use Q-learning with data from the Extending Treatment Effectiveness of Naltrexone (ExTENd) SMART (N = 250) to construct empirically an ATS employing naltrexone, behavioral intervention, and telephone disease management to reduce alcohol consumption over 24 weeks in alcohol dependent individuals.
  
  
  RESULTS
  Q-learning helped to identify a subset of individuals who, despite showing early signs of response to naltrexone, require additional treatment to maintain progress.
  
  
  CONCLUSIONS
  Q-learning can inform the development of more cost-effective, adaptive treatment strategies for treating substance use disorders.
authors.affiliation: Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Inbal
authors.initials: I
authors.lastname: Nahum-Shani
authors.affiliation: Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Ertefaie
authors.affiliation: Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Xi Lucy
authors.initials: XL
authors.lastname: Lu
authors.affiliation: Treatment Research Center and Center for Studies of Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Lynch
authors.affiliation: Center on the Continuum of Care in the Addictions, Department of Psychiatry and Philadelphia Veterans Administration Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: McKay
authors.affiliation: VISN 4 MIRECC, Cpl Michael J Crescenz VA Medical Center and the Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Oslin
authors.affiliation: Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Almirall
mesh_terms: D000075522:Adaptive Clinical Trials as Topic; D000437:Alcoholism / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D003627:Data Interpretation, Statistical; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D013689:Telephone; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone
keywords: Adaptive interventions; Q-learning; Sequential Multiple Assignment Randomized Trial (SMART); adaptive treatment strategies; alcohol dependence; stepped-care