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Risk and resistance perspectives in translation-oriented etiology research

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Translational Behavioral Medicine

Abstract

Risk for a disorder and the mechanisms that determine its elevation, risk factors, are the focus of medical research. Targeting risk factors should serve the goal of prevention and treatment intervention. Risk, however, is but one of the aspects of liability to a disorder, a latent trait that encompasses effects of all factors leading to or from the diagnostic threshold. The coequal but opposite aspect of liability is resistance to a disorder. The factors that increase resistance and thus enable prevention or recovery may differ from those that elevate risk. Accordingly, there are nontrivial differences between research perspectives that focus on risk and on resistance. This article shows how this distinction translates into goals and methods of research and practice, from the choice of potential mechanisms tested to the results sought in intervention. The resistance concept also differs from those of “resilience” and “protective factors,” subsuming but not limited to them. The implications of the concept are discussed using substance use disorder as an example and substantiate the need for biomedical research and its translation to shift to the resistance perspective.

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Notes

  1. vaccination against some infections is a discussion point further in the paper

  2. It should be noted that “resistance” herein denotes a construct that is entirely different from the same name construct in the recent article by Kendler and Myers [15], which is based on scaling “lifetime maximal use of the relevant substance.”

  3. This also implies a possibility of reversal of the positive trend—if smoking’s “coolness” is reestablished. Growth in hookah-smoking [40] illustrates this point. The reinstatement of the “cool” status is also possible via a role model’s using tobacco. Legalization of cannabis, the euphoriant effects of which, rather than other factors as for tobacco (symbolism of adulthood, masculinity, etc.) determine its appeal, may also diminish the repellent effects of the act of smoking that have been somewhat established for tobacco, especially when both substances are mixed in a cigarette. That could finally render cannabis a “gateway”—for reintroduction of smoking as a mainstream behavior.

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Authors and Affiliations

  1. University of Pittsburgh, 3520 Forbes Ave., Suite 203, Pittsburgh, PA, 15213, USA

    Michael M. Vanyukov Ph.D., Ralph E. Tarter Ph.D., Galina P. Kirillova Ph.D. & Dennis C. Daley Ph.D.

  2. National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA

    Kevin P. Conway Ph.D. & Redonna K. Chandler Ph.D.

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  1. Michael M. Vanyukov Ph.D.
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  2. Ralph E. Tarter Ph.D.
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  3. Kevin P. Conway Ph.D.
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  6. Dennis C. Daley Ph.D.
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Correspondence to Michael M. Vanyukov Ph.D..

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Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Michael Vanyukov, Ralph Tarter, Kevin Conway, Galina Kirillova, Redonna Chandler, and Dennis Daley declare that they have no conflict of interest. All procedures were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national).

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The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of NIDA or any of the sponsoring organizations, agencies, or the US government.

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Implications

Practice: The approach described in this paper can be used to strengthen or ensure the studies’ ability to discover factors leading to prevention of and recovery from a disorder.

Policy: Funders who wish to improve the likelihood of detecting factors causing recovery and preclude pathogenesis of a disorder may recommend adoption of the approach described in the paper.

Research: Specifically targeting mechanisms that increase resistance to a disorder, as opposed to risk factors, enabled by the approach described herein, may improve the likelihood of obtaining practically significant research results.

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Vanyukov, M.M., Tarter, R.E., Conway, K.P. et al. Risk and resistance perspectives in translation-oriented etiology research. Behav. Med. Pract. Policy Res. 6, 44–54 (2016). https://doi.org/10.1007/s13142-015-0355-7

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