Will community standards of care be influenced by patient preference?

How long have we been talking about getting the patient more involved in their care?

What happens if they do — and the definition of the community standard of care is now determined or influenced by their preference?

“No doctor, I don’t think I want to take the low cost, high efficacy treatment pathway. I’d like to take the experimental, individualized-medicine that is tailored and developed based on my DNA.”

Or, if you think that example is too extreme, how about this:

“Thank you for the prescription for this generic drug. I saw an ad on TV that says this new drug would be much better for me. So, I’d like to just have a script for that drug, please.”

To some degree, these conversations already happen. What could be different in the future, particularly if the American Society of Addiction Medicine has its way, is that patient preference about the course of treatment received could be used to help determine the community standard of care.

That is what is proposed in the new draft ASAM guidelines that are currently getting public comment.

Under the “Principles of Treatment for Behavioral Addictions” in the draft guidelines, the criteria that will be used to determine the appropriate patient care will include the following language:

Treatment plans are individualized based on patient needs and preferences and focused on the holistic success and wellbeing of the patient.

Treatment plans are tailored to the needs of the individual and jointly developed with the patient and other relevant support persons, as appropriate. Collaborative, patient-centered treatment planning can foster a therapeutic alliance and therefore improve treatment outcomes. The individualized plan should be based on a comprehensive biopsychosocial assessment of the patient and consideration of their individual risks and needs. For adolescent patients and transition aged youth, assessment should also include comprehensive evaluation of the family and other support systems and treatment plans should be family-driven and youth-guided.

Public comments on the draft guidelines are due November 20, 2026.

This might seem reasonable within the context of addictions. Patients who believe their treatment will fail are more likely to fail. Patients who believe their treatment is likely to be successful are more likely to be successful. The “placebo effect” explains this, as do studies on individual beliefs and one of the most influential books on patient-centered care of the last 50 years.

So, having the patient believe in the outcome of the treatment is an important piece of efficacy.

Now, ASAM wants that to influence and shape the care that is provided and paid for.

It’s an interesting notion to expand beyond addiction treatment. The “placebo effect” doesn’t just apply to addiction treatments. It’s much broader than that, as are the citations above of studies and literature.

Should the patient’s belief in a course of treatment, beyond addiction, start to impact what is paid for and what isn’t based on the assumption that said belief could improve the patient’s outcomes?

For a broken arm, belief may not matter. The body will tend to heal one way or another. A diabetic’s believing that it is eating a light salad does not make it’s pizza and beer less impactful to one’s blood sugar.

But, maybe belief can play a role in auto-immune diseases or in cancer treatments. Maybe the impact is at the margins at a population level, but could be significant at the individual level.

It’s not clear where this will lead, or whether these draft guidelines get fully adopted. But, this notion of calibrating the community standard of care to include the patient’s preferences is interesting and worth keeping an eye on to see if it spreads.