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Promoting Precision Addiction Management (PAM) to Combat the Global Opioid Crisis

Volume 2 - Issue 2

Kenneth Blum*^1-9, Edward J Modestino¹, Jennifer Neary⁵, Marjorie C Gondré-Lewis^8,11,12, David Siwicki⁵, Mark Moran⁵, Mary Hauser⁴, Eric R Braverman⁵, David Baron³, Bruce Steinberg¹⁰, Thomas Mc Laughlin¹³ and Rajendra D Badgaiyan¹⁴

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- ¹Department of Psychiatry, Wright State University, USA
- ²Department of Psychiatry, University of Florida College of Medicine, USA
- ³Department of Psychiatry and Behavioral Sciences, Keck Medicine University of Southern California, USA
- ⁴Division of Applied Clinical Research & Education, Dominion Diagnostics, USA
- ⁵Department of Precision Medicine, Geneus Health LLC, USA
- ⁶Department of Clinical Neurology, Path Foundation, USA
- ⁷Institute of Psychology, Eötvös Loránd University, USA
- ⁸National Human Genome Center at Howard University, USA
- ⁹Department of Psychiatry, University of Vermont, USA
- ¹⁰Department of Psychology, Curry College, USA
- ¹¹Department of Anatomy, Howard University College of Medicine, USA
- ¹²Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, USA
- ¹³Center for Psychiatric Medicine, USA
- ¹⁴Department of Psychiatry, Icahn School of Medicine, USA
*Corresponding author: Kenneth Blum, Department of Psychiatry, Boonshoft School of Medicine, Dayton VA Medical Center, Wright State University, Dayton, OH, USA

Received: January 24, 2018; Published: February 07, 2018

DOI: 10.26717/BJSTR.2018.02.000738

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Abstract

It is universally agreed that dopamine is a major neurotransmitter in terms of reward dependence, however, there remains controversy regarding how to modulate its role clinically to treat and prevent relapse for both substance and non-substance-related addictive behaviors. It is also agreed by most that there is a need to provide early genetic identification possibly through a novel researched technology referred to Genetic Addiction Risk Score(GARS).™ The existing FDA-approved medications promote blocking dopamine, however, we argue that a more prudent paradigm shift should be biphasic-short-term blockade and long-term upregulation, enhancing functional connectivity of brain reward. It is critical to understand that the real phenotype is not any specific drug or non –drug addictive behavior, but instead is Reward Deficiency Syndrome (RDS). Thus the true phenotype of all addictive behaviors is indeed RDS. Finally, we are suggesting that one way to combat the current out of control Opioid /Alcohol crisis worldwide is to seriously reconsider treating RDS by simply supplying powerful narcotic agents (e.g. Buprenorphine). This type of treatment will only keep people addicted. A more reasonable solution involving genetic testing, urine drug screens using Comprehensive Analysis of Reported Drugs (CARD) and dopamine homeostasis we call “ Precision Addiction Management” ™ seems parsonomiuos.

Keywords: Genetic addiction risk score; Hypodopaminergic; Pro-dopamine regulation; Reward deficiency syndrome

Abbreviations: GARS: Genetic Addiction Risk Score; CARD: Comprehensive Analysis of Reported Drugs; ASI: Addiction Severity Index; BRC: Brain Reward Cascade; RDS: Reward Deficiency Syndrome; SUD: Substance Use Disorder; NAc: Nucleus Accumbens

Abstract| Introduction| Acknowledgement| References|