title: Neurogenetics of acute and chronic opiate/opioid abstinence: treating symptoms and the cause.
abstract: This review begins with a comprehensive history of opioid dependence and treatment in the United States. The focus is an evidence-based treatment model for opioid/opiate dependent individuals. The role of reward genetic polymorphisms and the epigenetic modifications that lead to vulnerability to use and misuse of opiates/opioid to treat pain are reviewed. The neurochemical mechanisms of acute opiate withdrawal and opiate/opioid reward mechanisms are explored with a goal of identifying specific treatment targets. Alterations in functional brain connectivity based on neurobiological mechanisms in heroin dependence and abstinence are also reviewed. A new clinical model an alternative to merely blocking acute withdrawal symptoms as identified in the DSM -5 is proposed. Genetic diagnosis at the onset of detoxification, to determine risk stratification, and identify polymorphic gene targets for pharmaceutical and nutraceutical interventions, followed by the simultaneous initiation of Medication Assisted Therapy (MAT), to enable psychological extinction, and steady pro-dopaminergic therapy with the goal of developing "dopamine homeostasis" is recommended. The objective of these interventions is to prevent future relapse by treating all "Reward Deficiency Syndrome" (RDS) behaviors and eventually make an addiction-free life possible.
authors.affiliation: Departments of Psychiatry and Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA, drd2gene@gmail.com.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Blum
authors.affiliation: Department of Psychiatry, McKnight Brain Institute, University of Florida, College of Medicine, Gainesville, FL, USA,and Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Gold
authors.affiliation: Department of Psychiatry and Health Behavior, Georgia Regents University Augusta, GA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Jacobs
authors.affiliation: Department of Psychiatry and Health Behavior, Georgia Regents University Augusta, GA, USA.
authors.forename: William Vaughn
authors.initials: WV
authors.lastname: McCall
authors.affiliation: Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Febo
authors.affiliation: Departments of Psychiatry and Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Baron
authors.affiliation: Department of Clinical Neurology, PATH Foundation NY, New York, NY,USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Dushaj
authors.affiliation: Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Demetrovics
authors.affiliation: Department of Psychiatry, Wright State University, Boonshoft School ofrMedicne, Dayton, OH.
authors.forename: Rajendra D
authors.initials: RD
authors.lastname: Badgaiyan
mesh_terms: D000818:Animals; D002186:Cannabinoids / Q000378:metabolism; D004298:Dopamine / Q000502:physiology; D058999:Drug-Seeking Behavior / Q000502:physiology; D019317:Evidence-Based Medicine; D005971:Glutamates / Q000502:physiology; D006801:Humans; D008959:Models, Neurological; D018377:Neurotransmitter Agents / Q000502:physiology; D018847:Opioid Peptides / Q000502:physiology; D009293:Opioid-Related Disorders / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D012201:Reward; D012701:Serotonin / Q000502:physiology; D013375:Substance Withdrawal Syndrome / Q000235:genetics / Q000503:physiopathology / Q000628:therapy; D014481:United States; D005680:gamma-Aminobutyric Acid / Q000502:physiology
chemical_list: D002186:Cannabinoids; D005971:Glutamates; D018377:Neurotransmitter Agents; D018847:Opioid Peptides; D012701:Serotonin; D005680:gamma-Aminobutyric Acid; D004298:Dopamine