TITLE:
Understanding the Importance of Dopaminergic Deficit in Reward Deficiency Syndrome (RDS): Redeeming Joy Overcoming “Darkness” in Recovery
AUTHORS:
Kenneth Blum, Mary Hauser, Gozde Agan, John Giordano, James Fratantonio, Rajendra D. Badgaiyan, Marcelo Febo
KEYWORDS:
Reward Deficiency Syndrome, Dopamine, Genetic Addiction Risk Score, Comprehensive Analysis of Reported Drugs (CARD), Dopamine Agonist Modalities (DAM)
JOURNAL NAME:
Psychology,
Vol.6 No.4,
March
16,
2015
ABSTRACT: Dopamine’s role is central to motivation, pleasure states and anti-stress
behavioral traits. Throughout five decades of observations of prevention,
diagnosis, and tertiary treatment, many positive changes have been instrumental
in the enhancement of lives of millions. However, we have not yet developed any
workable “Standard of Care” for the chronic disorder known as “Reward
Deficiency Syndrome (RDS)” first coined by Blum’s laboratory in 1996. In the
1980s, the addiction field turned toward adoption of the well-known 12-step
program to assist in the treatment for many addictions. The biological
psychiatry field together with the pharmaceutical industry developed an array
of “Medication Assisted Treatment (MAT)”
compounds approved for alcohol and opioids but not psychostimulants.
Furthermore, the FDA approved drugs favoring the blocking of dopamine instead
of its important activation based on deficit especially in terms of blunted
reward response at the pre-frontal cortices and meso limbic brain regions. A major problem is that powerful
dopamine D2 agonists chronically induce down-regulation of dopaminergic
function leaving a gap between dopamine agonistic therapy (up-regulation over a
long period of time) and promotion of dopamine homeostatic mechanisms. This
editorial will focus on the incorporation of appropriate diagnosis of genetic
risk utilizing a novel panel of genes (SNPs), advanced urine drug testing “Comprehensive
Analysis of Reported Drugs (CARD)” and enhancement of functional connectivity
with a complex putative dopaminergic D2 agonist KB220Z. Until we can
incorporate these and other holistic approaches, the relapse rate will continue
to be unacceptable. It is important to re-evaluate our current treatment
tactics including dopaminergic activation in the longterm as part of the
after-care program in the 14,500 treatments center in the United States alone.
In doing so, we may be able to overcome this horrific societal dilemma redeeming
“dopamine Joy” in recovery bringing light to the reward system instead of
darkness.