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The need for genetic testing as a way of understanding or pinpointing therapeutic targets is certainly the wave of the future. It is well established that many polymorphisms since the earliest study from our laboratory on the DRD2 gene has morphed into a remarkable list of gene polymorphism associations in the field known today as Psychiatric Genetics. It is no longer acceptable simply to utilize Diagnostic and Statistical Manual (DSM) criteria as the only method of diagnosis of psychiatric disorders. We are hereby proposing that coupling known standard pencil and paper tests (e.g., Addiction Severity Index among others) along with DSM and Genetic Addiction Risk Score (GARS) should enhance our information on each patient presenting for example to an addiction clinic for treatment. In fact it will provide a stratification risk profile removing current quessing, as well as DNA targeted therapeutic opportunities. It is further proposed that since we are beginning to understand the power of Genome Wide Association Studies (GWAS); Whole- Exome Sequencing (WES) and Epigentic Wide Association Studies (EWAS) studies, and especially epigenetics on gene expression via mRNA transcription, knowing these hot spots will pave the way for either highly specific pharmaceuticals directed at select neuronal sites (reduce toxic side effects) or nutrigenomic solutions. In either case, we strongly recommend additional studies to provide the recovering addict with an epigenetic tool to activate DA D2 receptors while attenuating the anti-reward effects of DA D1 and possibly D3 receptors, respectively. Finally, we as neuroscientists should begin to perform studies that control for possible comorbid medical and psychiatric conditions in their research (dual diagnosis) this work supports earlier non-genetic concepts of addiction in psychiatric medicine.
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