In Search of Reward Deficiency Syndrome (RDS)-Free Controls: The “Holy Grail” in Genetic Addiction Risk Testing

Background: The search for an accurate, gene-based test to identify heritable risk factors for Reward Deficiency Syndrome (RDS) was conducted based on hundreds of published studies about the role of dopamine in addictive behaviors, including risk for drug dependence and compulsive/impulsive behavior disorders. The term RDS was first coined by Blum’s group in 1995 to identify a group of behaviors with a common neurobiological mechanism associated with a polymorphic allelic propensity for hypodopaminergia. Objectives: To outline the process used to select risk alleles of reward genes for the Genetic Addiction Risk Score (GARS) test. Consequently, to address the limitations caused by inconsistent results that occur in many case-control behavioral association studies. These limitations are perhaps due to the failure of investigators to adequately screen controls for drug and alcohol use disorder, and any of the many RDS behaviors, including nicotine dependence, obesity, pathological gambling, and internet gaming addiction. Method: Review of the literature related to the function of risk alleles of reward genes associated with hypodopaminergia relevant case-control association studies for the selection of alleles to be measured by the Genetic Addiction Risk Score (GARS) test. Result: The prevalence of the DRD2 A1 allele in unscreened controls (33.3%), compared to “Super-Controls” [highly screened RDS controls (3.3%) in proband and family] is used to exemplify a possible solution. Conclusion: Unlike One Gene-One Disease (OGOD), RDS is polygenetic, and very complex. In addition, any RDS-related behaviors must be eliminated from the control group in order to obtain the best possible statistical analysis instead of comparing the phenotype with diseaseridden controls.

Reconceptualizing Addiction: Integrating the Sciences of Addiction & Reward Deficiency Syndrome, Part 1

Analytic review of research study results from psychology, addiction science, and interactive sciences like neurology, genetics, and epigenetics, implore psychology, psychiatry and addiction recovery treatment fields to enlarge their perspective, by considering underlying causal influence. The appropriate time to re-conceptualize addiction for the practitioner world is now! Treatment protocol must expand beyond mitigation of the symptoms and address genetic, epigenetic and neurological causal influence. The science of Reward Deficiency Syndrome (RDS), offers a new phenotype for addiction, providing a common rubric for all obsessive, compulsive, and addictive behavioral patterns, and contributes understanding of the psychiatric genetics and/or causal influence of dopaminergic dysfunction in other co-occurring mental disorders. In consideration and review of the body of scientific knowledge, to successfully bridge the gap between science and practice, an integration of the sciences of addiction, and Reward Deficiency Syndrome must be achieved [1].