Precision Behavioral Management (PBM): A Novel Genetically Guided Therapy to Combat Reward Deficiency Syndrome (RDS) Relevant to the Opiate Crisis

The Cambridge Handbook of Substance and Behavioral Addictions

“…There are at least two competing theories regarding what underlies appetitive system vulnerability: reward deficiency (Blum et al, 2011, Appetitive Needs and Addiction 2012; see also Blum et al, 2020) versus reward over-reactivity (Berridge, 2017; see Warlow et al, 2020). First, it is possible that dopaminergic gene polymorphisms may be associated with subjective reports of dissatisfaction, anhedonia, or what has been coined as the "reward deficiency syndrome (RDS)" (Blum et al, 2011).…”

“…The DRD2 gene, which is associated with pleasure or novelty, has been referred to as the "reward gene" (Downs et al, 2009). This gene and the taq1 A1 allele have been associated with a variety of behavioral disorders such as addiction (Blum et al, 2011; see Blum et al, 2020;Vandenbergh et al, 2007). Extensive behavioral activation may be needed to fulfil appetitive desires in certain individuals; moderation may gradually fail to guide behavior.…”