Understanding the Importance of Dopaminergic Deficit in Reward Deficiency Syndrome (RDS): Redeeming Joy Overcoming “Darkness” in Recovery

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 " Re-ward Deficiency Syndrome (RDS) " first coined by Blum's laboratory in 1996. In the 1980s, the ad-diction 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 * Corresponding author. K. Blum et al. 436 and opioids but not psychostimulants. Furthermore, the FDA approved drugs favoring the block-ing 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 con-nectivity 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 impor-tant to re-evaluate our current treatment tactics including dopaminergic activation in the long-term 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.