IMR Press / FBL / Volume 22 / Issue 8 / DOI: 10.2741/4544

Frontiers in Bioscience-Landmark (FBL) is published by IMR Press from Volume 26 Issue 5 (2021). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with Frontiers in Bioscience.

Open Access Review

Neurogenetics of acute and chronic opiate/opioid abstinence: treating symptoms and the cause

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1 Departments of Psychiatry and Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA
2 Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA
3 Human Integrated Services Unit, University of Vermont Centre for Clinical and Translational Science, College of Medicine, Burlington, VT USA
4 Division of Addiction Services, Dominion Diagnostics, LLC., North Kingstown, RI, USA
5 Department of Psychiatry, Wright State University, Boonshoft School ofrMedicne, Dayton, OH, USA
6 Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
7 Department of Psychiatry and Health Behavior, Georgia Regents University Augusta, GA, USA
8 Department of Clinical Neurology, PATH Foundation NY, New York, NY, USA
9 Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
10 Division of Neuroscience Research & Addiction Therapy, The Shores Treatment & Recovery Center, Port Saint Lucie, FL, USA

Academic Editors: Kenneth Blum, Mark Gold

Front. Biosci. (Landmark Ed) 2017, 22(8), 1247–1288; https://doi.org/10.2741/4544
Published: 1 March 2017
Abstract

This review begins with a comprehensive history of opioid dependence and treatment in the United States. The focus is an evidence-based treatment model for opioid/opiate dependent individuals. The role of reward genetic polymorphisms and the epigenetic modifications that lead to vulnerability to use and misuse of opiates/opioid to treat pain are reviewed. The neurochemical mechanisms of acute opiate withdrawal and opiate/opioid reward mechanisms are explored with a goal of identifying specific treatment targets. Alterations in functional brain connectivity based on neurobiological mechanisms in heroin dependence and abstinence are also reviewed. A new clinical model an alternative to merely blocking acute withdrawal symptoms as identified in the DSM –5 is proposed. Genetic diagnosis at the onset of detoxification, to determine risk stratification, and identify polymorphic gene targets for pharmaceutical and nutraceutical interventions, followed by the simultaneous initiation of Medication Assisted Therapy (MAT), to enable psychological extinction, and steady pro-dopaminergic therapy with the goal of developing “dopamine homeostasis” is recommended. The objective of these interventions is to prevent future relapse by treating all “Reward Deficiency Syndrome” (RDS) behaviors and eventually make an addiction-free life possible.

Keywords
Review
Acute Opiate
Opioid Abstinence
Withdrawal
Anti-Opiate Dopamine Restoration Model
AODR
Functional Connectivity
Dopamine Homeostasis
Endorphinergic
Glutaminergic and Dopaminergic Reward Mechanisms
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