Introduction: Since the time of Jellinek and his “disease concept of alcoholism” the addiction scientific literature has exploded and we are beginning to not only understand the neurobiological and genetic basis of all addictive behaviors but plausible treatments. Through the advent of neuroimaging techniques we are getting closer to linking neurochemical and neurogenetic mechanisms to reward circuitry brain function. Through candidate and GWAS approaches many gene polymorphisms and clusters have been implicated in drug, food and behavioral dependence linked to a common rubric termed Reward Deficiency Syndrome (RDS). Recognizing the clinical benefit of early genetic testing for determination of addiction risk stratification and coupling dopaminergic agonistic rather than antagonistic therapies potentially genomic based is the wave of the future. The results of studies including gene therapy in animal models, epigenetics and even the role of non-coding micro RNAs reviewed in this presentation provides a frame work for potential genomic based therapies, but none to date has given rise to human trials. Certainly further development especially in gene transfer work and viral vector identification could make gene therapy for RDS a possibility in the future.

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