Characteristics and problems of 600 adolescent cannabis abusers in outpatient treatment. Effectiveness of multidimensional family therapy with higher severity substance-abusing adolescents: report from two randomized controlled trials. Substance use in young adults with schizophrenic disorders. A preliminary study of the neural effects of behavioral therapy for substance use disorders. Characteristics of subgroups of individuals with psychotic illness and a comorbid substance use disorder. A randomized controlled trial of family intervention for co-occurring substance use and severe psychiatric disorders. Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. A randomized controlled pilot study of motivational interviewing for patients with psychotic and drug use disorders. Predictors of drug treatment response in obsessive-compulsive disorder. Matching adolescents with a cannabis use disorder to multidimensional family therapy or cognitive behavioral therapy: treatment effect moderators in a randomized controlled trial. Occurrence of comorbid substance use disorders among acute psychiatric inpatients at Stikland Hospital in the Western Cape, South Africa. Shared Decision-Making Reduces Drug Use and Psychiatric Severity in Substance-Dependent Patients Association of dopamine and opioid receptor genetic polymorphisms with response to methadone maintenance treatment A randomized clinical trial of a new behavioral treatment for drug abuse in people with severe and persistent mental illness. A randomized trial of a telecommunications network for pregnant women who use cocaine. Impact of psychiatric comorbidity on treatment of adolescent drug abusers. Psychopathological correlates of reduced dopamine receptor sensitivity in depression, schizophrenia, and opiate and alcohol dependence.
AIMS Risk factors among adolescent substance abusers have been shown to correlate with substance use severity . Characteristics related to severity , such as demographic and family factors , peer influences , psychiatric co-morbidity and HIV risk behaviors , are examined for a sample of adolescent cannabis users entering treatment . DESIGN These data are from a clinical trial study utilizing blocked r and om assignment of clients to one of five treatment conditions . The study targeted adolescents entering outpatient treatment for primarily cannabis abuse or dependence . SETTING Treatment and research facilities in four metropolitan areas of the US were used to recruit study participants . Treatment was delivered in outpatient drug-free setting s. PARTICIPANTS Participants were 600 clients , ages 12 - 18 , admitted to outpatient substance abuse treatment programs for cannabis problems , 96 % with DSM-IV diagnoses of substance abuse or dependence , with the remaining 4 % having at least one symptom of dependence plus significant problems indicating need for treatment . MEASUREMENTS The Global Appraisal of Individual Needs ( GAIN ) was used to collect the information presented in this paper . The GAIN incorporates DSM-IV criteria for substance use disorders , conduct disorder and attention deficit hyperactivity disorder , as well as dimensional ( scale ) measures for physical and mental health . FINDINGS All participants reported at least one symptom of substance use disorders , and 46 % met the DSM-IV criteria for substance dependence , while 50 % met criteria for a diagnosis of abuse . Only 20 % of the participants perceived any need for help with problems associated with their drug or alcohol use . Clients participating in the study typically presented multiple problems at treatment entry , most often including conduct disorder , attention deficit hyperactivity disorder ( ADHD ) , internal ( mental ) distress , and physical health distress . The co-occurrence of conduct disorder and ADHD was found in 30 % of the sample . Clients meeting criteria for substance dependence tended to have more co-occurring problems and significantly less denial at admission . CONCLUSIONS The characteristics of this sample exemplify the complex nature of adolescent substance use and abuse among adolescents entering outpatient treatment programs . Patterns of co-occurring problems are at rates comparable to those found in other clinical studies . Those with more severe substance use disorders tend to manifest more problems of social functioning , more mental health problems , and physical health problems . Implication s of these findings are discussed in terms of treatment needs , challenges , and prognostic implication OBJECTIVE We used growth mixture modeling to examine heterogeneity in treatment response in a secondary analysis of 2 r and omized controlled trials testing multidimensional family therapy ( MDFT ) , an established evidence -based therapy for adolescent drug abuse and delinquency . METHOD The first study compared 2 evidence -based adolescent substance abuse treatments : individually focused cognitive-behavioral therapy and MDFT in a sample of 224 urban , low-income , ethnic minority youths ( average age = 15 years , 81 % male , 72 % African American ) . The second compared a cross-systems version of MDFT ( MDFT-detention to community ) with enhanced services as usual for 154 youths , also primarily urban and ethnic minority ( average age = 15 years , 83 % male , 61 % African American , 22 % Latino ) , who were incarcerated in detention facilities . RESULTS In both studies , the analyses supported the distinctiveness of 2 classes of substance use severity , characterized primarily by adolescents with higher and lower initial severity ; the higher severity class also had greater psychiatric comorbidity . In each study , the 2 treatments showed similar effects in the classes with lower severity/frequency of substance use and fewer comorbid diagnoses . Further , in both studies ,  MDFT  was more effective for the classes with greater overall substance use severity and frequency and more comorbid diagnoses . CONCLUSIONS Results indicate that for youths with more severe drug use and greater psychiatric comorbidity , MDFT produced superior treatment outcomes Use of nonprescribed mood altering substances is pervasive and problematic in young adults with serious mental illnesses in community care . Fifty-eight percent of young adult clients with clearly defined schizophrenia or schizophrenia-related disorders participating in a long-term community treatment study were rated by staff or themselves as using alcohol , cannabis , or other street drugs several times a week or more . We interviewed in depth a r and om sample of these " significant users " to obtain their perspective on their frequencies , patterns , histories , contributing factors to , and effects of substance use and their related treatment experiences . Results revealed these clients ' substance use to be of long duration and deeply entrenched , with current use often involving multiple substances including both street drugs and substances of " everyday life " ( e.g. , caffeine , nicotine ) . Clients reported compelling reasons for use including anxiety reduction , relief of boredom , and a means for social contact . Staff and clients clearly view substance use quite differently , with the latter focusing at least as much on consequences of symptom relief as symptom exacerbation . Treatment implication s are discussed BACKGROUND The mechanisms by which behavioral therapies for substance use disorders ( SUDs ) exert their effects and the components of treatment that contribute most to substance use outcome remain unclear . Disruptions to aspects of impulse control and attention have been hypothesized to contribute to the development and maintenance of addiction ; moreover , alterations in these processes may underlie responses to treatment . METHODS Individuals participating in a r and omized clinical trial evaluating computer-assisted cognitive behavioral therapy ( CBT ) for substance abuse participated in fMRI Stroop before and after treatment .  A non-substance-using comparison group performed the same task under test-retest conditions . RESULTS The patient group demonstrated decreased Stroop-related BOLD signal in regions including the anterior cingulate , inferior frontal gyrus and midbrain at post-treatment relative to pre-treatment , and displayed a greater decrease in the subthalamic nucleus and surrounding regions compared to healthy controls following test-retest . CONCLUSIONS Behavioral therapies may be associated with reduction in substance use and effects on neural systems involved in cognitive control , impulsivity , motivation and attention OBJECTIVES The co-occurrence of severe mental illness and substance use disorder , or dual diagnosis , is prevalent and is associated with significant clinical and social problems . Most studies have treated persons with a dual diagnosis as a homogeneous population , grouping together different substances of misuse . This study investigated whether subgroups defined by their main substances of misuse were heterogeneous . The primary hypothesis was that users of stimulants , such as cocaine or amphetamines  , would be characterized by especially high rates of inpatient admission , violence , and self-harm . METHODS Case managers ' ratings were used to identify individuals with serious mental illness and comorbid substance abuse or dependence who were being treated by 13 community mental health teams in South London . St and ardized instruments were used to elicit sociodemographic , clinical , social , and service use data . RESULTS A total of 233 cases of comorbid substance use disorder and psychotic illness were identified . On the basis of best available information , 78 ( 34 percent ) patients were classified as alcohol misusers only , 52 ( 22 percent ) as alcohol and cannabis users , 29 ( 12 percent ) as users of cannabis only , and 55 ( 24 percent ) as stimulant users ; 19 patients ( 8 percent ) were excluded from the analysis . No significant differences were found between subgroups in the use of inpatient services and lifetime history of self-harm , but there was a significant difference in lifetime history of violence , which was more frequent among stimulant users . The alcohol users were older and more likely to be white , but otherwise few differences between subgroups were suggested by exploratory analyses . CONCLUSIONS Apart from differences in history of violence , little heterogeneity was found among subgroups of patients with different types of substance misuse Substance use disorders have a profound impact on the course of severe mental illnesses and on the family , but little research has evaluated the impact of family intervention for this population . To address this question , a r and omized controlled trial was conducted comparing a brief ( 2 - 3 mo ) Family Education ( ED ) program with a longer-term ( 9 - 18 mo ) program that combined education with teaching communication and problem-solving skills , Family Intervention for Dual Disorders ( FIDD ) . A total of 108 clients ( 77 % schizophrenia-spectrum ) and a key relative were r and omized to either ED or FIDD and assessed at baseline and every 6 months for 3 years . Rates of retention of families in both programs were moderate . Intent-to-treat analyses indicated that clients in both programs improved in psychiatric , substance abuse , and functional outcomes , as did key relatives in knowledge of co-occurring disorders , burden , and mental health functioning . Clients in FIDD had significantly less severe overall psychiatric symptoms and psychotic symptoms and tended to improve more in functioning . Relatives in FIDD improved more in mental health functioning and knowledge of co-occurring disorders . There were no consistent differences between the programs in substance abuse severity or family burden . The findings support the utility of family intervention for co-occurring disorders , and the added benefits of communication and problem-solving training , but also suggest the need to modify these programs to retain more families in treatment in order to provide them with the information and skills they need to overcome the effects of these disorders AIMS The comorbidity of mental disorders and substance dependence is well documented , but prospect i ve investigations in community sample s are rare . This investigation examines the role of primary mental disorders as risk factors for the later onset of nicotine , alcohol and illicit drug use , abuse and dependence with abuse . DESIGN The National Comorbidity Survey ( NCS ) was a nationally representative survey of mental and substance disorders in the United States carried out in 1990 - 92 . The NCS-2 re-interviewed a probability sub sample of NCS respondents in 2001 - 03 , a decade after the baseline survey . PARTICIPANTS A total of 5001 NCS respondents were re-interviewed in the NCS-2 ( 87.6 % of baseline sample ) . RESULTS Aggregate analyses demonstrated significant prospect i ve risks posed by baseline mental disorders for the onset of nicotine , alcohol and illicit drug dependence with abuse over the follow-up period . Particularly strong and consistent associations were observed for behavioral disorders and previous substance use conditions , as well as for certain mood and anxiety disorders . Conditional analyses demonstrated that many observed associations were limited to specific categories of use , abuse or dependence , including several mental disorders that were non-significant predictors in the aggregate analyses . CONCLUSIONS Many mental disorders are associated with an increased risk of later substance use conditions , but important differences in these associations are observed across the categories of use , abuse and dependence with abuse . These prospect i ve findings have implication s for the precision of prevention and treatment strategies targeting substance use disorders AIMS This pilot study examined the efficacy of a two-session motivational interview adapted for dually diagnosed psychotic and drug-related disordered patients ( DDMI ) in comparison to a two-session st and ard psychiatric interview ( SI ) . DESIGN The study used a r and omized controlled trial design . Participants received either DDMI or SI and were assessed at baseline , 4- , 8- and 12-week follow-up points . The principal analysis for examination of treatment effects across time was a r and om effects regression model . SETTING Both DDMI and SI interviews served as pre-admission intake interventions to an ambulatory specialty dual diagnosis intensive out-patient and partial hospital program . PARTICIPANTS Forty-four treatment-seeking participants ( DDMI = 24 ; SI = 20 ) who had co-occurring psychotic and drug-related disorders were assigned r and omly to the treatment conditions . Measurements Primary outcomes were days of primary drug use , secondary drug use , alcohol use and psychotropic medication adherence , proportion of participants admitted into the program and days of attendance . FINDINGS AND CONCLUSIONS DDMI and SI result ed in improved treatment outcomes , but there were no main effects for the sample as a whole . Separate examination of primary cocaine and primary marijuana using sub sample s , however , suggested that DDMI result ed in significantly better primary drug treatment outcomes for the cocaine-using group , whereas SI result ed in significantly better primary drug treatment outcomes for the marijuana-using group . These findings indicate that MI may not work equally well for all types of psychotic disordered dually diagnosed patients and that alternative approaches may be as effective in fostering improved substance use treatment outcomes for subgroups of these individuals BACKGROUND Although a large body of evidence indicates the efficacy of pharmacotherapy in the treatment of obsessive-compulsive disorder ( OCD ) , a considerable percentage of these patients do not respond . Very few studies focus on factors related to treatment response of OCD . The purpose of this study was to investigate which clinical factors are related to drug treatment response in OCD . METHOD We examined 53 OCD patients treated with either clomipramine or fluoxetine for a period of 6 months , dividing the sample into " responders " and " nonresponders " to treatment . At admission , patients were evaluated using a semistructured clinical interview , the Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) , the Hamilton Rating Scale for Depression , and the Hamilton Rating Scale for Anxiety . We then compared acute-phase patient characteristics and response to drug treatment . Response was defined as a decrease of at least 40 % in the Y-BOCS total score and a rating of " improved " or " very improved " on the Clinical Global Impressions scale within 16 weeks of treatment and maintained over three consecutive evaluations . RESULTS By the sixth month of treatment , 31 patients ( 58.5 % ) responded to either clomipramine or fluoxetine . Nonresponders had lower age at onset and longer duration of the disorder ; in addition , they showed higher frequency of compulsions , washing rituals , chronic course , concomitant schizotypal personality disorder , and previous hospitalizations . A worse response to drug treatment was predicted in a stepwise multiple regression by ( 1 ) concomitant schizotypal personality disorder , ( 2 ) presence of compulsions , and ( 3 ) longer illness length . CONCLUSION Our findings suggest that there are distinct types of OCD with respect to drug treatment response . They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities , which may be of value in the selection of patients for alternative treatments BACKGROUND In a recent r and omized controlled trial ( Hendriks et al. , 2011 ) , multidimensional family therapy ( MDFT ) and cognitive behavioral therapy ( CBT ) were equally effective in reducing cannabis use in adolescents ( 13 - 18 years old ) with a cannabis use disorder ( n=109 ) . In a secondary analysis of the trial data , we investigated which pretreatment patient characteristics differentially predicted treatment effect in MDFT and CBT , in order to generate hypotheses for future patient-treatment matching . METHODS The predictive value of twenty patient characteristics , in the area of demographic background , substance use , substance-related problems , delinquency , treatment history , psychopathology , family functioning and school or work related problems , was investigated in bivariate and subsequent multivariate linear regression analyses , with baseline to month 12 reductions in cannabis use days and smoked joints as dependent variables . RESULTS Older adolescents ( 17 - 18 years old ) benefited considerably more from CBT , and younger adolescents considerably more from MDFT ( p<0.01 ) . Similarly , adolescents with a past year conduct or oppositional defiant disorder , and those with internalizing problems achieved considerably better results in  MDFT  , while those without these coexisting psychiatric problems benefited much more from CBT ( p<0.01 , and p=0.02 , respectively ) . CONCLUSIONS The current study strongly suggests that age , disruptive behavior disorders and internalizing problems are important treatment effect moderators of MDFT and CBT in adolescents with a cannabis use disorder . If replicated , this finding suggests directions for future patient-treatment matching in adolescent substance abuse treatment OBJECTIVE Little is known about the epidemiology of substance use disorders ( SUD ) among psychiatric in patients in the Western Cape , South Africa . Therefore , this study was conducted to examine the prevalence of SUD among acute adult psychiatric in patients at Stikl and Hospital , one of three state acute psychiatric hospitals in the Western Cape . METHOD A prospect i ve descriptive prevalence survey was undertaken over a three-month period . During this period , data was collected on psychiatric patients ( N=298 ) who were hospitalized in the acute psychiatric wards at Stikl and . This included patient demography , psychiatric and substance use history . Urine was also collected and analyzed for substances commonly abused in the Western Cape . RESULTS A co-morbid SUD ( abuse or dependence ) was diagnosed in 51 % of patients . In addition , a diagnosis of a substance-induced psychiatric disorder was made in 8 % of these patients , 1 % of who was diagnosed with a substance-induced mood disorder , while 7 % was diagnosed with a substance induced psychotic disorder . Patients diagnosed with a co-morbid SUD were younger than those without a SUD and more likely to have been involuntary admissions . These patients also displayed more violence prior to admission that contributed to their admission and were more likely to have used cannabis or methamphetamine as their preferred drug of abuse . Only a small group of patients had documented evidence of any prior interventions for their SUD . CONCLUSION SUD are prevalent among psychiatric in patients and contribute to their morbidity . This has implication s for staff training and service development Background : In the last decades , shared decision-making ( SDM ) models have been developed to increase patient involvement in treatment decisions . The purpose of this study was to evaluate a SDM intervention ( SDMI ) for patients dependent on psychoactive substances in addiction health care programs . The intervention consisted of a structured procedure to reach a treatment agreement and comprised 5 sessions . Methods : Clinicians in 3 treatment centres in the Netherl and s were r and omly assigned to the SDMI or a st and ard procedure to reach a treatment agreement . Results : A total of 220 substance-dependent patients receiving inpatient treatment were r and omised either to the intervention ( n = 111 ) or control ( n = 109 ) conditions . Reductions in primary substance use ( F(1 , 124 ) = 248.38 , p < 0.01 ) and addiction severity ( F(8 ) = 27.76 , p < 0.01 ) were found in the total population . Significant change was found in the total population regarding patients ’ quality of life measured at baseline , exit and follow-up ( F(2 , 146 ) = 5.66 , p < 0.01 ) . On the European Addiction Severity Index , SDMI  showed significantly better improvements than st and ard decision-making regarding drug use ( F(1 , 164 ) = 7.40 , p < 0.01 ) and psychiatric problems ( F(1 , 164 ) = 5.91 , p = 0.02 ) at 3-month follow-up . Conclusion : SDMI showed a significant add-on effect on top of a well-established 3-month inpatient intervention . SDMI offers an effective , structured , frequent and well-balanced intervention to carry out and evaluate a treatment agreement BACKGROUND Genetic variations of the dopamine and opioid receptors could influence the response to methadone maintenance treatment ( MMT ) . METHODS We included 238 MMT patients according to their response to treatment and methadone dosing , along with 217 subjects without substance dependence . All were genotyped for polymorphisms of the dopamine D1 , D2 , micro-opioid and delta-opioid receptor genes . RESULTS The polymorphisms of the micro-opioid ( 118A > G ) , delta-opioid ( 921T > C ) , dopamine D1 ( DdeI ) and D2 ( TaqI A ) receptor genes were not associated with response to MMT and methadone dosing , whereas an association was found with the dopamine D2 receptor ( DRD2 ) 957C > T polymorphism . The 957CC carriers were more frequently non-responders to treatment ( OR=2.4 ; p=0.02 ) and presented a fourfold shorter period of negative urine screening ( p=0.02 ) . No significant differences in allele frequencies were observed between the MMT patients and the control group , suggesting no association of the analyzed polymorphisms with opioid dependence . CONCLUSIONS These results suggest that DRD2 genotype may contribute to the underst and ing of the interindividual variability to the response to MMT CONTEXT Drug abuse by people with severe mental disorder is a significant public health problem for which there is no empirically vali date d treatment . OBJECTIVE To evaluate the efficacy of a new behavioral treatment for drug abuse in this population : Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness ( BTSAS ) . DESIGN Participants were r and omly assigned to 6 months of treatment in either BTSAS or a manualized control condition : Supportive Treatment for Addiction Recovery ( STAR ) . SETTING Treatment was conducted in community-based outpatient clinics and a Veterans Affairs medical center in Baltimore , Md. PARTICIPANTS Participants were 129 stabilized out patients meeting DSM criteria for drug dependence ( cocaine , heroin , or cannabis ) and serious mental illness : 39.5 % met DSM-IV criteria for schizophrenia or schizoaffective disorder ; 55.8 % , for major affective disorders ; and the remainder met criteria for severe and persistent mental illness and other Axis I disorders . INTERVENTIONS Both treatments were administered by trained health care professionals in small groups , twice a week for 6 months . The BTSAS program is a social learning intervention that includes motivational interviewing , a urinalysis contingency , and social skills training . The control condition , STAR , is a supportive group discussion treatment . Main Outcome Measure The primary outcome measure was urinalysis results from twice-weekly treatment sessions . RESULTS The BTSAS program was significantly more effective than STAR in percentage of clean urine test results , survival in treatment , and attendance at sessions . The BTSAS program also had significant effects on important community-functioning variables , including hospitalization ; money available for living expenses ; and quality of life . CONCLUSIONS The BTSAS program is an efficacious treatment . Further work needs to be done to increase the proportion of eligible patients who are able to become engaged in treatment OBJECTIVES The authors describe computer services design ed to make patients better informed and more motivated to participate in treatment . Patients use these services through their touch-tone telephone ; access to a home computer or a modem is not needed . METHODS The authors tested the impact of these computer services on the management of 179 pregnant women who had used cocaine during pregnancy or 1 month before pregnancy ( as reported by the woman ) . Patients were r and omly assigned to control and experimental groups ; only the experimental group had access to the computer services .  Patients were enrolled during the prenatal period and followed for 6 months after the birth of a live child . Self-reported data on the subjects ' participation in drug treatment programs , health status ( using the SF-36 ) , and addiction severity ( using the addiction severity index ) were collected . The computer collected data on the frequency of the use of the service . The dependent variables were participation in formal treatment during the course of the project , and drug and alcohol use at exit interview . Multiple and logistic regressions were used to identify the effects of the intervention after controlling for demographic and baseline variables . RESULTS Data showed that poor , pregnant , undereducated clients who use drugs and lived in multiple residences could use the services ; about one-third of clients used the services more than three times a week . Access to the service did not lead to significant change in patients ' health status , drug use , or utilization of services . Use of the services did lead to significant changes in participation in drug treatment : subjects who used the service more than three times a week were 1.5 times more likely to participate in formal drug treatment than subjects who used the service less often . Participation in formal drug treatment , however , was not effective in reducing the drug or the alcohol use . CONCLUSIONS Almost all patients used the  computer services  to some extent , but there seems to be a threshold after which the use of the services had a more positive impact Comorbidity of substance abuse disorders ( SUD ) and psychiatric disorders is one of the most important areas of investigation in contemporary drug abuse treatment research . This study examined the impact of psychiatric comorbidity on the treatment of 182 adolescent drug abusers in a r and omized clinical trial comparing family and individual cognitive-behavioral therapy .  Three distinct groups of adolescent substance abusers were compared : ( 1 ) Exclusive Substance Abusers ( SUD only ) ; ( 2 ) Externalizers ( SUD + externalizing disorder ) ; and ( 3 ) Mixed Substance Abusers ( SUD + externalizing and internalizing disorder ) . The purpose of this study was to determine whether adolescents in these comorbid groups differed in clinical presentation and treatment response . More severe comorbidity was associated with greater family dysfunction and being female and younger at intake . An examination of substance use trajectories over time indicated that the Mixed group initially responded to treatment but returned to intake levels of substance use by 1 year post-discharge A dysfunction of central dopaminergic neurotransmission has been found in various neuropsychiatric diseases , and may be associated with a common psychopathological correlate . One hypothesis suggests that dopaminergic stimulation of the brain reward system reinforces behavior because it is experienced as pleasurable , and that dopaminergic dysfunction leads to anhedonia , the inability to experience pleasure . An alternative hypothesis assumes that dopaminergic stimulation does not promote pleasure or " liking " of a reward but rather mediates " wanting " of a reward , and suggests that dopaminergic dysfunction is associated with a failure to be motivated by stimuli that indicate reward . We measured negative symptoms , psychomotor slowing and dopamine receptor sensitivity in twelve drug-free patients with major depression , seventeen alcohol-dependent and sixteen opiate-dependent patients , ten schizophrenics with neuroleptic medication , and ten healthy controls . The sensitivity of central dopamine receptors was assessed with the growth hormone response to apomorphine application . Psychomotor slowing was measured in a reaction-time test and anhedonia and other negative symptoms were assessed with self-rating scales and the Scale for the Assessment of Negative Symptoms . Patients with major depression , alcohol dependence and neuroleptic medication displayed a reduced sensitivity of central dopamine receptors compared to control subjects . Anhedonia was not a common correlate of dopamine receptor dysfunction . Instead , affective flattening was associated with both dopamine receptor sensitivity and psychomotor slowing . Our findings thus do not support the anhedonia hypothesis of central dopaminergic dysfunction . Rather , affective flattening may result from the lack of an emotional response towards reward-indicating stimuli . These findings indicate that patients with dopaminergic dysfunction are not unable to experience pleasure , but may fail to be motivated by environmental stimuli to seek reward
Polymorphisms of the DRD2 , ANKK1 , DAT1 , DBH , and DRD4 genes have been found to moderate the effects of pharmacotherapy  of alcohol , opioid , and cocaine use disorders .
The integration of genetic information with clinical data will inform health professionals of the most efficacious pharmacotherapeutic intervention for substance use disorders .
Substance use disorders have significant personal , familial , and societal consequences .
Despite the serious consequences of substance use , only a few therapies are effective in treating substance use disorders , thus highlighting a need for improved treatment practice s. Substance use treatment response depends on multiple factors such as genetic , biological , and social factors .
It is essential that each component is represented in treatment plans .
The dopaminergic system plays a critical role in the pharmacotherapy for addictions , and an underst and ing of the role of variation of genes involved in this system is essential for its success .