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 .
Disulfiram treatment for cocaine dependence in methadone-maintained opioid addicts.
AIMS Cocaine use by patients on methadone maintenance treatment is a widespread problem and is associated with a poorer prognosis . Recent studies have evaluated disulfiram as a treatment for individuals with comorbid alcohol and cocaine abuse . We evaluated the efficacy of disulfiram for cocaine dependence , both with and without co-morbid alcohol abuse , in a group of methadone-maintained opioid addicts . DESIGN R and omized double-blind , placebo-controlled trial . SETTING Urban methadone maintenance clinic . PARTICIPANTS Sixty-seven cocaine-dependent , methadone-maintained , opioid-dependent subjects ( 52 % female ; 51 % Caucasian ) . INTERVENTION Study medication , either disulfiram or placebo , was placed directly in the methadone to ensure compliance for 12 weeks . MEASUREMENTS Primary outcome measures included weekly assessment s of the frequency and quantity of drug and alcohol use , weekly urine toxicology screens and breathalyzer readings . FINDINGS Disulfiram treated subjects decreased the quantity and frequency of cocaine use significantly more than those treated with placebo .  Alcohol use was minimal for all subjects regardless of the medication . CONCLUSIONS Disulfiram may be an effective pharmacotherapy for cocaine abuse among methadone-maintained opioid addicts , even in those individuals without co-morbid alcohol abuse . Disulfiram inhibits dopamine beta-hydroxylase result ing in an excess of dopamine and decreased synthesis of norepinephrine . Since cocaine is a potent catecholamine re-uptake inhibitor , disulfiram may blunt cocaine craving or alter the " high " , result ing in a decreased desire to use cocaine
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 .