Reward Deficiency Syndrome phase two addiction treatment, targets the unique needs of the individual’s brain: Project Reconceptualizing Addiction: The Elle Foundation Case Study 102

Abstract

In the Elle Foundation, Case Study 102, the participant was given a Reward Deficiency Syndrome Symptom Checklist, in which she was asked about her dopamine deficiency symptom experience. The Reward Deficiency Syndrome Questionnaire (RDSQ-29)[1] was administered and the GARS, Genetic Addiction Risk Severity test [2] given in follow up. The GARS determined her predisposition for neurological challenge, in both dopaminergic and serotonergic channels, and her RDS phenotype [3]. In this retrospective, observational study, it is easy to discern the predictive value of the GARS, in 2020 hindsight, to determine predisposition for selective choice of various addictive behavioral paths to boosting dopamine deficiency [4] This participant's life experience is used to illustrate the new Reward Deficiency Syndrome paradigm, including the therapeutic value of the GARS [5], RDS Solutions for her phenotype (Blum et al., 2011) and RDS Solution Focused Brief Therapy (RDS-SFBT) [6], which is psychological education for overcoming dopamine deficiency, to achieve and maintain dopamine homeostasis [7].

Full text

Reward Deciency Syndrome phase two addiction treatment, targets the unique
needs of the individual’s brain: Project Reconceptualizing Addiction:
The Elle Foundation Case Study 102
Case report
Volume 2 | Issue 2 | 1 of 9
J of Addict Dis & Ment Heal, 2022 www.unisciencepub.com
E D Gilley
Journal of Addictive Disorders and Mental Health
*Correspondence author
Elizabeth Gilley
119 Executive Center Drive
Suite 404
West Palm Beach, FL
E-Mail : gilley.elizabeth@yahoo.com
Submitted : 22 Apr 2022 ; Published : 13 June 2022
The Elle Foundation, West Palm Beach, FL. 33401, USA
Abstract
In the Elle Foundation, Case Study 102, the participant was given a Reward Deciency Syndrome Symptom
Checklist, in which she was asked about her dopamine deciency symptom experience. The Reward Deciency
Syndrome Questionnaire (RDSQ-29)[1] was administered and the GARS, Genetic Addiction Risk Severity test [2]
given in follow up. The GARS determined her predisposition for neurological challenge, in both dopaminergic and
serotonergic channels, and her RDS phenotype [3].
In this retrospective, observational study, it is easy to discern the predictive value of the GARS, in 2020 hindsight,
to determine predisposition for selective choice of various addictive behavioral paths to boosting dopamine
deciency [4] This participant’s life experience is used to illustrate the new Reward Deciency Syndrome paradigm,
including the therapeutic value of the GARS [5], RDS Solutions for her phenotype (Blum et al., 2011) and RDS
Solution Focused Brief Therapy (RDS-SFBT) [6], which is psychological education for overcoming dopamine
deciency, to achieve and maintain dopamine homeostasis [7].
Citation: Gilley, E.D, Reward Deciency Syndrome phase two addiction treatment, targets the unique needs of the individual’s
brain: Project Reconceptualizing Addiction: The Elle Foundation Case Study 102, J of Addict Dis & Ment Heal, 2022; 2(2): 1-9.
Introduction
In the Elle Foundation Case Study 102, we build upon the
Reward Deciency Syndrome (RDS) foundation demonstrated
in Case Study 101. Case Study 102 introduces analysis of a
biological sister’s Reward Deciency Syndrome (RDS) risk
score, as determined by Genetic Addiction Risk Severity
(GARS) screening [8], to illustrate a new paradigm or lens
through which to view substance use disorders and some
mental illnesses [9][10][11][12]. For those with Reward
Deciency Syndrome, drug use is a predictable symptom, or
outcome of the underlying dopamine deciency challenge [13]
[14][15].
Building upon the neurodevelopment model [16][17], the RDS
paradigms focuses upon underlying neurogenetic challenge or
impairment, that the individual is born with, or may acquire,
which has potential for disruption of brain chemistry, leading
to addiction and/or mental health disorders[18]. It addresses
dopamine deciency, with the goal of facilitating dopamine
homeostasis. RDS Solutions, precision addiction management
[19] and RDS Solution Focused Brief Therapy are a phase two
treatment [20],to be initiated upon completion of substance use
disorder treatment [21] [22], to address the unique neurogenetic
challenges of the individual[23].
It is estimated that Homo sapien has between 25,000 to 30,000
genes. We are just going to look at the ten most common gene
mutations, or eleven alleles found in clients with substance use
disorders and mental health disorders. Alleles is the term used
for different variations of genes. Genetic mutations are both
inherited, and can be acquired through epigenetic response,
as the brain adapts to environmental inuences [24]. Genes,
alone, do not determine outcome. It is the interaction between
genetic and epigenetics inuences which determines outcome.
This case study review highlights the importance of genetic
screening, to become aware of genetic predisposition for
psychopathology. The GARS screening can benet prevention
effort, by providing awareness of potential areas of neurological
impairment [25]. For those still suffering from addiction’s
repetitive cycles of relapse [26], GARS results can inform

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proper selection of pharmaceutical therapy, by consideration of
mechanism of action. GARS also determines phenotype, for
designer RDS Solutions, which include neuroadaptagen amino
acid therapy (NAAT) [27][28][29][30], to aid in achieving
dopamine homeostasis [31].
The Elle Foundation Case Study 102, is the biological sister
of our proband, Case Study 101, [32][33], who is the subject of
ongoing research analysis regarding family polymorphic gene
variances which predispose mental health disorders, including
but not limited to substance use disorders. The author utilizes
this case study 102, to illustrate the new Reward Deciency
Syndrome paradigm [34], which advocates for a stage two,
Reward Deciency Syndrome Solutions treatment (RDSS)
[35-41], based upon enlarged neurogenetic perspective,
beyond the scope of the Hazelden Model.
In the 1980’s, decades ago, when Case Study 102, was
experiencing potential alcohol abuse issues, alcohol
dependence was diagnosed through the American Psychiatric
Association’s Diagnostic and Statistical Manual of Mental
Disorders (DSM), 3rd Edition. Today the DSM, 5th Edition, is
the diagnostic standard, and alcohol dependence and/or abuse
is now called Substance Use Disorder [42]. Our case study
102, sought the assistance of a mental health therapist, in the
middle to latter 1980’s, who looked closely, at her behavioral
patterns, to discern, if they were serving her overall greater
good, and to help the client determine, if these behaviors
were in alignment with the subject’s higher ideals and chosen
purpose in life. Subsequently, the subject chose to stop using
alcohol and attended twelve step meetings for a period of more
than one year.
In the three and half decades since, the subject continued to
seek freedom from dysfunctional family behavioral patterns
[43] and achieved increasing degrees of autonomy and
thriving. The subject excelled in tennis, personal tness and
nutrition. She earned her Life Coach certication, and became
both a leader and role model for others in her community. The
subject earned her Bachelors Degree in Psychology of Child
Development and is an accomplished business woman. She
has a long history of charitable work in addition to being a
yearly tax payer, and good citizen without a criminal record.
Over the past thirty-ve plus years, since she initially sought
help with alcohol, it has not been necessary for Case Study 102
to work a twelve step program of abstinence from recreational
usage of psychoactive drugs, mainly alcohol. She matured
out of the problems of her early adulthood. She controls her
impulses to use, and chooses balance along the continuum, or a
harm reductionist theoretical stance, choosing when to imbibe,
and when to walk away. Her occasional social use no longer
interferes with the quality of her life, nor does it interfere with
her taking care of her responsibilities. This case study has
never required or merited in-patient treatment.
Ironically, Case Study 102, the biological sister, of our proband,
Case study 101, has a greater degree of Reward Deciency
Syndrome predisposition risk, scoring 8 out of a possible 22.
Our proband received a RDS risk score of 5 out of a possible
22 polymorphic variances. We will examine these polymorphic
variances in greater detail for illustration of the RDS paradigm.
CASE STUDY 102 – Methods
Case Study 102 was determined to have the personality type
ESFJ, based upon the Myers Briggs personality test. On
the Neurotransmitter Balance Questionnaire, derived from
“The Edge Effect,” developed by Dr. Eric Braverman, her
dominant chemistry scores were: 1A – Dopamine = 19; 1B –
Acetylcholine = 24; 1C GABA = 36; and 1D – Serotonin = 20.
The deciency chemistry scores were: 2A dopamine = 4; 2B
– Acetylcholine = 8; 2C- GABA = 10; and 2D Serotonin = 6.
The subject is a part of a convenience sample, of family
members willing to participate in the Elle Foundation 100 series
research case studies. This is an observational study, conducted
retroactively, and retrospectively. The subject was given the
Reward Deciency Syndrome Symptom Checklist created
for the Elle Foundation 100 series research study participants.
She responded positively that she did have experience of
the following: depression [44]; experience of being bullied;
increased tolerance of substances used; compulsive shopping/
spending; felt out of control; felt unlovable; codependency;
family dysfunction; craving for foods; binging on the weekends;
experience of mental health treatment through attending out-
patient therapy; used illegal substances; and attended a twelve
step group.
Subject indicated that she had either wondered if the following
applied, or had received a diagnosis for, or had it suggested
that she might need to be screened for the following: 1)
Eating Disorders – which could include binging [45], purging,
anorexia, excessive dieting, extreme weight gains or losses
[46], and 2) Substance Use Disorders – which could include
alcohol, pharmaceuticals, nicotine, illicit street drugs, like
cocaine, or marijuana, etc., sugar, caffeine, etc.
When introduced to the new RDS criteria, Anhedonia [47] and
Dysphoria, the subject did not recognize the subtle experience
of Anhedonia, which is being dened for this study, as “an
inability to feel good, or at ease; an uncurrent of discomfort;
feeling as if something is not quite right in the body or mind,
that you are somehow below zero in functioning, and/or an
ongoing undercurrent of stress.” She did, however, have a
positive response to recognition of the new term Dysphoria,
which we have dened for this research study as “an inability
to handle frustration, or sit with the discomfort of Anhedonia,
the feeling of a lack of adequate dopamine, which results in
sudden rage or explosive, volatile behavioral which is not
characteristic of your personality, like snapping, throwing your
phone, or needing to scream.”
The new RDSQ-29 was administered with the case study
showing adequate RDS symptomology, to indicate need for
further follow up through genetic investigation. The genetic
addiction severity risk score (GARS) was administered. DNA

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sample was collected through buccal swab and analyzed by
Geneus Health, LLC in San Antonio, Texas. Test results were
reviewed and approved by Patricia Jeffreys, MD, FCAP. (See
Table 1).
Gene Identiers Risk
Allele
Patient
Result
Risk
Allele
Count
COMT rs4680(Val158Met) G A/A 0
DRD1 rs4532 A A/A 2
DRD2/
ANKK1
rs1800497(Taq1A) A G/G 0
DRD3 rs6280 C T/T 0
DRD4 rs1800955 C C/C 2
OPRM1 Rs1799971 G A/A 0
Single Nucleotide Polymorphisms (SNPs)
Table 1: EF102 GARS® TEST RESULTS
Variable Tandem Number Repeats & Insertion/Deletions
Gene Identiers Risk
Allele
Patient
Results
Risk
Allele
Count
DAT1 rs8363170 <than 9
repeats
10R/10R 0
5-HTT-
LINKED
rs4795541 S, LG S/S 2
MAOA rs768062321
(chrX*)
3.5R, 4R 4R/4R 2
DRD4 rs7610104587 > 7
repeats
4R/4R 0
Dinucleotide Repeat
Gene Identiers Risk Allele Patient
Results
Risk
Allele
Count
GABRB3 Rs764926719 181 197/201 0
Score 8 out of possible 22 for females.
Discussion
We will look at the genetic results from the GARS and support
ndings with information provided by personal interview and
the subject’s background material. Results found serotonin
challenge in reuptake. This family has a long history of mood
disorders, depression and bi-polar disorder dating back several
generations in female family members, from many interactive
family lines intersecting through marriage. Specically looking
at the variable tandem, number repeats, insertions or deletions
of the 5-HTT linked, RS 4795541 genetic polymorphic
variance, this subject has both risk factors.
Notably, unlike most other neurotransmitters, serotonin
is manufactured predominately in the gut. Many positive
lifestyle behaviors, like exercise [48], physical tness,
nutrition and quality diet [49] benet to serotonin function,
potentially offsetting inherited serotonin challenge that might
be inuential in disorders. Benets from regular exercise
[50], increases wellbeing through increased endorphins, often
minimizing depression[51]. The proband’s family is passionate
about sports. Case study 102 is known for her dedication to
excellence in physical tness. She was a tennis star for most
of her life.
Ironically in early developmental periods of her life, she
experienced obesity [52]. As a child of a working mother,
she was positioned in front of a television, which served as a
baby sitter, daily with a bag of potato chips and chip dip, at her
grandmother’s house, Monday through Friday afternoons after
school. As should have been expected, weight gain followed.
She experienced the emotional and psychological pain of being
bullied for her size, and remembers being called “elephant,” in
the third grade, by her classmates at her new school.
She also experienced shame for her size in her family of
origin, with her father setting the example, that women need
to be pleasing to the eye to be valued. Too often, he spoke of
breeder’s hips with a negative connotation, as if having the
necessary broadness in hip size to facilitate ease in reproduction
was somehow unattering. This family is of both Germanic
and Viking heritage, upper standard deviations from the mean,
in both height and weight, are to be expected.
While, granted, the passing down of improper
psychopathological expectation of size is abusive, we also nd
from a literature review, that obesity is a common component
of the dopaminergic dysfunction which is Reward Deciency
Syndrome [53]. The two most common RDS symptoms in the
extended family, beyond just the 8, who have consented to be a
part of this case series, are depression and obesity [54].
Her earliest known drug of choice is glucose, carbohydrates or
sugar [55][56]. It seems a natural progression, to select alcohol
as the new drug of choice, in young adulthood, when in a
competitive collegiate environment. She followed socialized
standards for her culture and ethnicity, while playing,
undefeated, the number one position of the college tennis team.
Those with a moderate RDS risk score of 7 or more, are likely to
have issues with alcohol, and glucose, among other substance
and nonsubstance behaviors. In retrospect her GARS results
clearly indicate an increased likelihood, or predisposition for
both eating disorder [57] and alcoholism [58].
The summary guide provided by Geneus Health details the
substance use and non-substance behaviors associated with
certain alleles of genes (geneushealth.com). The A allele of
DRD1 receptor gene indicates behavior predisposition risks
for alcohol and nicotine use, and the non-substance behavior
of novelty seeking. The case study reports that she did smoke
periodically for a few years, but did not allow herself to become
incumbered by nicotine addiction over the long haul [59]. She
laid the cigarette vice down and made healthier choices. She
also reveals that she has indulged her predisposition for novelty
seeking, usually through travel adventure, or shopping/retail

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therapy, and on one occasion, through the high-risk behavior of
sky diving. She is managing genetic challenge through proper
control of impulse.
Individuals with the A1 variant of the DRD2 receptor gene,
have behavior predisposition risks for substance use disorder
involving alcohol, cannabis [60], glucose, heroin, nicotine,
and opioids. They also have the non-substance behavioral
predisposition risk for Attention Decit Disorder/Attention
Decit Hyperactivity Disorder (ADD/ADHD) [61][62],
conduct disorder, gambling disorder, hypersexuality disorder
[63], internet gaming [64-65] or gambling [66-68], novelty
seeking, pathological aggression, as well as Post Traumatic
Stress Disorder (PTSD).
Individuals with the S or LG allele of the 5-HTTLPR gene
(which we discussed in the serotonin section above) have
behavior predisposition risks for the following substances:
alcohol, cannabis, cocaine, glucose, nicotine, and opioids.
Non-substance use behaviors for these alleles include ADD/
ADHD, pathological aggression, and PTSD [69].
Individuals with the 4R variant of the MAOA gene have
behavioral predisposition risks for the following substances:
alcohol, glucose, nicotine and opioids; and non-substance
behaviors: ADD/ADHD, harm avoidance, and novelty seeking.
Again, the Geneus Health Summary Guide provides detailed
predisposition risk for GARS results found at geneushealth.
com.
When Case Study 102 was presented with her GARS results,
initially she did not know what they meant, understandably so.
But when she was provided information on the new Reward
Deciency Syndrome paradigm, through psychoeducation
provided in the RDS solution focused brief therapy, it began to
make more sense. In her formative years, she had been taught
that drug use led to addiction, as her therapy followed the
Hazelden model of addiction.
With understanding of this new RDS paradigm, the case
study 102 understands that neurogenetic challenge predates
addiction, and for the most part determines addictive outcome.
She understands that prolonged use of illicit street drugs and/
or legal pharmaceutical drugs do in fact, cause further damage,
to the brain, in what is known as epigenetic insult.
Summary
Case study 102 has mastered her genetic challenges through
life style choices, self-discipline, and has lead a life advocating
for the rights of children of addicts. She has been instrumental
in providing a safe household environment for a child who
was removed from his family of origin for reasons of active
drug use, or substance use disorder. She has paid for this
child’s genetic addiction risk severity (GARS) screening for
prevention purposes.
Why is it, that some individuals will try drugs and never
become addicted? Or address drug abuse and return to a
healthier lifestyle, while others seem to lose themselves in
a downward spiral of increasing dependence? When asked
what she thought the differences were in outcome, between
herself and her sister, Case Study 101, the EF 100 research
series proband, who suffered greater mental health disorder
dysfunction, but who had a lower RDS risk score, CS102 states
that her sister suffered early adverse sexual assault trauma, that
she, herself, did not, as well as chronic pain issues. Case study
102 believes that experiential or environmental differences
have been inuential in her sister’s more serious problems.
On a more positive psychological note, the Case Study 102
subject has an unshakeable religious faith [70-71]. She
believes her faith, has allowed her to have resilience through
life’s hardships, which has included surviving breast cancer.
Case Study 102 conveys, that she believes, that if she had
prior understanding of the Reward Deciency Syndrome
paradigm, psychoeducation for RDS solution focused brief
therapy, and GARS testing results back in the time when
her predispositions for alcoholism and eating disorders were
causing problems, that she would have recovered more quickly
[72]. She expresses gratitude for the enlarged perspective and
the scientic advances in brain reward circuitry, which have
produced Reward Deciency Syndrome Solutions ™ (RDSS).
In hindsight, she understands that she would have had more
resources to treat the underlying cause of her problems, beyond
just mental health talk therapy and twelve step support groups,
for help with her drinking. CS102 understands that these older
modalities merely address the behavioral symptoms and not
the underlying neurogenetic causal inuences. She wants to
help make sure that her children and future grandchildren
have access to these resources, should the need arise. In other
words, she wants them to have treatment for the underlying
neurogenetic causal inuences for substance use disorders,
nonsubstance use disorders, obsessive, compulsive, impulsive
mental health disorders, as well as the whole range of RDS
symptomology which includes the Autism/Asperger spectrum,
if or when they need it!
Conclusion
The GARS DNA results can provide a wealth of information,
for RDS symptomology self-management and also for
prevention, For some individuals, GARS results have informed
proper pharmacological intervention, specically targeting
preferred mechanisms of action. This Elle Foundation 100
research series family is fortunate to have access to cutting
edge Reward Deciency Syndrome Solutions ™ (RDSS) for
substance use disorder, non-substance, or behavioral process
addictions, and comorbid mental health disorders which
involve dopamine depletion or dopamine dysfunctions. Other
families in our American culture, the United States and indeed,
the world, are handicapped by mental health protocol which is
more than fty years out of date[73-80].

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Reward Deciency Syndrome Solution Focused Brief Therapy
is a stage two treatment, to be initiated after completion
of substance use disorder treatment. Psychoeducation for
understanding the Reward Deciency Syndrome paradigm can
be outsourced by certied RDS professionals. This treatment
looks closely at the underlying neurogenetics and intervenes
to address the cause of addiction and other mental health
disorders.
By addressing the neurogenetic challenges which precede
addictions and mental health comorbidity, corrective
action may be taken to address the dopamine depletion and
deciency challenge. RDS Solution Focused Brief Therapy
provides psychoeducation to assist in self-management skill
development to achieve and maintain, dopamine homeostasis,
which may aid in prevention of potential future RDS dementias
over the lifespan.
Clearly RDS is the phenotype and addiction, the endotype.
Or in layman’s terms, RDS is the disease, and addiction is
the symptom. This is a bold statement and it is right on the
money. Why wait one hundred years for the advancements of
the research arena to trickle down into common knowledge of
the public? People are dying. 100,000 were lost just last year
to the opioid epidemic, within a pandemic.
For addiction therapists and mental health counselors who
are interested in becoming certied in Reward Deciency
Syndrome Solution Focused Brief Therapy (RDS-SFBT), the
2022 Global Conference on Addiction Medicine, Behavioral
Health and Psychiatry is providing a three hour seminar, for
6 continuing education credits in October 2022. For more
information, please contact the Elle Foundation at 336-608-
0881.
Statement of Acknowledgement
The Elle Foundation wishes to thank Dr. Frank Lane, MD,
Harry Henshaw, Ph.D, John Giordano, Ph.D, Eric Braverman,
MD., and Kenneth Blum, Ph.D. Contributions of time and
resources by representatives of the Kenneth Blum Behavioral
Neurogenetic Institute, Austin, TX., geneushealth.com, San
Antonio, TX., One Body One Mind Clinic, Dallas, TX.,
EnhancedHealing.com North Miami, FL, JohnJGiordano.com
Davie, FL., PATH Medical and the PATH Foundation made
this research study possible. Funding for operating costs were
provided by The Elle Foundation, a private nonprot, founded
in 1995. The author declare no potential conicts of interest
with respect to the research, authorship and/or publication of
this article.
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