Authors’ response

We thank Dr. Kapoor for appreciating our review on nicotine dependence and psychological distress and having taken it as a cue to reflect on the possible association between the A118G single nucleotide polymorphism of the OPRM1 gene and drug dependence. The literature offers several data on such an issue but, unfortunately, only a small number of studies focused on nicotine dependence. For instant, recently, Ray et al. noted that Human Mu Opioid Receptor (OPRM1 A118G) polymorphism is associated with brain μ-opioid receptor (MOR) binding in smokers. And, Falcone et al. found, in smokers, an increased availability of MOR in the amygdala that could contribute emphasizing the motivation to smoke to obtain a negative affective relief. Although we really hope that future investigations will clarify the possible association between smoking and genes and, as a further step, lead to the development of novel therapeutics; it is noteworthy that we are constantly reminded that genetics will transform and improve our practice but nothing has really come in the past two decades. Thus, psychopathology and clinical judgment, still underappreciated as scientific tools but commonly used in clinical practice, can be a valid alternative approach to make the correct diagnosis and choose the tailored treatment for drug dependence, in particular for nicotine dependence. Indeed, a good organization of clinical information (encompassing for instance psychological distress and psychological well-being), the use of transfer station with repeated evaluations instead of diagnostic end-points, and staging methods may guide assessment, treatment choice, as well as planning of follow-up visits or interventions.