PubMed · 7663196
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S B Blume. 1995-08-26. Pathological gambling.. https://doi.org/10.1136/bmj.311.7004.522
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Despite an estimated heritability of ~50%, genome-wide association studies of opioid use disorder (OUD) have revealed few genome-wide significant loci. We conducted a cross-ancestry meta-analysis of OUD in the Million Veteran Program (N = 425,944). In addition to known exonic variants in OPRM1 and FURIN, we identified intronic variants in RABEPK, FBXW4, NCAM1 and KCNN1. A meta-analysis including other datasets identified a locus in TSNARE1. In total, we identified 14 loci for OUD, 12 of which are novel. Significant genetic correlations were identified for 127 traits, including psychiatric disorders and other substance use-related traits. The only significantly enriched cell-type group was CNS, with gene expression enrichment in brain regions previously associated with substance use disorders. These findings increase our understanding of the biological basis of OUD and provide further evidence that it is a brain disease, which may help to reduce stigma and inform efforts to address the opioid epidemic.
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The goal of this paper is to show from an interactional or systemic perspective how intimacy may be damaged through traditional sex therapy approaches. This is in opposition to stated claims by sex therapists, who have, since the pioneering work of Masters and Johnson, sought to improve intimacy by removing the impediment of poor sexual response. Prescribed masturbation in sex therapy is identified as particularly problematic in its potential for iatrogenic effects. These potentials are demonstrated from a relational perspective and from a functional perspective. Prescribed masturbation, intended to narrow the focus of attention from the "distraction" of a partner's response, may actually serve to further damage the openness and trust necessary for truly rewarding sexual expression. Difficulties in a relationship that preclude the trust necessary for open sexual interaction ought to be addressed before any sexual activity is prescribed. If clinicians' work circumvents the interactional component of the dysfunction, they may be guilty of colluding with clients in protecting them from intimacy. Recommended alternatives for clinicians are offered.