Feb. 27, 2025 – About 3 in 10 people will develop a substance use disorder in their lifetime. A new test can predict how likely you are to become one of them – and provide a personalized roadmap to help you avoid that fate.
It works by analyzing the genetic information in your saliva and combining that with key details about your past, like childhood experiences, previous alcohol or substance use, and family history.
Called the Comprehensive Addiction Risk Evaluation System (CARES), the test recently became available through the Rutgers Addiction Research Center, in Piscataway, New Jersey. (It’s also commercially available to hospitals and health care organizations through Rutgers startup Thrive Genetics.) It costs $149 (to cover processing and administrative fees), and it takes about six weeks to get results.
Linking genes to disease risk is nothing new – genetic testing can reveal a person’s risk of heart disease or cancer, for example. But behavioral outcomes like addiction, influenced by nature and nurture, are trickier to predict.
CARES combines environmental risk factors with genetic ones. The platform is based on data from more than 1.5 million people.
“It's the most predictive genetic risk score for any behavioral outcome to date,” said Danielle Dick, PhD, director of the Rutgers Addiction Research Center.
Even though Rutgers researchers are using CARES for ongoing studies, Dick pushed for the public to have access to it, too, because she believes the tool could help people and even save lives.
How the Test Works
DNA accounts for about half of why some people develop addiction, but environment and behavior are also powerful predictors, opening an opportunity for prevention. Only about 4% of people with the lowest genetic and environmental risks will develop a substance use disorder, compared with up to 84% of people with the highest genetic and environmental risks, Dick said.
In particular, the test is designed to spot “externalizing” behaviors and disorders, Dick said – problems with behavioral regulation and impulsivity. These behaviors might show up as engaging in risky sex or staying up all night partying in college, even though you have a big exam the next day.
“They all share a common genetic basis, and that reflects the way our brains process risks and rewards and consequences,” Dick said. “Do you have a brain that is really excited about the things that are right in front of you, or do you have a brain that's a little more like, ‘That sounds nice, but I'm going to think through all these consequences here’?”
To find out, you first answer survey questions – like “How old were you when you had your first alcoholic beverage?” and “Do you think any of your biological relatives ever had a drinking problem?” Then you spit in a tube that arrives in the mail. Mail it back, and a month or two later, you’ll receive an online report with a risk estimate.
Risk is described as average, lower than average, or higher than average. For example, a higher-than-average risk estimate may state that “9 in 10 individuals with your risk profile go on to develop a substance use disorder compared to population averages.”
The assessment is rooted in findings from a trailblazing study published in Nature Neuroscience in 2021, in which Dick’s research team linked a range of behavioral and medical outcomes across more than 500 locations in the human genome.
“If anyone tells you that they're genotyping just a few genes, then that is not state-of-the-science anymore, and there are companies that are out there, and they're doing it, and they're marketing it,” said Dick. “That is not what scientists are doing at all in the field. That's what we were doing a decade ago.”
Developed along with psychiatric genetic counseling expert J9 Austin, PhD, the report highlights environmental or behavioral risk factors that people can consider focusing on to address their risk level, like spending time with people who encourage alcohol or drug use or being in places where those things are easily available.
“Genetic counseling is really about helping people make meaning out of genetic information and helping them find ways to use that information in ways that align with their values,” said Austin, a professor of medical genetics and psychiatry at the University of British Columbia in Vancouver, Canada.
Ready to Take the Test?
First, spend some time considering why you want to do it and how you may react to the results, Austin said.
“One of the things that we know from research that we've done is that lots of people go into the idea of genetic testing thinking ‘I'm just curious,’ and approach it as if it's just a bit of fun, or that it's like a personality test or something,” Austin said. “Then they end up being surprised when they get information back that they weren't prepared for, and that can actually be quite impactful.”
Learning about genetic risk can affect people in different ways. Think through those possibilities ahead of time. For example, someone who has a strong family history and learns of a genetic link may worry that addiction is inevitable, or it may motivate them to make changes.
For a person who feels like it’s all their fault, knowing the genetic contribution could provide “a powerful relief from guilt,” Austin said.
“The information is not neutral,” Austin said. “It's how it's received that matters.”
A genetic counselor can help provide context and support to encourage a positive outcome. The assessment offers ways for you to connect with one, Dick said.
The point is to empower people to use the report’s information to improve their lives, she said.
“Once you understand something about your risk, we also want to help you understand what that means,” Dick said. “So then you know what kind of actions you can take to reduce your risk, because this gets at the genes-aren't-destiny concept. Knowledge is power, and we're trying to give that power.”
