These initial findings suggest the current PRSs are unlikely to prove useful for SUDs in a clinical setting. Being able to eventually identify those at heightened risk for SUDs may allow for more targeted early intervention and prevention. However, before this is possible, larger discovery GWAS across substance use phenotypes with PRS that explain greater portions of the variance will be necessary. As GWAS sample sizes for SUDs increase, we will likely see increases in effect sizes35. Additionally, using multivariate techniques to model the shared genetic architecture across existing SUD GWAS to include both aspects of externalizing and internalizing (e.g. depression, anxiety) may also improve prediction36,37. Inclusion of genetic data in a clinical setting will also require that psychiatrists and clinicians receive greater training in genetics and/or that they partner with genetic counselors, so they are both better able to understand what increased genetic risk means and be able convey that information accurately to their patients38,39. In addition to clinical utility, we must ensure that regulations and protections surrounding the use of genetic information in clinical settings can adequately protect the rights of individuals who are identified to be “at risk.”
