Neuroscientists also need to consider some less welcome consequences of adopting the brain disease view of addiction, says Adrian Carter.
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Most people would welcome more effective treatments for drug addiction: anyone close to someone with an addiction knows it can destroy families and lives.
Recently, neuroscience has given us important insights into how changes in the brain produced by chronic drug use can lead to addiction, focussing the mind on drug use and making it difficult to stop using.
This research has led some to argue that addiction is best thought of as "a chronic brain disease". Nora Volkow, the current director of the U.S. National Institute for Drug Addiction, believes that this research will foster greater acceptance of addiction as a disease requiring treatment, lessen the stigma associated with addiction, and ultimately lead to a cure.
These are noble goals. However, neuroscientists also need to consider some less welcome consequences of adopting the brain disease view of addiction.
Neuroscience has been used to justify highly invasive and dangerous interventions in the brain, such as psychosurgery. In China and Russia, neurosurgeons have tried to block drug use by destroying parts of the brains of addicted individuals (eg. the nucleus accumbens and the cingulated gyrus) that are implicated in motivation and the processing of reward. Unfortunately, the treatment was only minimally effective despite causing permanent brain damage.
Given the central role that these brain regions play in our motivation for all rewarding activities and other goal directed behaviour - relationships, eating, work - it would be expected that the surgery would also have had subtle, but significant impacts on cognitive function. Unfortunately, the scientists that conducted this research did not look very hard for such predictable deficits.
Such misuses of neuroscience are also evident in Australia. In the 1990s, enthusiasm for a radical treatment, ultra-rapid opioid detoxification, saw thousands of opioid dependent individuals pay large sums of money (up to $10,000) for a poorly evaluated treatment that ultimately doubled their chance of dying from an overdose if they returned to drug use, as most did.
The treatment itself also carried unnecessary risks as the accelerated withdrawal from opioids (usually heroin) required the patient to undergo general anaesthesia for 24 hours. Proponents of this treatment mistakenly argued that it would restore the disordered state of addicted individual's neurotransmitters. Unfortunately, this was not the case, and many fruitlessly paid large amounts of money without any benefit. Sadly, some lost their lives.
Recently, naltrexone implants for heroin addiction have captured media attention. The treatment involves the surgical insertion of a long-acting polymer implant impregnated with naltrexone - a drug that blocks the effects of opioids such as heroin. It has been used to treat thousands of patients in Australia, despite not being submitted to the clinical trials required of every other new medication.
These examples illustrate how neuroscience research can be misused and misrepresented, sometimes with dreadful consequences. Drug addiction is a condition that often evokes strong opinions, and sometimes moral outrage. These strong moral responses can shape the way that neuroscience research is understood and applied.
We need to ensure that neuroscience research, and the technologies it provides, are used to treat individuals with a medical condition - an addiction - and not as a way of controlling deviant social behaviour or achieving other social goals, such as reducing crime or criminal justice costs.
The complexities of neuroscience mean that its findings can be readily misunderstood and misused. Neuroscientists need to anticipate possible misrepresentations of their research and caution against them. They should also clearly communicate its limitations - what the neuroscience cannot say, and should not be used for.
Neuroscientists need to be aware of how their research is read by individuals outside the scientific community, and how treatments that they develop might be used by society when they leave the lab bench. Addiction neurobiologists cannot avoid taking responsibility for the use that is made of their research once it is in the public domain. They cannot remain silent when their work is misused. Neuroscientists may not be able to prevent all abuses of their research, but by speaking out, they will at least be able to provide patients, policy makers and the public with the information to ensure that these abuses are minimised.
Adrian Carter is a National Health & Medical Research Council Postdoctoral Fellow in Public Health who is studying neurobiological understanding of addiction at the University of Queensland's Centre for Clinical Research in Brisbane.
Good point, and...
The piece that is often missing in addiction research is "How long will it take my brain to bounce back to normal, given abstention from the addictive substance/behavior?" For example, on our site ("Your Brain On P---"), men who are recovering from p--- addiction report that there seems to be a major turning point (way fewer cravings, stable improvements in mood and sexual performance) at about eight weeks of no masturbation to p---.
It's likely this improvement correlates with neurochemical events (such as decrease in Delta FosB, upregulation of dopamine receptors in the reward circuitry, etc.). While it may take longer for all of the addiction-related brain changes to correct themselves (and while some degree of sensitization may always remain), the struggle gets much easier for these guys at about two months.
If such landmarks were well established by research on different addictions, recovering addicts wouldn't need to rely on drug interventions. They could chart their own course because they would know when to expect the light at the end of the tunnel.
Greater knowledge of brain science *is* the answer for addicts, but only if it also empowers them by telling them more about what is entailed in reversing the changes to their brains.
Good point, and...
The piece that is often missing in addiction research is "How long will it take my brain to bounce back to normal, given abstention from the addictive substance/behavior?" For example, on our site ("Your Brain On P---"), men who are recovering from p--- addiction report that there seems to be a major turning point (way fewer cravings, stable improvements in mood and sexual performance) at about eight weeks of no masturbation to p---.
It's likely this improvement correlates with neurochemical events (such as decrease in Delta FosB, upregulation of dopamine receptors in the reward circuitry, etc.). While it may take longer for all of the addiction-related brain changes to correct themselves (and while some degree of sensitization may always remain), the struggle gets much easier for these guys at about two months.
If such landmarks were well established by research on different addictions, recovering addicts wouldn't need to rely on drug interventions. They could chart their own course because they would know when to expect the light at the end of the tunnel.
Greater knowledge of brain science *is* the answer for addicts, but only if it also empowers them by telling them more about what is entailed in reversing the changes to their brains.
Marnia Robinson