Addictions are one of the biggest problems for human health. Especially smoking addiction… But scientists are close to ending cigarette smoking. And with an unpredictable method…
When we think of brain damage, we usually think of irreversible deficits in recall, speech, mobility and similar physical or cognitive losses. However, in very rare cases, brain damage can lead to positive outcomes.
Damage to a certain part of the brain can suddenly improve symptoms caused by another disease as if by a magic wand, opening new treatment doors for doctors.
A recent study is one of the best examples of this. The subjects of the study were nicotine addicts who had smoked for years. What they all have in common is that they suddenly lost the desire to smoke as a result of a stroke-like brain injury.
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Scans of their brains revealed damage to several interconnected areas of the brain. Experts believe that in-depth studies in these areas will make it much easier to treat addictions that affect the lives of millions of people around the world every year.
The research, published on Monday in the scientific journal Nature Medicine, is based on a theory that has recently gained in popularity. Researchers now believe that addiction does not live in a single part of the brain, but in a network of regions connected by nerve fibers.
The results of the study could improve the success rate of addiction treatments such as electroshock, which has shown promising results in smokers.
“One of the biggest problems with addiction is that we don’t know where in the brain the problem lies, so we can’t apply a targeted treatment,” said Dr. Juho Joutsa, one of the study’s coordinators. “After this study, we hope to have a comprehensive understanding of the regions and networks involved,” said Dr. Joutsa, a neurologist at the University of Turku in Finland.
SIMILAR RESULTS WERE OBTAINED FOR ALCOHOL DEPENDENCE
Some independent experts say that the study by Dr. Joutsa and his colleagues is an extraordinary example of a very powerful demonstration of the brain’s role in substance use disorders. It is striking that in smokers who had suffered a stroke or other brain injury, damage to a particular neural network cut the desire to smoke like a knife.
And it’s not just about smoking addiction.
The researchers tested these findings from the first phase of the study on a cohort of brain-injured patients at risk of alcohol addiction. As with nicotine, people with damage to certain areas of the brain were found to have a reduced desire to drink alcohol. Moreover, these areas overlapped with the brains of the patients in the nicotine study. In short, both smoking addiction and alcohol addiction were hiding in similar places in the brain.
THE MOST INFLUENTIAL SURVEY OF THE LAST DECADE
“I think this could be one of the most influential publications not just of this year, but of this decade,” said A. Thomas McLellan, professor emeritus of psychiatry at the University of Pennsylvania. McLellan, who is also Deputy Director of the Office of National Drug Control Policy, discussed the study, which he was not part of, with the New York Times:
“This research could dispel a lot of the stereotypes that are common in the field of addiction. No longer will we say, ‘Addiction is bad parenting,’ ‘Addiction is a weakness of character,’ or ‘Addiction is a lack of morality.
To tell the truth, in recent years, study after study has shown that lesions or injuries to certain parts of the brain can end addiction. However, in each study, a different part of the brain seemed to be responsible for addiction. The research we mentioned above is very important in terms of putting all these studies into a framework.
KNOWLEDGE OF THE HUMAN CORTEX IS ACCURATE BUT INCOMPLETE
In this new study, Dr. Joutsa and his colleagues applied various statistical techniques to old brain scans of smokers living in Iowa with brain damage.
An earlier analysis of the same brain scans showed that people with damage to the part of the brain called the insular cortex, which governs conscious desires, were more likely to quit smoking.
But when Dr. Joutsa compared these brain scans pixel by pixel, he found a more interesting result. Many patients without damage to the insular cortex had also lost the desire to smoke. “The explanation about the insular cortex was not wrong, but it was incomplete,” Dr. Joutsa told the New York Times.
Working with Dr. Michael Fox, a professor of neurology at Harvard Medical School, Dr. Joutsa began studying brain scans of stroke-affected smokers living in Rochester, New York.
In total, the experts, who analyzed brain images from 129 patients, were struggling to find a single region where the injuries that helped the patients quit smoking clustered. So the researchers started working on standard brain association graphs, which show how activity in one area of the brain is linked to activity in another. This allowed them to identify brain networks that, when damaged, did and did not lead to freedom from nicotine cravings.
Dr. Fox told the New York Times, “What this shows is that it’s not specific regions of the brain that we need to target with treatments, but interconnected brain circuits. If you take into account how the brain is interconnected, you can increase the chances of treatment success.”
The study did not look at how people’s home life (or how many times a day they were exposed to a smoker) affected their habits. The vast majority of patients reported that they quit smoking completely immediately after their brain injury, that they did not feel the urge to smoke and that their desire to smoke did not return in the future.
On the other hand, the experts looked for other changes in brain injury survivors besides the desire to smoke. The researchers tested the hypothesis that the reduced desire to smoke might have been due to changes in intelligence or mood, and found no significant difference in this respect.
HOW DOES BRAIN ELECTROCUTION TREATMENT WORK?
Some experts who were not involved in the research said they were familiar with the brain networks identified by Joutsa, Fox and colleagues through their previous work. For example, Dr. Martijn Figee, a psychiatrist at Mount Sinai Hospital’s Center for Advanced Circuit Therapy in Manhattan, studies the role of electrical waves sent to the brain in the treatment of obsessive-compulsive disorder, depression and addiction. Dr. Figee said that addiction is often the result of underactivity in the brain’s cognitive control circuitry and overactivity in its reward-related circuitry.
By electrically stimulating the surface of patients’ heads or, more invasively, deep inside the brain, doctors can create an artificial brain injury, suppressing activity in some areas while stimulating more activity in others.
According to the latest research, a region called the medial frontopolar cortex is a favorable spot for stimulating more mobility. In fact, an addiction treatment recently approved by the Food and Drug Administration in the US was aimed at stimulating this region of the brain.
The treatment involves sending electrical pulses to the surface of the brain with the help of an electromagnetic pulley placed on the patient’s scalp. There are also treatment techniques that involve the placement of electrodes in certain areas of the brain or the permanent anesthesia of certain areas.
“This paper is really interesting in that it points to certain achievable goals,” said Dr. Figee.
RESEARCH IS PROMISING BUT…
While brain-stimulating techniques are rapidly gaining popularity in the treatment of depression and obsessive-compulsive disorder, their use in addiction treatment is not yet as widespread. Researchers say it could be years before these techniques are adapted to addiction treatment.
There is research showing that electrical or magnetic stimulation can reduce cravings for addictive substances, but it is not clear how long these effects last. Dr. Figee emphasized that some of the promising targets are very deep in the brain and that the appropriate reels have only recently been developed.
Knowing where in the brain to stimulate does not solve the problem of how often the treatment should be administered, experts said. Moreover, because the connections in each patient’s brain are different, individualized treatments may be needed.
Researchers emphasize that people with addiction adopt brain stimulation later than those with depression or movement disorders, which may be due to the taboo of considering addiction as a brain disorder.
SOCIAL AND ENVIRONMENTAL FACTORS SHOULD NOT BE IGNORED
There are also structural barriers. For example, Dr. Judy Luigjes, professor of psychiatry at the University of Amsterdam Medical Centers, launched a study that brought together thousands of patients from addiction treatment centers across the Netherlands. But in the three years since, only two patients have started treatment trials.
According to the paper written by Dr. Luigjes and her colleagues, the motivation for treatment was more fluctuating in patients with substance use disorders than in patients with obsessive-compulsive disorder.
The highs and lows associated with substance use disorders also make it difficult to invest in time-sensitive treatments. For example, Dr. Luigjes found that only one-third of patients attended their appointments with the research team with a family member or friend.
According to Dr. Luigjes, the brain is an entry point in addiction treatment, but not the most important element. Other scientists believe that focusing on the model of addiction as a disease of the brain has hindered funding for research into the social and environmental factors that contribute to the problem.