Addiction
It is estimated that worldwide 76.3 million people suffer from alcohol dependence, a shocking statistic that doesn’t account for the millions of people addicted to illegal and legal drugs, food, sex, gambling, pornography, etc (Muller, Sturm, Voges, Heinze, Galazky, Heldmann, Scheich & Bogerts, 2009). Addiction is a condition that results when a person ingests a substance, or takes part in an activity that is pleasurable, and after continued use can cause behavior that leads to interference with the normal responsibilities of daily life. Cravings and compulsions are terms often used to describe an addict’s desire to use the substance or participate in said activity. A key characteristic of addiction is marked by repeated attempts to resist the urges caused by these cravings and compulsions, with little to no success. Attempts to stop the use of addictive substances are also accompanied by withdrawal symptoms such as irritability, anxiety, shakes and nausea. And, often times the friends and family of the addict will be well aware of the growing problem long before the addict himself (Psychology Today, 2011). However, these are only the outward, visible signs of addiction, and it’s now being discovered that far more is occurring in the addict’s brain, below the surface, than once thought.
After a four year process involving more than 80 experts, the American Society of Addiction Medicine (ASAM) released a new definition of addiction as a chronic brain disorder. Ever growing advancements in the field of neuroscience helped to convince the ASAM officials that addiction should be redefined by the processes taking place in the brain (Live Science, 2011).
There are multiple theories of the exact processes, and brain regions, involved in addiction. However, one of the most prominent of these theories involves a disruption of the reward pathway. The ventral tegmental area, located at the center of the brain, plays a central role in the reward pathway. The VTA is essential for determining how well various fundamental human needs are being met, and it passes this information on to other brain areas via the brain’s chemical messengers (Dubuc, 2002). People feel pleasure when neurons in this reward pathway release a neurotransmitter called dopamine into areas of the brain such as the nucleus accumbens, the amygdala, and the prefrontal cortex. When dopamine is released into the synapse, it crosses over to the next neuron and binds to it, providing an increase in pleasure. Excess dopamine is then taken back up by the releasing neuron, in a process called reuptake, and GABA (an inhibitory neurotransmitter) works to prevent over stimulation of the receptor neuron. Simply put, addictive substances disrupt these processes and increase the amount of dopamine in the synapse, giving the user a heightened feeling of pleasure. Repeated use of drugs and alcohol disrupt the normal balance of brain circuits that control reward, memory and cognition, and ultimately addiction occurs (TIME, 2011).
Another theory involves dysfunction of the dopaminergic transmission to the prefrontal cortex and the anterior cingulate gyrus. Dysfunction in these areas leads to problems with inhibitory control and decision making, which would help to explain inability to resist abusive behavior even though the addict knows the negative consequences (Van den Broek, 2008).
Case Study
This case study focused on three individuals that had all struggled with alcoholism for much of their lives. All three patients were chosen based on their severity of struggles with alcoholism, their lack of success with long-term inpatient therapy, and their having an education level of at least nine years. The patients were all administered the same deep brain stimulation (of varying frequencies) technique, in which the nucleus accumbens was targeted. Also, after deep brain stimulation, the patients received no additional psychotherapy or anti-craving medication besides routine assessment (Muller et al., 2009).
Deep brain stimulation (DBS) is a safe surgical procedure that has been used successfully in neurology for over 15 years in the treatment of diseases such as Parkinson’s. The process involves the implanting of electrodes within specified regions of the brain. After implantation, electrical currents are transmitted through the electrodes which affect brain cells and chemicals. The amount of stimulation is controlled by a pacemaker-like device that is implanted under the skin of the patient above the collar bone. A wire then connects the device to the electrodes in the brain (Mayo Foundation for Medical Education and Research, 2011).
Patient one is a 36-year-old male who started drinking at the age of 12. He averaged about two liters of alcohol a day, and throughout his struggles he has been admitted to numerous inpatient detoxifications and long-term inpatient therapies (LTIT). Even with all the help, his longest period remaining abstinent from alcohol, prior to DBS, was only six months. After implantation and initiation of the DBS, the patient has remained abstinent from alcohol for 18 months. He reports that he feels no cravings for alcohol, enjoys normal daily life activities and did not experience any adverse physiological symptoms from the implantation.
Patient two is a 37-year-old male who started drinking at the age of 11. His mother, father and the majority of his first degree relatives are all alcoholics. He received his first inpatient detoxification at the age of 15, and has participated in, and finished, three LTITs. After his first LTIT he remained sober for three years, but described massive alcohol cravings whenever faced with the slightest cue stimuli. He states that he spent much of his time and effort avoiding being exposed to these alcohol related stimuli. After initiation of DBS he has remained abstinent from alcohol since January 2008 (at time of publication). During the first two weeks after implantation, he developed a hypomanic period that subsided after adjustment of the stimulation. He reports that cravings have completely disappeared, and his nicotine consumption has gone down from 40 to 15 cigarettes a day.
Patient three is a 40-year-old male who began drinking in his early teens. By the time he was 30 he was drinking up to three liters of alcohol a day. The patient has only participated in one LTIT of seven weeks, and states that he cannot remember being sober for more a few months during his struggles with alcoholism. During this time the patient has had several troubles with the law, and even served two years of a three year sentence in a forensic psychiatric hospital. After initiation of DBS the patient has had four relapses, all of which he was able to stop at his own will. Even with the relapses, the patient has put together 12 months of sobriety, and recalls that he had not been able to do this in the 10 years prior to DBS. In his own opinion, DBS has changed his life (Muller et al., 2009).
Discussion
Although it is hard to find this study being replicated anywhere, just yet, I believe it is only the beginning in a new direction for addiction related treatments. Even though DBS is not practical, being that it requires surgery and can cost upwards of $30,000 dollars, it has provided a new way to look at addiction other than it being a behavioral or spiritual problem. I sincerely believe that this is the beginning of a paradigm shift in the way addiction is treated and even viewed by the public.
