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Treating Addiction with Deep Brain Stimulation

When it comes to even more dramatic cutting-edge treatments, some doctors are turning to what we have already learned from two totally unrelated problems: Parkinson's disease and epilepsy. One treatment proving effective in both these conditions is a surgical intervention known as "electrical deep brain stimulation," and some experts believe it may work in drug addiction as well.

"For people who are sufficiently affected by their [addiction], deep brain stimulation it might be totally appropriate -- as appropriate as it is for Parkinson's or epilepsy," says Michael Kaplitt, MD, director of stereotactal and functional neurosurgery at Columbia Presbyterian Medical Center.

In this treatment, doctors implant a tiny electrode deep within the brain. Attached wires run under the skin to a small device located in the chest, not unlike a cardiac pacemaker. Using a hand-held unit similar to a remote control, patients can turn the electric current to their brain on and off, and in some instances, even regulate its strength.

In Parkinson's, Kaplitt says deep brain stimulation is being used to help control muscle tremors. In epilepsy, the treatment helps offset the occurrence of seizures. In drug addiction, he theorizes it may be useful in either stimulating the same area of the brain as the addictive substance -- thereby eliminating the need for the drug -- or by simply short-circuiting the cravings when they do occur.

"The anatomic pathways of drug addiction are similar to the Parkinson's pathways. Anatomically the areas affected are extremely close ... and thus far, animal studies suggest if you put electrodes into these same areas you can simulate or block drug addiction depending on how you stimulate," says Kaplitt.

While he stresses there are no human trials using deep brain stimulation under way for drug addiction, there are some in progress for depression and obsessive compulsive disorder. As such, Kaplitt believes the potential is also there for electronically wiping away drug addiction, and he hopes to start a clinical trial in the near future.

"Given that we have an even better understanding of the [changes in the brain that occur in] people with drug addictions as compared to depression, it seems perfectly reasonable to consider that we might be able to apply what we have learned from treating other diseases with deep brain stimulation to help people addicted to drugs. We can't predict or promise, but there's a definite possibility," says Kaplitt.

SOURCES:

Gopal K. Upadhya, MD, medical director, Areba Casriel Institute, New York. Marc Galanter, MD, director, division of alcohol and substance abuse, NYU Medical Center/Bellevue Hospital, New York. Margaret Haney, PhD, associate professor of clinical neuroscience, Columbia University; researcher, New York Psychiatric Institute, New York. Michael Kaplitt, MD, director of stereotactal and functional neurosurgery, Columbia Presbyterian Medical Center, New York. The 2003 National Survey on Drug Use and Health, Department of Health and Human Services Substance Abuse and Mental Health Services Administration. Drug Abuse Report: Buprenorphine, National Institute on Drug Abuse.

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Reviewed: 3/2006