‘Brain pacemakers': implants to be tested to help alcohol and opioid addicts
Surgeons are to put implants into the brains of alcoholics and opioid addicts in a trial aimed at testing the use of electrical impulses to combat drink and drug cravings.
The technique is already used to help patients control some of the effects of Parkinson's disease, depression and obsessive-compulsive disorder (OCD). Now a group of doctors and researchers – from Cambridge and Oxford universities and King's College London – are preparing to use deep brain stimulation to try to decrease addicts' yearnings and to boost their self-control.
'Deep brain stimulation acts like a pacemaker,' the project's chief investigator Prof Valerie Voon, of Cambridge University's psychiatry department, told the Observer.
'Just as we can use a pacemaker to stabilise abnormal electrical rhythms in a person's heart, we believe we can use a brain implant to act like a pacemaker and normalise deviant electrical brain rhythms that are linked to addiction. This trial will show if this is a practical idea.'
The use of brain implants has become popular with doctors treating brain disorders in recent years. More than a quarter of a million people are fitted with them to control symptoms of a range of conditions. In the case of Parkinson's disease, implants deliver impulses to movement centres in patients' brains and halt symptoms that include tremors and involuntary movements.
Several recent small proof-of-concept studies have suggested the technique could be expanded for use as a treatment for alcohol and opioid addicts. Scientists are now finalising plans for the first full clinical trial of deep brain stimulation to determine if it could be expanded to counter the growing crisis of alcohol and drug addiction in the UK and other countries.
Several hundred thousand people are dependent on alcohol in the UK and about a quarter of those require treatment for anxiety and depression and other associated health problems.
Opioid addiction is also a serious health problem. Almost half of all fatal drug poisonings now involve opiates such as heroin and morphine.
'Most people are highly disabled if they become seriously addicted to alcohol or opioids,' said Voon. 'Nor does their craving affect only them. Their families, their parents, their siblings, their spouses and their children also suffer. Addiction is never just an individual disorder.
'Addicts are unable to work and also face the danger of taking overdoses. It has become a very serious issue for modern society.'
A total of six alcoholics and six opioid addicts will be picked for the trial, which is called Brain-Pacer (brain pacemaker addiction control to end relapse). To be selected, these individuals will have to have suffered at least five years of addiction and had at least three relapses. They will also have to have previously received conventional medications or psychotherapy.
Each person in the trial – which will be carried out at Addenbrooke's hospital in Cambridge and King's College hospital in London – will have a slender electrode placed in precise locations in the brain.
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For addicts, this will involve neural areas that are involved in reward, motivation and decision-making. The electrodes will then be connected to a pulse generator that is implanted in their bodies, most likely in their chests. This device will deliver the electrical impulses that will moderate the neural activity that is triggering their addiction, it is hoped.
'The aim is to decrease a person's craving and increase their self-control by providing these electrical impulses,' added Voon.
Crucially, the trials will be randomised so that electrical signals will not be turned on at all times while the brain activity of addicts will be recorded. In this way, the team hopes that they will not only develop new treatments for addiction but will generate fresh understanding of the brain mechanisms that drive alcohol and opioid cravings.
Keyoumars Ashkan, professor of neurosurgery at King's College hospital and the lead surgeon for the study, said deep brain stimulation was clearly a powerful surgical technique that could transform lives.
'It will be a major leap forward if we can show efficacy in this very difficult disease with a huge burden to the patients and society.'
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