Alcoholics struggling to stay sober are faced with countless triggers that can lead to relapse — driving past a bar, getting together with former drinking buddies or even just feeling down.
And this is a big problem. Alcoholism is a growing epidemic responsible for at least a quarter trillion dollars in U.S. health care costs per year, as well as inestimable anguish. Current medical therapies have high rates of noncompliance and variable effectiveness.
In the future, severe alcoholics with multiple failed attempts at intensive medical therapies and in-patient rehabilitation may have a different treatment option for their addiction — deep brain stimulation (DBS) — as recently reported in a review article by Stanford researchers in Neurosurgical Focus.
Currently, deep brain stimulation therapy for alcohol use disorders is not approved by the U.S. Food and Drug Administration, but it is widely used to treat Parkinson’s disease and obsessive-compulsive disorder.
“DBS is a minimally-invasive brain surgery,” explained senior author Casey Halpern, MD, an assistant professor of neurosurgery at Stanford. “For Parkinson’s, we place deep brain stimulators to restore normal function of the region in the brain known to be dysfunctional. Patients improve immediately when a small dose of current is delivered to this area. We anticipate a similar treatment will be possible for alcoholism. At the moment, we’re performing animal studies to optimize this potential therapy and to learn its underlying mechanism of action.”
For alcohol use disorders, researchers are targeting the nucleus accumbens, which plays a central role in the brain’s reward circuitry. They previously found that brain stimulation of this region could reduce impulsive behavior.
“The nucleus accumbens is triggered when patients anticipate a reward or prior to completing a rewarding behavior. It's been shown to be perturbed in both addictive disorders and OCD,” said Allen Ho, MD, a Stanford neurosurgery resident working with Halpern. “By targeting this brain structure with stimulation, we hope to modulate the reward circuit in the brain to help patients resist the temptation to indulge in a binge and other addictive behaviors.”
The review article outlines animal studies and pilot human subject studies that have shown promising reductions in alcohol consumption and, in some cases, long-term abstinence.
According to Ho, this success is in part due to the fact that DBS doesn’t rely on patient compliance with therapy sessions, in-patient rehab, medications and abstinence. “Once the patient makes a decision to undergo treatment and the stimulator is implanted and turned on, they don't have to make a conscious decision to pursue treatment — it is 'on' all the time,” said Ho.
Brain surgery may sound scary, but Ho explained that DBS is one of the safest and least invasive operations that they do as neurosurgeons. He believes alcoholics will consider the treatment since the addiction can devastate their lives, he said.
The Stanford team also hopes to apply deep brain stimulation to other addictions. “Should DBS prove effective for alcoholism, we anticipate a similar therapy could be very helpful for all addictions and even obesity,” said Halpern.
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