Kick Ass Kick Addiction
Gallimberti thought TMS might offer a practical way to do that. Our brains run on electrical impulses that zip among neurons with every thought and movement. Brain stimulation, which has been used for years to treat depression and migraines, taps that circuitry.
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The device is nothing but a coiled wire inside a wand. When electric current runs through it, the wand creates a magnetic pulse that alters electrical activity in the brain.
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Gallimberti thought repeated pulses might activate drug-damaged neural pathways, like a reboot on a frozen computer. He and his partner, neurocognitive psychologist Alberto Terraneo, teamed up with Bonci to test the technique.
They recruited a group of cocaine addicts: Sixteen underwent one month of brain stimulation while 13 received standard care, including medication for anxiety and depression. By the end of the trial, 11 people in the stimulation group, but only three in the other group, were drug free. The investigators published their findings in the January issue of the journal European Neuropsychopharmacology. That prompted a flurry of publicity, which drew hundreds of cocaine users to the clinic. Perotti came in edgy and agitated. After his first session, he says, he felt calm.
Soon he lost the desire for cocaine. It was still gone six months later. It will take large, placebo-controlled trials to prove that the treatment works and the benefits last. The team plans to conduct further studies, and researchers around the world are testing brain stimulation to help people stop smoking, drinking, gambling, binge eating, and misusing opioids. In Seoul, e-stadiums and gaming parlors charge about a dollar an hour, and some venues are open around the clock.
Soon after South Korea made super-high-speed Internet cheap and widely available, it became clear that some people were ruining their lives through obsessive game playing. The government now pays for treatment. But advances in neuroscience have upended conventional notions about addiction—what it is, what can trigger it, and why quitting is so tough. That explained alcohol, nicotine, and heroin reasonably well. Why do people long for the burn of whiskey in the throat or the warm bliss of heroin after the body is no longer physically dependent? This view has led many scientists to accept the once heretical idea that addiction is possible without drugs.
The most recent revision of the Diagnostic and Statistical Manual of Mental Disorders, the handbook of American psychiatry, for the first time recognizes a behavioral addiction: gambling. For years Childress and other scientists have tried to unravel the mysteries of addiction by studying the reward system. Through complex algorithms and color-coding, brain scans are converted into images that pinpoint the circuits that kick into high gear when the brain lusts. Childress, who has flaming red hair and a big laugh, sits at her computer, scrolling through a picture gallery of brains—gray ovals with bursts of color as vivid as a Disney movie.
All we see is spots that the computer turns into fuchsia and purple and green. But what are they trying to tell us? It operates in the realm of instinct and reflex, built for when survival depended on the ability to obtain food and sex before the competition got to them. Craving is driven by the neurotransmitter dopamine. Desire is triggered when dopamine, which originates near the top of the brain stem, travels through neural pathways to act on the brain. Drugs increase the flow of dopamine.
Desire depends on a complex cascade of brain actions, but scientists believe that the trigger for this is likely to be a spike in the neurotransmitter dopamine.
A chemical messenger that carries signals across synapses, dopamine plays wide-ranging roles in the brain. Most relevant to addiction, the flow of dopamine heightens what scientists call salience, or the motivational pull of a stimulus—cocaine, for instance, or reminders of it, such as a glimpse of white powder. How powerfully? The disease destroys dopamine-producing cells, primarily affecting movement. Through learning, the signals or reminder cues for rewards come to provoke surges of dopamine.
In a study published in PLoS One she scanned the brains of 22 recovering cocaine addicts while photos of crack pipes and other drug paraphernalia flashed before their eyes for 33 milliseconds, one-tenth the time it takes to blink. By the time they became conscious of it, it was like a snowball rolling downhill. The brain, of course, is more than an organ of reward. Why do craving and habits overpower reason, good intentions, and awareness of the toll of addiction? Goldstein and her team are testing whether neurofeedback, which allows people to observe their brains in action, can help addicts take more control over compulsive habits.
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Changes in this part of the brain affect judgment, self-control, and other cognitive functions tied to addiction. People with addiction often persist in using drugs to relieve the misery they feel when they stop. At Marshak Clinic, a drug-treatment center near Moscow, a six-month dose of Antabuse is implanted under the skin of a recovering alcoholic about to be discharged after a day stay.
The medication will cause him to vomit if he drinks, a form of aversion therapy. The clinic also relies heavily on other strategies to try to break the addiction, including yoga, individual and group counseling sessions, amino acid supplements, dietary changes, and antidepressants. In , working with Nora Volkow, now the director of NIDA, Goldstein published what has become an influential model of addiction, called iRISA, or impaired response inhibition and salience attribution.
As drug cues gain prominence, the field of attention narrows, like a camera zooming in on one object and pushing everything else out of view. They generally perform worse, but not always. It depends on the context. For example, on a standard task that measures fluency—how many farm animals can you name in a minute?
But when Goldstein asks them to list words related to drugs, they tend to outperform everyone else. Chronic drug users are often great at planning and executing tasks that involve using drugs, but this bias may compromise other cognitive processes, including knowing how and when to stop. A study tracked 19 cocaine addicts who had abstained or severely cut back for six months.
They showed significant increases in gray matter volume in two regions involved in inhibiting behavior and evaluating rewards. Marc Potenza strides through the cavernous Venetian casino in Las Vegas. Electronic games—slot machines, roulette, blackjack, poker—beep and clang and trill. Out of the pleasure palazzo, he heads down an escalator and through a long concourse to a sedate meeting room in the Sands Expo Convention Center, where he will present his research on gambling addiction to about a hundred scientists and clinicians.
The meeting is organized by the National Center for Responsible Gaming, an industry-supported group that has funded gambling research by Potenza and others.
Potenza stands at the podium, talking about white matter integrity and cortical blood flow in gamblers. Just beyond the room, expo exhibitors are setting up displays touting innovations engineered to get dopamine flowing in millennials. E-sports betting. Casino games modeled on Xbox. More than 27, game manufacturers, designers, and casino operators will attend. Potenza and other scientists pushed the psychiatric establishment to accept the idea of behavioral addiction. The association considered the matter for more than a decade while research accumulated on how gambling resembles drug addiction.
Insatiable desire, preoccupation, and uncontrollable urges. The fast thrill and the need to keep upping the ante to feel the fireworks.
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An inability to stop, despite promises and resolve. Potenza did some of the first brain-imaging studies of gamblers and discovered that they looked similar to scans of drug addicts, with sluggish activity in the parts of the brain responsible for impulse control. Sylvie Imbert and Yves Brasey credit baclofen, a medication used to treat muscle spasms, with freeing them from their devotion to the bottle. In studies, baclofen has shown promise for treating alcohol dependency. Brasey, having a beer at the Hotel Luxembourg Parc in Paris, now has just a few drinks at a time. Imbert had six to nine drinks almost daily until she started taking baclofen.
Now she drinks only occasionally. Imbert and Brasey have become outspoken advocates for the drug. Now that the psychiatric establishment accepts the idea that addiction is possible without drugs, researchers are trying to determine what types of behaviors qualify as addictions. Are all pleasurable activities potentially addictive? Or are we medicalizing every habit, from the minute-to-minute glance at email to the late-afternoon candy break?
In the United States the Diagnostic and Statistical Manual now lists Internet gaming disorder as a condition worthy of more study, along with chronic, debilitating grief and caffeine-use disorder. So do compulsive shopping and sex, food addiction, and kleptomania. Can a primal desire be addictive? The World Health Organization has recommended including compulsive sex as an impulse control disorder in its next edition of the International Classification of Diseases, due out by But the American Psychiatric Association rejected compulsive sex for its latest diagnostic manual, after serious debate about whether the problem is real.
Nicole Avena, a neuroscientist at Mount Sinai St. She says high-fat foods and highly processed foods such as refined flour may be as problematic as sugar. Avena and researchers at the University of Michigan recently surveyed adults: Ninety-two percent reported a persistent desire to eat certain foods and repeated unsuccessful attempts to stop, two hallmarks of addiction.
The respondents ranked pizza—typically made with a white-flour crust and topped with sugar-laden tomato sauce—as the most addictive food, with chips and chocolate tied for second place. Avena has no doubt food addiction is real. Science has been more successful in charting what goes awry in the addicted brain than in devising ways to fix it. A few medications can help people overcome certain addictions. Buprenorphine activates opioid receptors in the brain but to a much lesser degree than heroin does.