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Trends in Treatment: Brain Imaging and Recovery

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Neuroimaging and Addiction Treatment:

What It is and How It Can Help

Modern medicine is like a miracle.

Today we can treat diseases, injuries, and chronic conditions that not long ago would have left many of us dead or disabled. This is true for everything from cancer to heart disease to broken bones and torn tendons. Early in the 20th century, a badly torn anterior cruciate ligament (ACL) in the knee would have left someone limping for life. Now that same person can get arthroscopic surgery, go through rehab, and resume typical or even extreme activity within months.

The same goes for a wide range of ailments. We have the ability get people up and running after heart attacks, strokes, brain surgeries, and spinal injuries. It’s an amazing time in medicine, one which most of us take it for granted. We fail to realize how good our doctors, our treatments, and our medications truly are, in the grand scheme of human medical history.

Seeing Inside the Body

One of the main reasons we can do so much these days is because of our diagnostic tools. For centuries we flew blind. We only looked inside human bodies after they were dead – obviously too late for diagnosing injury or illness. Then, X-ray technology allowed us to peer inside the living body and see solid structures like bones. MRI (Magnetic Resonance Imaging) came next, allowing us to see soft tissue like tendons and ligaments. Not long after that, CAT (computerized axial tomography) showed us the brain, spinal cord, and major organs in ways we’d never imagined. More recently, Electroencephalograms (EEG) have allowed us to visualize brain activity by measuring the electrical waves released when neurons (brain cells) fire. Which is all day, every day.

Now, a whole new era of imaging is here. The latest techniques allow us to see inside the brain in real time. That means we can see not only form – i.e. physiological structures – but also function – i.e. the way the brain works when it’s performing the complex task of staying alive. This is great news for addiction and substance/alcohol use disorders, conditions with causes and manifestations that blur the lines between form and function.

Peeking Inside the Brain: The Techniques

Brain imaging technology falls into three classes:

  1. Nuclear imaging techniques such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) use the radioactive nature of photons and positrons to create pictures of the brain.
  2. Magnetic Resonance techniques use electromagnetic waves to create pictures of the brain.
  3. Electrophysiological techniques use the electrical activity of neurons to create pictures of the brain.

Rusty on your chemistry and physics?

Here what you need to know about what you just read: positrons are always paired with electrons, which are tiny particles that orbit around the nucleus of an atom. Photons are light particles. In this case they’re released when a positron interacts with an electron from a nearby atom. Magnetic resonance basically works like radar. Magnets send focused electromagnetic waves into the body, which then bounce back. The MRI machine collects them to form a picture of the target tissue. Electrophysiology simply refers to the electrical nature of our brain. Neurons fire as the result of a chemical reactions that causes the releases an electric charge. Depending on the brain area being measured, they release waves of a particular length (wavelength).

How Neuroimaging Helps Treat Addiction

First, we need to back up and explain what we know about the relationship between brain function and alcohol/substance use disorders. Disclaimer: neuroscientists typically spend about a decade in college, graduate school, and post-doctoral positions before they get a handle on how the brain functions. Even then, the wisest of them admit they really know very little in comparison to what’s left to know about the brain. Which means the following explanation will be simplified for general consumption.

Here’s what the latest research tells us about brain form, function, and addiction:

Cue Reactivity

The brains of individuals diagnosed with substance use disorders show non-typical reactions to certain types of input from the environment. Input, or cues, related to drugs, alcohol, or other substances receive a higher priority than other cues. This means the addicted brain rearranges internal motivations, which can lead to intense craving – a primary contributor to active addiction and relapse.

Impulse Control

Impulsivity, defined as “making decisions quickly without forethought or regard for potential consequences,” is widely accepted as a behavioral tendency directly associated with substance use disorders. The brains of individuals diagnosed with substance use disorders show non-typical function in brain areas known to control decision-making, risk assessment, and outcome prediction. This means addiction compromises brains when it comes to making choices regarding substances of abuse.

Cognition

Cognition means how the brain processes information, makes decisions, and controls behavior. Individuals diagnosed with substance use disorders show cognitive deficits in many areas, such as attention, impulsivity, mental flexibility, and working memory. Brain imaging in these individuals shows non-typical function in brain regions that control cognition. This means that the addicted brain thinks – generally speaking – in ways that are different than the non-addicted brain. These altered modes of thought predispose the addicted individual to continued substance use and relapse.

How This Knowledge Helps Addiction Treatment

This new information – derived from the latest neuroimaging techniques – allows behavioral scientists to understand what’s going on at the physiological level while an individual is struggling with addiction. Data from MRI and CAT scans show the non-typical brain physiology associated with addiction, as compared to the typical physiology of non-addicted brains. This is a giant step in the world of addiction treatment. It proves there’s a biophysical component to substance use disorders.

Though MRI and CAT scans do not show brain function in real time – they’re not sensitive enough for that – their data debunk the notion that addiction is a behavioral disease only. This is crucial because for decades, a common misconception plaguing addiction treatment was that addicted people simply lack the willpower to quit and make it stick. While it does take considerable willpower to achieve sustained sobriety, willpower is far from the entire story. And now we have the data to fill in the gaps.

Enter fMRI, PET scans, SPECT scans, and EEG technology, which take brain imaging to the next level. These techniques allow scientists to look inside the brain in real time while it’s making choices using brain areas related to addiction. Whereas identifying non-typical physiology related to addiction is a big step, this step is even bigger. It allows both mental health professionals and people in treatment to see precisely what brain areas are working, and when. Imaging also allows them to see how those brain functions affect behavior and emotion. It gives quantifiable data and verifiable images to previously subjective notions. We can now understand craving, the inability to say no, and the ability to rationalize substance abuse in ways we never have before.

Potential Treatment Applications

Real-Time Feedback

Basic neuroimaging tells us that non-typical physiology in brain areas related to cue reactivity, impulse control, and cognition are common to individuals diagnosed with alcohol and substance use disorders. Real-time neuroimaging confirms non-typical function in those same areas is also common to individuals struggling with addiction. These two technologies, when combined with contemporary behavioral and medicinal therapies, have the potential to revolutionize addiction treatment. From a pharmacological perspective, they’ll enable bioengineers to tailor medications and test their effectiveness in real time. On a behavioral level, they’ll allow patients and therapists to try various techniques and analyze their effectiveness, also in real time.

Form and Function

Imagine this: an individual enters treatment for an alcohol or substance use disorder. They receive a baseline brain function test using the latest neuroimaging techniques. The new technology asses and records both form and function. The patient and therapist can see the results. They can use the data to collaborate on a course of treatment that remediates the non-typical areas, shores up the borderline areas, and doesn’t waste time on areas that work well. Then, after a period of treatment, form and function can be re-assessed, and compared against the patient’s subjective experience. The course of treatment can be adjusted, thrown out, or continued. All based on data and facts, rather than individual perceptions and professional judgment calls.

Techniques in Action

That’s not all, though. Imagine another scenario: a person struggling with addiction enters treatment and receives a neuroimaging assessment. They see the results and understand exactly which brain areas contribute to their addiction. They see the what, the why, the when, and the how. Then, after a time in treatment, they take the next step. While connected to the imaging device, their therapist challenges them with images or ideas that previously triggered addictive behavior.

They see their addiction-related brain areas light up like a Christmas tree.

Then – still connected to the device – they apply a mindfulness technique or a coping skill learned during talk therapy. It’s possible they’ll see, right then and there, whether the technique works or not. That would be revolutionary, indeed. They’d get real-time biophysical feedback on the effectiveness of their technique. They’d be able to compare that feedback to their subjective impressions. And they’d be able to do it all with the support of treatment specialists.

On the Cutting Edge

Granted, that last example is speculative, but it’s not sci-fi level speculative. It happens in pieces – not exactly as described above, but close – in various cutting-edge treatment centers around the world. It’s grounded in current technology and completely plausible. Especially considering the rate at which the information age propels medical technology forward every day. It’s likely an ambitious, creative scientist is hard at work right now, perfecting innovative ways to integrate real-time neuroimaging into addiction treatment. This idea gives us hope for all the people in the world currently searching for the right combination of therapies to help them break the cycles of substance abuse and achieve sustainable, lifelong sobriety.

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