The arguments surrounding the root cause of addiction have raged for decades. Addiction is often viewed as a societal or moral failing rather than a biological one. Many people believe that it is a choice to continue to drink or use vs. an illness. But is this really the situation?
I recently sat down with Dr. Mark Thomas of the Department of Neuroscience at the University of Minnesota who is conducting research into therapeutic brain stimulation. He talked with me at length about how it might affect those with addiction issues. To sum it up: This invaluable research will most likely change the current landscape of addiction recovery.
“To me, it will be a big leap forward when we convince more people that this is a biological failing and that by understanding the biology, we can reduce stigma and leverage that for new therapies,” Dr. Thomas stated.
It was apparent to me during this interview that Dr. Thomas is extremely knowledgeable and has had a lifelong dedication to the area of neurobiology. The unique research that he and his team are undertaking most likely will change both how we view addiction in the future and how we address the recovery journey around it. But how did he get here?
Where It All Began
Dr. Thomas was studying a basic biology undergrad class at UCLA back in the 90s when he was drawn into the world of neurobiology. Through this class he learned that “the brain changes with experience, memories are stored in a way we don’t yet still understand and last for a lifetime and laid down in physical changes and biochemical changes.” From there his journey culminated in a PhD in neuroscience and progressed further with two post doctorates in psychiatry and psychology. He moved around the States a bit before finding his place back in his home state of Minnesota in 2003 studying neurosciences.
This means that the brains of those suffering from addiction are working against them in some areas.In 2014, he became part of the Medical Discovery Team on Addiction, a research program funded by the state. The purpose of this research was to “examine how addictive drugs alter the brain and how these changes can lead to compulsive drug use.” Dr. Thomas is now director of the team and his team’s research is focused on ways to disrupt relapse in addiction.
The work that Dr. Thomas and his team is doing goes beyond the usual academic parameters. From the very beginning, he was out in the community giving talks and connecting with various groups on the goals of the project. Dr. Thomas explained that “[The goal of the research is] to get synergy between different research areas from biochemistry and genetics all the way up to human brain imaging and into the clinic.” Their goal is to work together in finding some tools that can be used directly with the people who can benefit the most.
“The memories laid down by the brain are not just beneficial changes but maladaptive changes that can disrupt normal functioning, for example PTSD (post-traumatic stress disorder), [as well as] substance use disorder,” Dr. Thomas told me. This means that the brains of those suffering from addiction are working against them in some areas.
Dopamine, the well popularized “pleasure molecule,” is viewed differently in the world of neuroscience these days. Dr. Thomas explains “This is not trivial. The way that we think of it now is that it is a ‘do it again’ molecule. It has developed over time in order for organisms to pursue the mechanisms for their own survival.” What this means is that dopamine is greatly enhanced when drugs that can be misused enter the body’s system. Basically, dopamine puts the body into survival mode, and it “instructs” the body to “do this again.”
Dr. Thomas presents a sobering thought: “This is a very different take. It’s a critical piece of this story. Once you think of it that way…even though it’s not a conscious thing, even though you’ve been repeatedly exposed to something, your brain is saying, ‘Go get some more of that stuff. That’s going to help us survive!’…that’s a different way of looking at it.”
Real Life Research
The University of Minnesota has one of the world’s best brain imaging centers. University of Minnesota’s director of the Center for Magnetic Resonance Research (CMRR), Dr. Kamil Ugurbil, has done research into magnetic resonance imaging; this has put the University of Minnesota on the world map in regard to neuroscience. All positive support for further research in the area of the brain in the state of Minnesota. Some of these previous monitoring modalities were also used in Dr. Thomas’ own research work.
One of the challenges presented by research work is working with animal models. Dr. Thomas explains that although working with animal models can be more cost and time effective than working with people, you have to then look to see if those principles hold in human brains. That makes translating the work into clinical practice more difficult.
However, the team has been working directly with human brains in clinical research. So, how does that work?
Non-invasive Therapeutic Brain Stimulation
The therapeutic brain stimulation research carried out by the Medical Discovery Team on Addiction is not invasive like past models of therapeutic brain stimulation. The brain is “an electrical organ” and it is not the first time that it has been used in therapeutic applications. Dr. Thomas gives an example. “Brain surgery that implants electrodes into motor areas for intractable Parkinson’s disease, and other motor disorders, has been used for a couple of decades.” It may not be the first line of approach but if drugs designed to help with the disease don’t work then this method of therapeutic brain stimulation reaches areas of the brain to disrupt motor control that causes rigidity and tremors.
Other less invasive but targeted motor stimulation therapies include transcranial magnetic stimulation and transcranial direct current stimulation.
Neuroscience stimulation carried out by the Medical Discovery Team on Addiction is still targeted but very mild. “It is a cap that goes over the skull, has electrodes on it, some are configured to measure electrical information from the brain and EEG [electroencephalogram] recordings or configured to direct electrical stimulation across the scalp and skull and into the brain regions affected during different psychiatric conditions including addiction,” Dr. Thomas said. “We think this is a new way forward, to steal a phrase, to really get at the key issue. With drugs you are going to have side effects. We may have side effects with this, but we think that the chances of having side effects are lower because we are actually targeting the specific brain region that we need to address.”
There have been some really impressive efficacies for alcohol use disorder.Patients are given transcranial direct current stimulation at the same time that they are performing cognitive tasks. These might be difficult cognitive games played on the computer, for example. Dr. Thomas expanded: “The two together, the thinking goes, is what provides real specificity of the stimulation. The electrical stimulation by itself is kind of so mild and not as able to be targeted as we’d like but when the brain’s own activity is layered on top of it, that gives enough efficacy and enough specificity that we’re really hitting the targets that we want to hit.” As with all research studies, sham treatments are also given in the study program where patients are set up with the cap but are not given the stimulation treatment.
Treatments are carried out daily. Much of this work has been done by team members Dr. Jazmin Camchong and Dr. Kelvin Lim of the psychiatry department. They follow the patient for a couple of weeks following release from the program, or even up to three months afterward.
And the results? Research shows that there has been a two-thirds lower relapse rate than normal. “There have been some really impressive efficacies for alcohol use disorder.” Dr Thomas added. He is optimistic that the research program is on the right track, and they just have to keep working on it and refining it.
Research on addiction from various focus groups from around the world (not just at the University of Minnesota neuroscience department) has shown that there are quite a number of things in common between different addictive substances in how the brain responds and changes. They are also seeing things that are different between them, but the focus has been on finding the commonalities and using that information. It’s hard to compare like for like as separate groups and studies carry out the research work and these could be experimental variabilities or the drugs themselves. Lab research also doesn’t take into account that people often take or use more than one drug at a time; this approach is too complicated to assess. By focusing on commonalities, it is hoped that something “broadly useful” might be found.
The Future of Neuroscience Research for the Recovery Community
Dr. Thomas is very optimistic about recovery treatment for addiction. He said he hopes that “Some forms of neurostimulation treatment will be widely available within, let’s say, ten years but there are individual to individual differences.” He believes that finding things that will be useful for subpopulations of people is going to be easier than finding something that will be a broadly useful tool. He added that a lot of refining needs to take place for it to be broadly useful.
He speculated that in the future, “There could potentially be temporary drug treatments that could be used in conjunction with brain stimulation in conjunction with cognitive training or other kinds of psycho-social training and finding those good combinations I imagine is going to take us a while.”
Dr. Thomas reiterated that “There is a lot of stigma surrounding addiction and if it is a brain disease or not. There is a clear biological component to it and the more that we understand about it and the more that we disseminate that understanding I think that it leads to an easier path to compassion for those who are suffering.” He also stated that it allows people to help them use this information for better treatment. All of this leads to leverage for new therapies.
Support from the Recovery Community
Back to the recovery community at large, where the initial word about the research program was spread. Dr. Thomas closed out with: “One thing that is important as a team is that we are in contact with people in our community who are working on the same issue from different angles. It is a bit unique for an academic team of neurobiologists to be out in the community in the way that we are, which is a pretty significant way of working with community partners and recovery organizations and with partners in our state government as well. It means a lot to us to interface with people outside of our academic silo.”
It means a lot to us to interface with people outside of our academic silo.There is a lot of work ahead, but the future looks a little brighter for the recovery community with the addition of a potentially more significant and powerful tool to help in the healing journey. It won’t eliminate the need for the support and care already in place but will bring new tools to the table.
In closing, Dr. Thomas philosophized: “Our basic philosophy is that addiction is not a moral failing, it is a biological failing…by trying to understand that we can leverage that information for new therapies that will be new tools in the toolbox for clinicians and therapists to use.”
Sharon Chapman is a published author and editor with over fifteen years’ experience. She is the published author of Authentic Aromatherapy (New York: Skyhorse Publishing) and editor in chief for various US publications. Learn more about her freelance writing, editing, and publishing services.
Last Updated on September 9, 2024