How Neuroscience Can Assist With the Treatment of Addiction

Neuroscience is the study of brain mechanisms, how they function, how they are constructed, and how they relate to behavior (Kuhn & Koob, 2010). Neuroscience is a broad field that scrutinizes these brain mechanisms at all levels from the molecular and genetic levels all the way to the higher-order psychological processes and even to the understanding of clinical conditions. Because of its scope and its relevance to all aspects of behavior, neuroscience offers several unique contributions to understanding issues like addiction from multiple levels of analysis.

John is a 60-year-old male with no prior history of addictive behavior or mental illness and no family history of substance abuse who developed a substance use disorder to alcohol and the benzodiazepine Valium. The clinical case of "John" is not unique; however, the case offers an example of how little science can help understand, assess, and treat addictions. In the treatment of addiction clinicians follow a three stage process: assessment, intervention, and treatment of the addictive behavior. Neuroscience can assist the process at all three levels.

Assessment

Neuroscientists are finding links to biological variations in the human brain that increase or even reduce the risk to develop a substance use disorder. Moreover, genetic neuroscience is finding associated genetic links that increase the risk for addictive behavior.

Typically the assessment of a substance use disorder is achieved via a clinical interview that includes the person's history, family history, self-report of the current problems, possible collaboration with friends or relatives, and possible adjunctive information such as reports from work, police reports, incarceration history, etc. (Samet, Waxman, Hatzenbuehler & Hasin, 2007). Clinicians may also administer paper and pencil assessment inventories that can be completed by the subject, the subject's friends or relatives, or others. The clinician will then develop a formulation based on self-reports, collaborative reports, and any other documentation available in the case. There is a need for -- clinical measures that can differentiate patients who meet the clinical criteria for substance use disorders for the same addictive agent while at the same time having different backgrounds, responses the prior treatment, and so forth.

Neuroscience has identified potential biomarkers that can be extremely useful in the assessment of a particular substance use disorder and help to understand the vulnerabilities and current neurobiological substrate of the person in question (Wilson, Thomas, & Iacono, 2015). Although still in their infancy, the techniques of neuro-imaging, EEG assessment, and biofeedback can be useful in differentiating these issues (Wilson et al., 2015). At this time it appears that using these instruments to help assess such things as the executive functioning ability of the individual, neural responses to certain types of incentives such as addictive substances or addictive activities, genetic associations that are associated with high probabilities to developing substance use disorders, and the valence of a person's emotional responses to specific types of stimuli can be useful in conjunction with the traditional assessment tools to help to assess the particular issues and etiology of an individual's problem as well as to outline specific types of treatment interventions, personal vulnerabilities, and specific goals of treatment for the individual in question (Wilson et al., 2015). Certain neuro-imaging techniques may be expensive; however, other techniques such as genetic testing, EEG analysis, biofeedback, etc. are less costly and offer the possibility of empirically validated neurological/biological assessment indicators.

In the case of John such techniques would have been useful in identifying particular vulnerabilities and biological indicators that suggest future risk factors.

Intervention

Neuroscience offers a unique opportunity to develop early prevention and early intervention programs based on the research regarding the findings of the vulnerability of certain individuals to substance use disorders/drug usage (Nutt, McLellan, Crome, Kimberley & McLellen, 2014). The research has outlined how the initial drug use can result in progressive changes in the brains of certain individuals that shape its future substance use disorders and other problems with addiction. Even though there are many unanswered questions regarding this process it makes little sense not to use the available information to help construct potential early detection programs for at-risk individuals and implement them at the community level.

One of the findings of neuroscience that has endured is the notion that repeated use of the substance aggressively and permanently alters both the neural circuits in the brain and gene expression leading to a situation where it becomes increasingly more difficult for the individual to stop their behavior. By implementing the findings of neuroscience to develop early intervention/prevention programs by identifying at-risk individuals, assisting them to find more positive and progressive ways to express themselves, offering them early access to mental health services, and so forth, such programs could only help decrease the incidence of new cases of addiction and substance use disorders.

In addition, the current governmental policies regarding how individuals with substance use disorders are treated (such as incarceration or other punishments) have been ineffective at reducing the prevalence of individuals with substance use disorders (Nutt et al., 2014). The findings of research in neuroscience has indicated that once the changes in the neural circuitry and genetic expression of individuals with substance use disorders has occurred the policy of punishing individuals with addiction is essentially ineffective (Nutt et al., 2014). The available research in neuroscience should serve as a societal incentive to develop more effective programs to deal with individuals who suffer from addiction.

In the case of John we can speculate that had specific identification and early intervention/prevention programs been implemented when he began to receive Valium his physician could have potentially assessed his risk for addiction and then develop a program to decrease the probability that John would experience issues with Valium.

Treatment

The current approach to treating addiction typically involves education, some type of therapeutic intervention, and unless the individual is also burdened by legal issues very little long-term follow-up. The treatments for substance use disorders are traditionally short-term and often not effective (Nutt et al., 2014). One of the advantages to evolving the research of neuroscientists in the treatment process could allow for a better understanding as to why the current treatment modalities are not consistently able to produce positive changes (see Carhart-Harris, Leech, Hellyer, Shanahan, Feilding, et al., 2014). Moreover, because the researcher neuroscience outlines the changes that occur in the brain and at the molecular level this research can help to emphasize the need for longer term interventions and long-term follow-up for individuals who have been victim to addiction. This research could also help identify changes and these traditional treatment modalities that could result in their being more efficacious.