The statistics are frightening. According to the Centers for Disease Control (CDC), more than 70,000 people in the U.S. died from drug overdoses in 2017, a number which doubled in 10 years. That translates into about 200 people dying every day from drug use, and the number continues to rise. More than half the overdose deaths were attributed to opioid use.
While many addicts have found recovery with the help of a treatment center or other addiction specialists, there are still those who have been unable to overcome addictive impulses. Recent studies using Deep Brain Stimulation (DBS) to treat addiction have shown promise.
What is DBS and How Does it Work?
DBS involves the implantation of electrodes into the areas of the brain responsible for producing abnormal symptoms. A neurostimulator, similar to a pacemaker, is placed under the skin of the chest. The neurostimulator delivers controlled high frequency electrical impulses to the brain via a wire connecting the device to the electrodes.
The electrical stimulation blocks abnormal signals that can trigger symptoms and helps normalize the impulses that govern certain physical or mental activity. Depending on the placement of the electrodes, the stimulation may affect areas of the brain controlling mood, movement, or other functions.
Deep brain stimulation (DBS) was first approved by the Food and Drug Administration (FDA) in 1997 to treat essential tremor and Parkinson’s disease. Subsequently, the FDA approved the therapy for dystonia (involuntary muscle contractions), obsessive compulsive disorder (OCD), and epilepsy. Currently, DBS is being evaluated as a potential therapy for depression, chronic pain, dementia, alcohol and drug addiction, and more.
While DBS does not cure disease, it can significantly reduce symptoms.
Risks and Side-Effects of DBS Surgery
As with any surgery, there are risks associated with the DBS procedure. Side effects may include brain hemorrhage, seizure, infection, or personality changes.
According to the National Institute of Mental Health (NIMH), possible adverse reactions of deep brain stimulation may include:
- Bleeding in the brain or stroke
- Disorientation or confusion
- Unwanted mood changes
- Movement disorders
- Trouble sleeping
The NIMH also cautions that long-term side effects and benefits of DBS are still being studied. However, the few studies that have been completed so far indicate that DBS could be a viable treatment option for addiction.
DBS for Addiction and Mental Disorders
While DBS has been FDA approved to treat obsessive compulsive disorder (OCD) since 2009, studies examining the efficacy of DBS to treat addiction and other mental health disorders are largely positive. Research and early study results indicate DBS may be useful in treating mental disorders, such as depression and substance use disorders.
DBS Treatment for Alcohol and Substance Use
Many animal studies have found a significant decrease in drug-seeking behavior when they receive brain stimulation during active drug use. A 2018 study published in Neurosurgical Focus theorizes that stimulation of the prefrontal cortex may block over-activity, “which is thought to lead to the diminished impulse control that is characteristic of drug addiction.” The study concludes more research is needed on the effects of DBS during withdrawal from drugs or alcohol.
Several studies of DBS to treat addiction are summarized on the International Neuromodulation Society website. Studies and findings include:
- 2016 study of DBS for cocaine dependence: After 2 1/2 years of study, DBS resulted in a significant decrease in the severity of cocaine dependence.
- 2016 study of DBS for alcohol dependence: DBS caused a complete and persistent absence of craving for alcohol but did not lead to complete abstinence in all patients treated.
- 2013 study of DBS for severe opioid addiction: DBS improved patients’ depressive and anxious symptoms and perceived quality of life. Some patients reported occasional consumption of other psychotropic substances.
- 2013 study of DBS for alcohol addiction: All patients experienced a significant and ongoing reduction in cravings. Two of five patients remained abstinent for more than 4 years.
- 2012 study of DBS for heroin addiction: Decreased use, and cessation of drug abuse for all 10 months of the study.
- 2011 study of DBS for heroin-seeking behavior: Complete cessation of drug use for 6 years (since the last follow-up). Significant improvement of memory and IQ. Improvements in depression and anxiety.
Three additional studies on the use of DBS for alcohol addiction have also shown similar positive findings.
DBS Treatment for Mental Health Disorders
Dr. Paul Holtzheimer, researcher on the neurobiology and treatment of mood disorder, states, “DBS is emerging as a potential intervention for patients with highly treatment-resistant depression (TRD)” in the webinar Deep Brain Stimulation for Treatment-Resistant Depression.
Holtzheimer heads a clinical research program at Dartmouth seeking to “better understand the neural circuitry underlying treatment-resistant depression and to use this information to develop and advance novel treatment approaches, with a particular emphasis on brain stimulation therapies.”
Researchers are finding DBS may help people with severe mental illness to improve focus, attention, working memory, and other cognitive processes, according to research recently published in the Journal of Neural Engineering. These processes are often impaired in those with mental disorders, making it difficult to overcome depression and anxiety.
The study states, “Electrical deep brain stimulation (DBS) can directly modulate the circuits underlying abnormal behaviors and has been proposed as a more effective approach for treating mental illnesses, including major depressive disorder (MDD) and obsessive compulsive disorder (OCD).”
DBS for Depression
Although there have been many studies of DBS for depression, few have been considered “high quality” studies, in which both a control group and a treatment group were used. However, as reported on the National Institute of Mental Health website, a review of 22 published studies found about 40-50% of participants receiving DBS had a 50 percent improvement in symptoms.
Another study, recently published online in The American Journal of Psychiatry, cites long-term data indicating DBS alleviates severe depression in patients for whom other treatment has been ineffective. Results also indicate that the anti-depressive effect lasts for a long period of time.
The study authors state, “Over eight years of observation, most of our study participants experienced an antidepressant response to the deep brain stimulation of Area 25 [area involved in mood regulation] that was robust and sustained.” The study, conducted at Emory University School of Medicine, supports findings of similar research.
Current Clinical Trials of Deep Brain Stimulation
Currently, there are several registered clinical trials throughout the world evaluating the use of DBS to treat addiction, according to the U.S. National Institutes of Health database. Most of these trials are located in China and include the use of DBS to treat alcohol, cocaine, and opioid addiction, as well as relapse.
The subject of one of their recent studies was a man who struggled for years with meth addiction. He had been in rehabilitation centers several times, without success, but after his DBS surgery was finally able to reach 6 months of sobriety. A separate study in China was published in January, showing that five of eight heroin users remained sober for two years after their DBS surgery. According to a U.S. National Institutes of Health database, there are now eight registered DBS clinical trials worldwide for drug addiction.
DBS Coming to America
Researchers at West Virginia University Rockefeller Neuroscience Institute (RNI) and West Virginia University Medicine (WVU) recently announced the first U.S. clinical trial using DBS for treatment-resistant opioid use disorder. Interestingly, West Virginia has one of the highest numbers of drug overdose deaths from opioids in the country. The trial is supported by the U.S. Food and Drug Administration and funded by a grant from the National Institute on Drug Abuse.
The first clinical trial participant in the West Virginia study is a 33-year-old man who has struggled with opioid addiction, overdoses, and relapses for decades. A DBS neurostimulator was implanted in the reward center of the brain, which is the area long associated with reinforcement of the addiction cycle. Results are forthcoming.
The use of deep brain stimulation to treat various substance use and mental disorders shows much promise. The therapy has successfully reduced symptoms and improved the quality of life for patients with Parkinson’s Disease, essential tremor, dystonia, obsessive compulsive disorder, and epilepsy. Research and early findings support the belief that DBS can be equally effective in the treatment of addiction and other mental health disorders.
There are many methods for fighting substance use disorders, and as research on the subject continues to expand, we are adding more tools to the toolkit to fight this crisis.