The modern addiction rehabilitation industry...even today is dominated by Wilson's Alcoholics Anonymous (AA) paradigm and its 'twelve-step' approach to recovery. Perhaps unsurprisingly, given its spiritual origins, this approach has had an uneasy relationship with the evidence-based culture of medical research. Both perceive addiction as a chronic disease; but whereas scientists seek rationally targeted interventions to blunt drug cravings, AA and related programmes tend to feature group therapy, tearful confessions and the call to "surrender to a higher power"...In the past few years, however, these two cultures have been finding common ground. Neuroscientists have begun to recognize that some of the most important brain systems impaired in addiction are those in the prefrontal cortex that regulate social cognition, self-monitoring, moral behaviour and other processes that the AA-type approach seems to target....treatment programmes are targeting these systems without necessarily knowing that they are doing it.
Religion has been shown to have a strong inverse association with drug addiction...Michael McCullough, who studies religion and behaviour at the University of Miami in Florida, suggests that when a person commits to any cultural system that regulates behaviour, the psychological effort to conform strengthens the brain systems that mediate self-monitoring and self-control. "What makes religion unique, I think, is that the code of conduct isn't just laid down by your parents or your friends or your principal at school, but ostensibly by the individual who is superintending the Universe, so it has an extra moral force." Some religious rituals, he says, have been shown to provoke enhanced activity in prefrontal regions (see Azari et al.). "It's as if certain forms of prayer and meditation are pinpointing precisely those [prefrontal] areas of the brain that people rely on to control attention, to control negative emotion and resolve mental conflict."
In pursuing other ways to boost prefrontal systems medicines for ADHD seem an obvious place to start. Attention-enhancing drugs such as methyl-phenidate and atomoxetine boost the activity of key receptor systems in the prefrontal cortex, in particular those for noradrenaline and dopamine. ..The National Institute on Drug Abuse has also been supporting studies of cognitive and behavioural strategies, and Volkow says that she is particularly enthusiastic about an approach that involves "real-time fMRI feedback". Developed by researcher and entrepreneur Christopher deCharms earlier this decade, the technique involves placing drug users in an fMRI machine and showing them a symbolic representation — a flame — of the fMRI-measured brain activity that corresponds to their cravings. The users are then asked to apply their own cognitive exercises, such as imagining their child is with them, to quench their cravings and douse the flame. After half a dozen sessions with this feedback the user will, in principle, develop cognitive circuitry that is more efficient at suppressing craving and that can then be used in ordinary life. A version of the technique, used for pain relief, has already shown some efficacy in a small clinical trial, and deCharms and his Silicon Valley start-up, Omneuron, are currently running a small trial in smokers — with plans for a follow up with some of Childress's cocaine users.
Wednesday, March 18, 2009
Rehab, neuroscience, and religion
Jim Schnabel offers a brief essay in NatureNews on neuroscientists who are suggesting that is effectiveness of drug intervention programs is related to their strengthening of executive frontal lobe functions. Here are a few clips: