Neuromodulation for substance addiction in human subjects: A review

Abstract

Substance abuse is one of the most prevalent and costly health problems in the world today. Standard medical therapy is often not curative, and relapse is common. Research over the past several decades on the neural underpinnings of addiction has implicated a network of structures within the brain shown to be altered in patients with substance abuse. The field of neuromodulation aims to utilize this knowledge to treat dysfunctional circuits by targeting and modulating specific brain circuits. While invasive neuromodulation such as DBS and VNS have proven to be effective in treating movement disorders, OCD and epilepsy, there is increasing interest and data with regards to its potential application for the treatment of severe, intractable addiction. Several neuromodulatory techniques and brain targets are currently under investigation in patients with various substance abuse disorders. This review aims to summarize the current state of evidence for neurosurgical neuromodulation as a therapy for substance abuse and addiction, and to provide additional expert opinions as to the obstacles and future directions of this endeavor.

Keywords: Addiction; Deep brain stimulation; Neuromodulation; Nucleus accumbens; Substance abuse; Vagal nerve stimulation.

Figure 1:

Illustration of cranial targets for invasive neuromodulation. A) All targets, B) Nucleus of the Solitary Tract, C) Subthalamic Nucleus, D) Nucleus Accumbens, E) Basolateral Amygdala, F) Locus Coeruleus.

Figure 2:

Graphic illustration of number of publications describing pre-clinical or clinical trials investigating brain stimulation techniques for treatment of addictive behaviors. In recent years the proportion of retrospective studies has decreased in favor of prospective studies using addictive behavior as primary endpoints being studied.