Can I Have Surgery to Cure My Addiction?

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The surgeons’ motto is “Cut to cure.” It reflects the idea that errors can be corrected structurally – remove this bit, repair that. And in China, this idea is being applied to brain surgery that attempts to remove that part of the brain responsible for the urge to use illegal drugs.

Frankenstein’s monster or valid technique?

The trend in modern medicine is to move as close to underlying biology as possible. No longer do we simply accept that a personality trait is other than how cells in the brain happen to be working, or, as the case may be, not working. The Holy Grail in cognitive neurology is to directly connect neurons in the brain with specific behaviors, feelings and attitudes. In fact, this and other branches of anatomy and physiology have made significant progress – we know quite a bit about how the brain is wired and how the brains of addicts differ from non-addicted brains.

With this picture in mind, it makes perfect sense to correct any aberrations, to open the skull and cut away those parts that are rotten or improperly functioning. That is, until we get into the messy details.

Because understanding the brain is a science still in its infancy, no western doctor would think it wise to alter the living brain unless a clear – and clearly demonstrated – result were available. In most of the civilized world, we don’t think it ethical to poke around in someone’s head, except as a last resort. But the terrain is a bit different in China.

Addiction in China is different

Prior to 1949, heroin, morphine and other derivatives of the opium poppy were commonly available in China. Addicting the Chinese to these substances had been used politically by the British for many decades. When Mao came to power, the country was reinvented and addiction nearly wiped out as the new communist culture swept the nation. Opium was clearly identified as a sin of the West and the populace added this evil to the existing horror of addiction to stamp out manufacture and use.

However, in the 1980’s, as modernization took hold, addiction to opiates re-emerged in China, primarily heroin. But the old view of opiate addiction being a problem imported from the West remained and the Chinese system allows for a strict policy, including human experiments with any technique that shows promise. The political legacy feeds into ideas of behavior resulting from a mis-wiring in the brain – addiction is a defect and one that makes the population vulnerable to victimization for political gain.

How it works

One area of the brain is strongly implicated in compulsion and impulsive behavior – the nucleus accumbens. This area, located deep within the brain, appears on each hemisphere and is a collection of neurons involved in sensing pleasure. But it isn’t a discrete organ like a kidney or pancreas, so removing any of it runs the risk of destroying brain functions you’d like to keep.

According to reporting in the Journal of Medicine surgeons use a technique called “ablation.” Ablation consists of destroying cells in the area of interest, in this case by using heat. The area is exposed and the patient stays awake – this allows doctors to stimulate different areas of the brain and hopefully, zero in on just those parts they wish to destroy while avoiding other areas.

The results reported at first seem encouraging, with 60% of patients showing a lasting effect. On the downside, half of those also lost motivation or had memory problems. About 53% had relapsed within five years of the treatment, putting the treatment on par with other forms of addiction therapy. Significantly though, surgery is cheaper.

One of the most disturbing side effects was the loss of the ability to feel joy.

In Europe and the West, the surgery to “fix” addiction by destroying parts of the brain is unconscionable. Ethical considerations do not allow physicians to risk a brain surgery when other forms of treatment have equivalent results. After all, brain surgery isn’t without risks, not only of permanent brain damage, but also infection. This is not to say that some mental illnesses aren’t treated through brain surgery, but this is considered a last resort and reserved for serious, intractable depression, schizophrenia and the like.

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