Nucleus Accumbens Deep Brain Stimulation for Alcohol Addiction – Safety and Clinical Long-term Results of a Pilot Trial

Abstract

We report on the long-term clinical outcome (up to 8 years) of 5 patients who received deep brain stimulation (DBS) of the nucleus accumbens to treat their long-lasting and treatment-resistant alcohol addiction. All patients reported a complete absence of craving for alcohol; 2 patients remained abstinent for many years and 3 patients showed a marked reduction of alcohol consumption. No severe or long-standing side effects occurred. Therefore, DBS could be a promising, novel treatment option for severe alcohol addiction, but larger clinical trials are needed to further investigate the efficacy of DBS in addiction.

Key words

alcohol addiction - deep brain stimulation - nucleus accumbens - craving

• References

• 1 Müller UJ, Sturm V, Voges J et al. Successful treatment of chronic resistant alcoholism by deep brain stimulation of nucleus accumbens: first experience with three cases. Pharmacopsychiatry 2009; 288-291
• 2 Gonçalves-Ferreira A, do Couto FS, Campos AR et al. Deep brain stimulation for refractory cocaine dependence. Biol Psychiatry 2015;
• 3 Luigjes J, van den Brink W, Schuurman PR et al. Is deep brain stimulation a treatment option for addiction?. Addiction 2015; 547-548
• 4 Kuhn J, Möller M, Treppmann JF et al. Deep brain stimulation of the nucleus accumbens and its usefulness in severe opioid addiction. Mol Psychiatry 2014; 145-146
• 5 Pierce RC, Vassoler FM. Deep brain stimulation for the treatment of addiction: basic and clinical studies and potential mechanisms of action. Psychopharmacology 2013; 487-491
• 6 Muller UJ, Voges J, Steiner J et al. Deep brain stimulation of the nucleus accumbens for the treatment of addiction. Ann N York Acad Sci 2013; 119-128
• 7 Muller UJ, Bogerts B, Voges J et al. Deep brain stimulation in psychiatry: ethical aspects. Psychiatr Prax 2014; 38-43
• 8 Kuhn J, Möller M, Müller U et al. Deep brain stimulation for the treatment of addiction. Addiction 2011; 1536-1537 author reply 1536–1537
• 9 Carter A, Bell E, Racine E et al. Ethical issues raised by proposals to treat addiction using deep brain stimulation. Neuroethics 2010; 129-142
• 10 Pisapia JM, Halpern CH, Muller UJ et al. Ethical considerations in deep brain stimulation for the treatment of addiction and overeating associated with obesity. AJOB Neuroscience. 2013: 35-46
• 11 Woopen C, Pauls KAM, Koy A et al. Early application of deep brain stimulation: clinical and ethical aspects. Prog Neurobiol 2013; 74-88
• 12 Carter A, Hall W. Proposals to trial deep brain stimulation to treat addiction are premature. Addiction 2011; 235-237
• 13 Everitt BJ, Robbins TW. Neural systems of reinforcement for drug addiction: from actions to habits to compulsion. Nat Neurosci 2005; 1481-1489
• 14 Jasinska AJ, Stein EA, Kaiser J et al. Factors modulating neural reactivity to drug cues in addiction: a survey of human neuroimaging studies. Neurosci Biobehav Rev 2014; 1-16
• 15 Tiffany ST. A cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes. Psychol Rev 1990; 147-168
• 16 Tiffany ST, Wray JM. The clinical significance of drug craving. Ann N Y Acad Sci. 2012: 1-17
• 17 Garbusow M, Sebold M, Beck A et al. Too difficult to stop: mechanisms facilitating relapse in alcohol dependence. Neuropsychobiology 2014; 103-110
• 18 Wise RA, Koob GF. The development and maintenance of drug addiction. Neuropsychopharmacology 2014; 254-262
• 19 Koob GF. The dark side of emotion: the addiction perspective. Eur J Pharmacol 2015; 73-87
• 20 la Monte de SM, Kril JJ. Human alcohol-related neuropathology. Acta Neuropathol 2014; 71-90
• 21 Buhler M, Mann K. Alcohol and the human brain: a systematic review of different neuroimaging methods. Alcohol Clin Exp Res 2011; 1771-1793
• 22 Durazzo TC, Tosun D, Buckley S et al. Cortical thickness, surface area, and volume of the brain reward system in alcohol dependence: relationships to relapse and extended abstinence. Alcohol Clin Exp Res 2011; 1187-1200
• 23 Beck A, Wüstenberg T, Genauck A et al. Effect of brain structure, brain function, and brain connectivity on relapse in alcohol-dependent patients. Arch Gen Psychiatry 21012: 842-852
• 24 Naqvi NH, Morgenstern J. Cognitive neuroscience approaches to understanding behavior change in alcohol use disorder treatments. Alcohol Res 2015; 37: 29-38
• 25 Maisel NC, Blodgett JC, Wilbourne PL et al. Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful?. Addiction 2013; 275-293
• 26 Roerecke M, Rehm J. Alcohol use disorders and mortality: a systematic review and meta-analysis. Addiction 2013; 1562-1578
• 27 Roerecke M, Rehm J. Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis. Int J Epidemiol 2014; 906-919