Current addiction treatment programs are far from optimal. For current psychosocially-based treatment programs, such as the 12-step program, relapse rates are anywhere between 40% and 90%. That is, even though people are going through costly treatment programs, it is highly likely they will not be able to maintain abstinence—which creates a significant burden to society, healthcare costs and their families. 

Jazmin Camchong, PhD, and Anna Zilverstand, PhD, both assistant professors in the Department of Psychiatry and Behavioral Sciences at the University of Minnesota Medical School, have been using neuroimaging research to try to inform brain-based treatments. To do this, it is necessary to understand how brain function is altered on an individual level throughout different stages of addiction. 

Studying Brain Changes During Recovery and Abstinence

Dr. Camchong says neuroimaging research measures brain function and organization. “This field has found evidence that the brain of a person who is addicted works differently from a healthy person’s brain even after sustained recovery,” Dr. Camchong said. These differences in brain function are linked to how severely someone is addicted and how likely that person will relapse later on. Most importantly, neuroimaging research has demonstrated that these networks change throughout recovery. 

Based on previous research findings, Dr. Camchong’s research currently focuses both on examining how the brain changes during the recovery stages of addiction and how the brain can be modulated to support abstinence. She has identified a specific frontal-striatal resting state network that is engaged in individuals with long-term abstinence, is not engaged in people that subsequently relapse and can be used to predict subsequent relapse. 

“We’re trying to enhance this network to see if we can help people stay abstinent by intervening with non-invasive neuromodulation,” Dr. Camchong said. “Our hope is helping patients stay abstinent longer.”

She is currently conducting a clinical trial, funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Westlake Wells Foundation, that measures whether a brain-based intervention targeting both underlying neural mechanisms and cognitive alterations can enhance an individual’s ability to maintain abstinence.

From an intervention design perspective, Dr. Camchong’s says that if her current clinical trials in alcohol use disorder and opioid use disorder show promising results, the next steps would be to try to “hone in” on the specific parameters—dose, length of intervention, etc.—needed to develop better treatments.

“The inability to stay abstinent is a cost to society, healthcare and their families,” said Dr. Camchong. “If we can identify what are the underlying mechanisms in the brain that put an individual at risk of developing substance abuse, the underlying mechanisms that have been affected by the chronic use of substances or the underlying mechanisms that support abstinence, we may be able to properly design more effective treatment approaches for addiction.”

Using Thoughts to Control Brain Activation Levels

Dr. Zilverstand uses neuromodulation with cognition through fMRI neuro-feedback, essentially using your thoughts to control brain activation levels and trying to improve brain function. 

“There are a lot of differences between people who are addicted in terms of their brain function,” Dr. Zilverstand said. She recently led a study on individual differences that has become the main focus of her work in understanding addiction. The goal is to discover what is driving their substance abuse to develop more effective treatments before they have the chance to relapse. 

So, what are the next steps? Dr Zilverstand, who has previously looked at chronic cocaine users, is now looking at data from cannabis and alcohol users, but there is currently no suited data set for opioid users. Dr. Zilverstand says, “There isn’t a lot of data on more illicit drug use, like opioids. I’m trying to collect large data sets to do a very systematic study looking at individual differences in that group of patients.”