Addiction Prediction May Be a Brain Image Away
Could it be that doctors can look at our brains as adolescents and predict whether we will develop an addiction? Science seems to be leaning that way.
According to a recent study in the journal Neuron, researchers have connected the dots that seem to connect adolescent brain development with future behavior.
Dr. John Gabrieli says neuroimaging, or brain scans, could prove valuable in the future, not only for pointing people to their areas of strength, but to warn them of potential pitfalls. It might also eliminate the trial-and-error nature of finding a treatment that works, such as taking drugs or using cognitive behavioral therapy.
“It has been difficult to know whether a person taking a particular approach to reduce an addiction or an unhealthy behavior is likely to benefit from that approach,” Gabrieli said. “These studies suggest that brain imaging may provide new and better information about whether a treatment is more or less likely to be helpful to a specific individual.”
Front Portion of Brain Is Key
Gabrieli led a Massachusetts Institute of Technology examination of dozens of studies that included whether alcohol and drug abuse, or unhealthy eating, could be determined by neuromarkers (brain measures) examined through functional magnetic resonance imaging brain scans.
There is a future in the science, it seems. A connection appeared to exist between activity in certain areas of the brain and being able to predict a child’s future behavior. The front portion of the brain is a key area because it develops into the mid-20s.
“The frontal lobes are known to be important for goal-driven cognitive control, for selecting behaviors that are useful but may be difficult to achieve and that may need to override old habits,” Gabrieli said. “For addictions and unhealthy habits, it makes sense that those brain regions may play an important role in overcoming powerful but self-destructive impulses.”
Eliminating Ineffective Treatment
A Grover Hermann Professor in Health Sciences and Technology and Cognitive Neuroscience, Gabrieli says the human and economic costs of sending people to treatments that are unlikely to work for them are high.
“We know that some programs of treatment—behavioral or pharmacological—work for some people, but not others,” Gabrieli said. “We may be able to better know whether a particular program will help a specific person, and if it is unlikely to help, then to try something else.
“Another example is the length of a program, like 28 days. If a person is likely to relapse soon after 28 days, we could extend the treatment period so it is more likely to be effective. This information should help us to personalize treatment approaches … now, we often try a one-size-fits-all approach, and wait to observe success or failure.”
Predicting Alcohol, Substance Abuse
There is also a lot at stake over the long haul, and being able to determine the likelihood of future binge drinking among young people could be helpful. A study of almost 700 adolescents predicted binge drinking in 271 of them.
“Alcohol use by underage drinkers is an important public health problem because such use in adolescents is risky and also associated with lifelong alcoholism,” researchers wrote. “Heavy or binge drinking is the primary source of preventable morbidity and mortality for the more than 6 million American college students.”
Subjects who responded more to monetary reward in the basal ganglia (the base of the brain) were more likely to engage in alcohol or drug use a year later. Those already using substances at baseline showed less activity in the basal ganglia.
Researchers studied children 12 to 14 years of age—with little or no history of substance abuse—and found there were widespread reductions in baseline activation by those who transitioned to heavy alcohol use four years later relative to those children who did not pursue alcohol.
Among subjects ages 16 to 19 with an ongoing history of substance use disorders, those who exhibited less prefrontal and greater parietal activation on the same task had higher levels of substance abuse over the subsequent 18 months.
The results suggest that relative weakness in the recruitment of the front part of the brain may be a predisposition for early alcohol use or sustained abuse.
A Science Whose Time Has Come
Eating was another area that was examined, and researchers found that response to food-related photos could predict changes in body mass index over the following six to 12 months.
Smoking cessation was another area that could be predicted. Caryn Lerman, deputy director of the Abramson Cancer Center at the University of Pennsylvania, said her team used brain imaging to predict 81 percent of patients who would quit smoking. Imaging was far more valuable than relying on surveys and questionnaires.
Although there is still much to learn, the inroads are there. Gabrieli said the practical service of assisting people through brain imaging could be “widely available” in five to 10 years.
“We have the technology now, we have an array of treatments now,” Gabrieli said. “We need a few larger studies in a given area to make sure that the approach is valid, but then it could operate. I think that the key judgment relates to other options for people: Are there other, better ways to help direct individuals to treatments that are likely to work for them?
“I would guess that anyone seeking help would want the best information possible in selecting a treatment approach that is best for them.”
By Martin Henderson