Hao Chen
Sören Kuitunen-Paul
Aviv M. Weinstein
Johannes Petzold- 1Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- 2Department of Clinical Psychology and Psychotherapy, Technische Universität Chemnitz, Chemnitz, Germany
- 3Department of Child and Adolescent Psychiatry, Technische Universität Dresden, Dresden, Germany
- 4Department of Psychology, Ariel University, Ariel, Israel
Editorial on the Research Topic
Addiction and the brain: current knowledge, methods, and perspectives
Addiction is commonly considered a disorder that affects the brain and changes behavior. Substance use disorders, among the leading causes of death and disability (1), continue to be major public health challenges. Behavioral addictions, which share certain neurobiological mechanisms with substance use disorders (2), have received increasing attention over the last two decades. Yet, we lack an overarching theoretical framework that integrates the advancements in neurobiological research with the development, progression, and treatment of addiction.
Despite the significant progress in our understanding of addiction (3–5), the translation of this knowledge into effective treatment options remains a critical challenge (6). In this Research Topic, we present selected studies that aim to bridge this gap by carefully assessing relevant cohorts, by evaluating available brain-related interventions, or by developing innovative approaches to the treatment of substance use disorders (see Table 1 for overview).
Table 1. Overview of edited primary studies on addictions.
Studies on brain-related intervention effects
Chen J. et al. evaluated the commonly adopted treatment approach, methadone maintenance treatment, for heroin use disorder, within a 1-year longitudinal study. The results confirmed the effectiveness of methadone in reducing withdrawal symptoms and preventing relapses. At the imaging level, increased connectivity within the default mode network (DMN) was associated with reduced withdrawal symptoms, while the increased connectivity between the DMN and the salience network might pose risks of relapse given its link to enhanced salience signal of heroin cues. Clinicians may need to evaluate both positive and negative effects of this treatment approach during application.
Mindfulness-based interventions, rooted in neurobiological findings and increasingly being adopted in treatment centers globally, have also emerged as a powerful treatment approach for substance misuse (7), offering the added advantages of ease of access and low costs. Rosenthal et al. aimed to better understand the underlying mechanisms of a short, guided meditation by assessing how changes in environmental cues influence instrumental behaviors in a Pavlovian-to-instrumental transfer (PIT) task. The meditation reduced the PIT effect in individuals with alcohol use disorder (AUD), but not in the control group. This pilot study paves the way for future research to further assess the effectiveness of mindfulness-based interventions and to better understand their cognitive mechanisms.
Another promising approach for the development of personalized treatments and recovery is to address problems in early abstinence and their underlying mechanisms. van Oort et al. studied brain network connectivity to find such mechanisms, which may ultimately help individuals to better maintain abstinence. In a related study, Gullett et al. investigated participants (heavy alcohol use; with or without HIV) who attempted abstinence for 30 days via contingency management. Lower baseline connectivity in the salience network, which is linked to susceptibility to environmental cues, predicted reduction in drinking. Although this finding highlights a promising target for intervention, individuals living with HIV, who tend to have lower baseline connectivity in the salience network, may not benefit as much from contingency management as those without HIV.
Studies on brain-centered interventions
Three studies evaluated non-invasive brain stimulation for treatment, highlighting it as a promising tool owing to its safety, precision, and importantly, potential for combination with other treatments. Hu et al. demonstrated the effectiveness of reducing relapse rates by combining repetitive transcranial magnetic stimulation (rTMS) and cognitive behavioral therapy in a clinical trial with 263 participants diagnosed with alcohol dependence. Building on the concept of rTMS, theta burst stimulation (TBS)—including continuous TBS (cTBS) and intermittent TBS (iTBS)—represents another innovative approach while being safe and efficacious (8). Upton et al. demonstrated the benefits of cTBS on the right inferior frontal gyrus in reducing cravings for smoking and increasing resting-state fronto-striatal functional connectivity over 24 h in individuals with nicotine dependence. Dong et al. investigated patients with polydrug (heroin and methamphetamine) use disorder and revealed the superior effect of iTBS compared to rTMS and sham iTBS in improving cognitive functions, thus highlighting its clinical value.
In their review, Chen Y.-H. et al. propose an intelligent closed-loop TMS neuromodulation system that is informed and repeatedly adapted via measurements from multimodal electroencephalogram–functional near-infrared spectroscopy (EEG-fNIRS) in order to treat methamphetamine addiction and methamphetamine-related craving. This innovative approach has the potential to improve clinical outcomes by providing real-time monitoring and intervention for patients seeking to achieve abstinence from drug use.
All these findings collectively underscore the promise and potential of non-invasive brain stimulation techniques, such as rTMS and TBS, in offering new and effective treatment modalities for various forms of addiction.
Studies on relapse prediction using brain parameters
While non-invasive brain stimulation has shown promising results, it is important to comprehend the mechanisms that cause some individuals to maintain abstinence while others relapse post-treatment. Two studies aimed to identify (bio)markers predictive of future relapses in individuals with AUD. Sasaki et al. measured fNIRS during cognitive tasks and identified reduced brain responses in right frontotemporal areas to emotional stimuli, along with risk-seeking behavior, as markers for relapse within 6 months. In a 7-year follow-up study, Martelli et al. identified a larger caudate volume as a biomarker for relapse. These studies highlight the potential for identifying specific biomarkers that can predict relapse, thus providing a valuable direction for future research and more individualized interventions.
Studies on comorbidities with a possible shared brain mechanism
Complementing the two studies that identified specific biomarkers predictive of relapse, Shen et al. provided further insight into the genetic factors that may influence withdrawal symptoms in individuals with AUD. The identification of the oxytocin receptor rs2254298 polymorphism as a significant modulator of mood disorders during alcohol withdrawal adds to our understanding of the genetic basis of addiction and withdrawal. This finding highlights the importance of personalized treatments that consider both genetic and environmental factors.
Given AUD often co-occurs with other mental disorders (9), Luderer et al. investigated the relationship between attention-deficit/hyperactivity disorder (ADHD) and AUD across many dimensions. Hyperactivity emerged as a significant symptom in individuals with both ADHD and AUD, indicating a treatment target for individuals with both conditions.
Lastly, Miller et al. addressed gender differences in gambling disorder, which is particularly relevant given its escalating prevalence and the notable overrepresentation of affected men (10). The study underscored the distinct motivations, patterns, and consequences of gambling behavior between men and women, thereby paving the way for more targeted and effective interventions. This may, in the future, include non-invasive rTMS given that neurobiological links have been found between gambling disorder and several of the substance-related use disorders (11) for which rTMS has been shown to be promising by authors in this Research Topic (Chen Y.-H. et al.; Dong et al.; Hu et al.; Upton et al.).
Conclusion
The studies presented in this Research Topic provide exciting insights into the current developments in neurobiologically informed addiction treatment, from traditional to innovative techniques. Several of the presented findings highlight the potential for new and effective treatment modalities that consider the neurobiological mechanisms underlying addiction, as well as the need for personalized interventions informed by both genetic and environmental factors. As we continue to explore the complexities of addiction, it is our hope that these insights will help develop more effective and targeted treatments, ultimately improving outcomes for individuals struggling with substance use disorders and behavioral addictions.
Author contributions
HC: Writing—original draft. SK-P: Validation, Visualization, Writing—review & editing. AW: Writing—review & editing. JP: Validation, Writing—review & editing.
Funding
The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
Acknowledgments
SK-P is indebted to Josie Eibisch (TU Chemnitz) for assistance in extracting study details.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Castelpietra G, Knudsen AKS, Agardh EE, Armocida B, Beghi M, Iburg KM, et al. The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990–2019: findings from the Global Burden of Disease Study 2019. Lancet Reg Health Eur. (2022) 16:100341. doi: 10.1016/j.lanepe.2022.100341
2. Yau YHC, Leeman RF, Potenza MN. Biological underpinning of behavioral addictions and management implications. In el-Guebaly N, Carrà G, Galanter M, Baldacchino AM, editors. Textbook of Addiction Treatment: International Perspectives. Berlin: Springer International Publishing (2021), p. 889–910. doi: 10.1007/978-3-030-36391-8_63
3. Heilig M, MacKillop J, Martinez D, Rehm J, Leggio L, Vanderschuren LJMJ. Addiction as a brain disease revised: why it still matters, and the need for consilience. Neuropsychopharmacology. (2021) 46:10. doi: 10.1038/s41386-020-00950-y
4. Volkow ND, Koob GF, McLellan AT. Neurobiologic advances from the brain disease model of addiction. N Engl J Med. (2016) 374:363–71. doi: 10.1056/NEJMra1511480
5. Wiers RW, Verschure P. Curing the broken brain model of addiction: neurorehabilitation from a systems perspective. Addict Behav. (2021) 112:106602. doi: 10.1016/j.addbeh.2020.106602
6. Verdejo-Garcia A, Lorenzetti V, Manning V, Piercy H, Bruno R, Hester R, et al. A roadmap for integrating neuroscience into addiction treatment: a consensus of the neuroscience interest group of the international society of addiction medicine. Front Psychiatry. (2019) 10:877. doi: 10.3389/fpsyt.2019.00877
7. Li W, Howard MO, Garland EL, McGovern P, Lazar M. Mindfulness treatment for substance misuse: a systematic review and meta-analysis. J Subst Abuse Treat. (2017) 75:62–96. doi: 10.1016/j.jsat.2017.01.008
8. Oberman L, Edwards D, Eldaief M, Pascual-Leone A. Safety of theta burst transcranial magnetic stimulation: a systematic review of the literature. J Clin Neurophysiol. (2011) 28:67. doi: 10.1097/WNP.0b013e318205135f
9. Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. (1997) 54:313–21. doi: 10.1001/archpsyc.1997.01830160031005
10. Potenza MN, Balodis IM, Derevensky J, Grant JE, Petry NM, Verdejo-Garcia A, et al. Gambling disorder. Nat Rev Dis Primers. (2019) 5:1. doi: 10.1038/s41572-019-0099-7
Keywords: addiction, substance use disorder (SUD), non-invasive brain stimulation, relapse prediction, addiction treatment, behavioral addictions
Citation: Chen H, Kuitunen-Paul S, Weinstein AM and Petzold J (2023) Editorial: Addiction and the brain: current knowledge, methods, and perspectives. Front. Psychiatry 14:1343524. doi: 10.3389/fpsyt.2023.1343524
Received: 23 November 2023; Accepted: 05 December 2023;
Published: 20 December 2023.
Edited and reviewed by: Yasser Khazaal, Université de Lausanne, Switzerland
Copyright © 2023 Chen, Kuitunen-Paul, Weinstein and Petzold. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Hao Chen, hao.chen@tu-dresden.de
†ORCID: Hao Chen orcid.org/0000-0002-0026-3623
Sören Kuitunen-Paul orcid.org/0000-0001-8224-6490
Aviv M. Weinstein orcid.org/0000-0002-9465-9943
Johannes Petzold orcid.org/0000-0003-4163-9014