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Doctors hope to switch off brain’s craving for tobacco

  1. Lunar Loops
    Now SWIS realises that this may have gone into the tobacco forum, but thought that it may be of more general interest as it does not solely deal with tobacco addiction.

    From The Times (http://www.timesonline.co.uk/article/0,,2-2566992.html):

    The TimesJanuary 26, 2007
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    Doctors hope to switch off brain’s craving for tobacco

    Mark Henderson, Science Editor
    Stroke victims lose urge to smoke
    Study opens new avenue of research

    [​IMG]
    Smokers who suffer damage to a particular part of the brain can give up quickly and easily without feeling any urge for a cigarette, according to research that promises new approaches to treating nicotine addiction.
    A study of smokers who suffered strokes has shown that part of the brain, the insula, appears to be intimately involved in their addiction, indicating that it could be targeted to help people to give up the habit.
    NI_MPU('middle');Patients who had strokes that damaged the insula, which is thought to be involved in emotions and cravings, lost the urge to smoke immediately, and many have not touched a cigarette since.
    The findings suggest the possibility of helping smokers to give up by manipulating the insula to kill their addiction, without causing the extensive brain damage of a stroke.
    Drugs could be developed to alter its activity, or it could be disrupted using magnetic fields. Another technique called deep brain stimulation, in which electrodes are implanted in the brain to switch off particular areas, has already been used successfully to treat Parkin-son’s disease and depression.
    Such treatments, however, will require much more research into exactly how the insula affects smoking and other addictions before patient trials could begin; it will be important not to disrupt other activities in which the region plays a critical role.
    The insula lies in the centre of the brain and is thought to translate information from other parts of the body into feelings such as hunger, pain or cravings for a drug.
    “The insula also carries out lots of normal everyday functions, so we would want to make sure we only interfere with functions that disrupt bad habits like smoking but not something vital like eating,” said Antoine Bechara, of the University of Southern California (USC) and the University of Iowa, who led the research.
    Nevertheless, the work is exciting because damage to the insula appears to break many smokers’ habits instantly; their brains seem to forget that they are supposed to crave cigarettes.
    “There is a lot of potential for pharmacological developments,” Dr Bechara said. “One of the most difficult problems in any form of addiction is the difficulty in stopping the urge to smoke, to take a drug, or to eat for that matter. Now we have identified a brain target for further research into dealing with that urge.”
    Antonio Damasio, Professor of Neuroscience at USC, who first suggested the insula’s role in feelings, said: “It’s really intriguing to think that disrupting this region breaks the pleasure feelings associated with smoking. It is immediate. It’s not that they smoke less. They don’t smoke, period.”
    The study, pubished today in the journal Science, was inspired by a patient who smoked 40 cigarettes a day before having a stroke that damaged his insula. He quit immediately, telling doctors that he “forgot the urge to smoke”.
    The scientists then turned to a database of stroke patients held by the University of Iowa and identified 69 who had smoked at least five cigarettes a day for at least two years before they suffered brain damage. They found that 19 of these patients had damage to the insula and 13 of them had given up smoking, 12 of them quickly and easily. The other six continued to smoke — possibly reflecting damage to different parts of the insula.
    Of the 50 patients who had strokes that did not disrupt the insula, 19 also gave up smoking, but only four did so instantly and without any cravings.
    The difference in the two groups’ experience of quitting suggests that the general stroke patients gave up in standard fashion because of the health risks. The insula-damaged patients, however, gave up because it no longer occurred to them to smoke.

Comments

  1. Paracelsus
    If this leads to the discovery of a drug that simply disables cravings, it could help thousands of heavy addicts (nicotine, meth, crack) to get over their psychological addiction. Side effects similar to the state after a stroke would suck though.

    I think this should get moved to Recovery and Addiction.
  2. BeetleJuice
    Great, now there researching ways into how to screw around with peoples brains directly..when will it end
  3. Lunar Loops
    You may be right, it was one of those articles that could have gone in any one of a number of forums. I never did like pigeon-holing.
  4. Jatelka
    And SWIY isn't screwing with their brain directly (albeit in more fun ways)?;)
  5. Alicia
    Also thats nothing new they used to do lobotomies if swia spelt that right where swia thinks they remove parts of the frontal lobe. not sure.
  6. Jatelka
    ^^^ Which is a very pertinent point. The insula is small, might be tempting to some to try and zap it surgically.
  7. Riconoen {UGC}
    This sounds like a lobotomy in disguise. It may be a breakthrough for thousands of hopeless addicts but I don't know, something just doesnt seem right about this. If they can do this, what stops them from cutting out various receptors in the brain that respond to drugs as some kind of crazy deterrent to doing drugs.
  8. Forthesevenlakes
    This is actually not a new idea. For some years in China, drug users have sometimes had reward centers in their brain lesioned or removed (forget which) so that taking drugs will lead to...a whole lot of nothing. The science behind this study is interesting, but as of now SWIM thinks that we still lack drug delivery systems that can target specific brain regions, thus leaving lobotomies as the main way to knock out some regions.

    What SWIM is wondering about, and what the researchers here do not bring up, is the problem of disrupting a brain function by removing a certain area or group of neurons. Smoking is a fairly recent development in human history, and so its obvious that the insula did not evolve in order to facilitate nicotine cravings. So, the insula either has a direct relationship to a given function in the brain, or it is part of a larger pathway which mediates some activity, or both. Until its known exactly what this structure does (and SWIM does not think that the insula ONLY mediates food, drink, and smoking cravings like stated in the article), it would be fallacious logic to attempt to reduce or destroy the function of this structure through pharmacological or surgical means, the result could be disasterous.
  9. Riconoen {UGC}
    Like scientists have ever given a shit about the consequences of thier actions. as ong as they get a fat paycheck courtesy of uncle sam they'll make everything from weaponized anthrax to h-bombs.
  10. BeetleJuice
    At least when people self screw with their brains they enjoy it like you said, this is going abit to far. and like iv said in a few other posts technoidgy always seems to get into the wrong hands and then its a controll tool,i mean how long b4 they start "immunising" babies at birth to completely wipe out freewill of ingestion of whatever one pleases.
  11. YKS
    With SWIM has a baby along the way he can honestly say that this is exactly the type of thing I'm worried about. I know that a few other random people mentioned something about what pharm companies can do but don't tell us. SWIM doesn't want to act like a character from a SC-FI film but those pharm companies can basically do whatever they want to every-day human beings. He agree's that there needs to an alternative answer to stop smoking for the people who can quit on there own but, it went from cold turkey, cutting back, patches (which SWIM has had), shots, pills, and now this?...

    SWIM does apologize for being so paranoid, you haft to keep in mind that i'm as educated about a lot of things everyone here talks about but it feels good to be a part of something like this.
  12. YKS
    totally messed that post up

    i haven't slept in 28 hours and counting... you readers should get the point.
  13. Lunar Loops
    A response to these findings in The New York Times:

    A Small Part of the Brain, and Its Profound Effects

    By SANDRA BLAKESLEE
    Published: February 6, 2007

    The recent news about smoking was sensational: some people with damage to a prune-size slab of brain tissue called the insula were able to give up cigarettes instantly.

    Suppose scientists could figure out how to tweak the insula without damaging it. They might be able to create that famed and elusive free lunch — an effortless way to kick the cigarette habit.
    That dream, which may not be too far off, puts the insula in the spotlight. What is the insula and how could it possibly exert such profound effects on human behavior?
    According to neuroscientists who study it, the insula is a long-neglected brain region that has emerged as crucial to understanding what it feels like to be human.
    They say it is the wellspring of social emotions, things like lust and disgust, pride and humiliation, guilt and atonement. It helps give rise to moral intuition, empathy and the capacity to respond emotionally to music.
    Its anatomy and evolution shed light on the profound differences between humans and other animals.
    The insula also reads body states like hunger and craving and helps push people into reaching for the next sandwich, cigarette or line of cocaine. So insula research offers new ways to think about treating drug addiction, alcoholism, anxiety and eating disorders.
    Of course, so much about the brain remains to be discovered that the insula’s role may be a minor character in the play of the human mind. It is just now coming on stage.
    The activity of the insula in so many areas is something of a puzzle. “People have had a hard time conceptualizing what the insula does,” said Dr. Martin Paulus, a psychiatrist at the University of California, San Diego.
    If it does everything, what exactly is it that it does?
    For example, the insula “lights up” in brain scans when people crave drugs, feel pain, anticipate pain, empathize with others, listen to jokes, see disgust on someone’s face, are shunned in a social settings, listen to music, decide not to buy an item, see someone cheat and decide to punish them, and determine degrees of preference while eating chocolate.
    Damage to the insula can lead to apathy, loss of libido and an inability to tell fresh food from rotten.
    The bottom line, according to Dr. Paulus and others, is that mind and body are integrated in the insula. It provides unprecedented insight into the anatomy of human emotions.
    Of course, like every important brain structure, the insula — there are actually two, one on each side of the brain — does not act alone. It is part of multiple circuits.
    The insula itself is a sort of receiving zone that reads the physiological state of the entire body and then generates subjective feelings that can bring about actions, like eating, that keep the body in a state of internal balance. Information from the insula is relayed to other brain structures that appear to be involved in decision making, especially the anterior cingulate and prefrontal cortices.
    The insula was long ignored for two reasons, researchers said. First, because it is folded and tucked deep within the brain, scientists could not probe it with shallow electrodes. It took the invention of brain imaging techniques, such as functional magnetic resonance imaging, or fMRI, to watch it in action.
    Second, the insula was “assigned to the brain’s netherworld,” said John Allman, a neuroscientist at the California Institute of Technology. It was mistakenly defined as a primitive part of the brain involved only in functions like eating and sex. Ambitious scientists studied higher, more rational parts of the brain, he said.
    The insula emerged from darkness a decade ago when Antonio Damasio, a neuroscientist now at the University of Southern California, developed the so-called somatic marker hypothesis, the idea that rational thinking cannot be separated from feelings and emotions. The insula, he said, plays a starring role.
    Another neuroscientist, Arthur D. Craig at the Barrow Neurological Institute in Phoenix, went on to describe exactly the circuitry that connects the body to the insula.
    According to Dr. Craig, the insula receives information from receptors in the skin and internal organs. Such receptors are nerve cells that specialize in different senses. Thus there are receptors that detect heat, cold, itch, pain, taste, hunger, thirst, muscle ache, visceral sensations and so-called air hunger, the need to breathe. The sense of touch and the sense of the body’s position in space are routed to different brain regions, he said.
    All mammals have insulas that read their body condition, Dr. Craig said. Information about the status of the body’s tissues and organs is carried from the receptors along distinct spinal pathways, into the brain stem and up to the posterior insula in the higher brain or cortex.
    As such, all mammals have emotions, defined as sensations that provoke motivations. If an animal is hot, it seeks shade. If hungry, it looks for food. If hurt, it licks the wound.
    But animals are not thought to have subjective feelings in the way that humans do, Dr. Craig said. Humans, and to a lesser degree the great apes, have evolved two innovations to their insulas that take this system of reading body states to a new level.
    One involves circuitry, the other a brand new type of brain cell.
    In humans, information about the body’s state takes a slightly different route inside the brain, picking up even more signals from the gut, the heart, the lungs and other internal organs. Then the human brain takes an extra step, Dr. Craig said. The information on bodily sensations is further routed to the front part of the insula, especially on the right side, which has undergone a huge expansion in humans and apes.
    It is in the frontal insula, Dr. Craig said, that simple body states or sensations are recast as social emotions. A bad taste or smell is sensed in the frontal insula as disgust. A sensual touch from a loved one is transformed into delight.
    The frontal insula is where people sense love and hate, gratitude and resentment, self-confidence and embarrassment, trust and distrust, empathy and contempt, approval and disdain, pride and humiliation, truthfulness and deception, atonement and guilt.
    People who are better at reading these sensations — a quickened heart beat, a flushed face, slow breathing — score higher on psychological tests of empathy, researchers have found. The second major modification to the insula is a type of cell found in only humans, great apes, whales and possibly elephants, Dr. Allman said. Humans have by far the greatest number of these cells, which are called VENs, short for Von Economo neurons, named for the scientist who first described them in 1925. VENs are large cigar-shaped cells tapered at each end, and they are found exclusively in the frontal insula and anterior cingulate cortex.
    Exactly what VENs are doing within this critical circuit is not yet known, Dr. Allman said. But they are in the catbird seat for turning feelings and emotions into actions and intentions.
    The human insula, with its souped-up anatomy, is also important for processing events that have yet to happen, Dr. Paulus said. “When you decide to go outside on a cold day, your body gets ready before you hit the cold air,” he said. “It starts pumping blood to where you need it and adjusts your metabolism. Your insula tells you what it will feel like before you step outside.”
    The same goes for drug addicts. When an addict is confronted with sights, sounds, smells, situations or other stimuli associated with drug use, the insula is activated before using the drug.
    “If you give cocaine to an addict, you are affecting their brain’s reward system, but this is not what drives the person to keep using cocaine,” Dr. Paulus said. The craving is what gets people to use.
    For example, smokers enjoy whole-body effects, said Nasir Naqvi, a student at the University of Iowa Medical Scientist Training Program, who was the lead author of the recent article on smoking. It is not just nicotine binding to parts of the brain, he said, but sensations — heart rate, blood pressure, a tickle in the lungs, a taste in the mouth, the position of the hands, all the rituals.
    The insula’s importance makes it an ideal target for many kinds of treatment, Dr. Paulus said, including drugs and sophisticated biofeedback. But methods to quell insular activity must be approached carefully, he said. People might lose the craving to smoke, drink alcohol or take other drugs, but they could simultaneously lose interest in sex, food and work.
    As clinicians explore the possibilities, Dr. Craig is thinking about the insula in grander terms.
    For example, lesions in the frontal insula can wipe out the ability to appreciate the emotional content of music. It may also be involved in the human sense of the progress of time, since it can create an anticipatory signal of how people may feel as opposed to how they feel now. Intensely emotional moments can affect our sense of time. It may stand still, and that may be happening in the insula, a crossroads of time and desire.
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