As much of the country grapples with problems resulting from opioid addiction, some Massachusetts scientists say they're getting a better understanding of the profound role the brain plays in addiction.
Their work is among a growing body of research showing that addiction is a complex brain disease that affects people differently. But the research also raises hopes about potential treatments.
Among the findings of some University of Massachusetts Medical School scientists is that addiction appears to permanently affect the connections between areas of the brain to almost "hard-wire" the brain to support the addiction.
They're also exploring the neural roots of addiction and seeking novel treatments — including perhaps the age-old practice of meditation.
Meditation As Part Of Addiction Treatment
After spending 40 minutes lying on the floor with his eyes closed, being led through a meditation exercise, one of the students in a recent mindfulness class said something that many of the other students appeared to be thinking.
"I'm irritated," he said, as several of the 30 other students murmured in agreement. Some giggled.
"I can't really sit this long with my eyes closed without falling asleep," he added. "I think this is overall positive. Maybe I just have a long way to go."
Mindfulness has been touted as a way to boost quality-of-life issues, and the students in the class were there for various reasons: some to learn to relax, others to cope with health issues, and — at least one student — to support her recovery from alcoholism.
"For me mindfulness fits into the practice of living an authentic life," said 38-year-old Mary Kate Farley-Dimino. She's been sober seven years, something she credits largely to the 12 steps of Alcoholics Anonymous. But she says that is intertwined with being mindful — or more present — in her everyday life.
"When I take the time to be mindful, I am improving my conscious contact with something bigger than myself, and I'm able to really see why I'm here," she said. "I've connected to a purpose. For me, that's recovery."
Farley-Dimino hopes the mindfulness classes at UMass Medical School's Center for Mindfulness not only help her recovery, but also allow her to teach mindfulness to others in her work at The Recover Project in Greenfield. She says she knows that meditation should be part of recovery from addiction.
Scientists know she's on to something, and they're trying to prove it.
Most of the studies being done at the Center for Mindfulness involve the most common and most addictive substance on the planet: nicotine. Using fMRI neurofeedback technology to measure brain activity, center researchers measured the effects of meditation in real time. They specifically found that meditation deactivates the part of the brain called the posterior cingulate cortex.
"What we found was interesting and a complete surprise to us, and different from other reports on meditation," said Dr. Judson Brewer, associate professor of medicine and psychiatry at UMass Medical School and director of research at the Center for Mindfulness. "We found that the default mode network got really quiet in experienced meditators."
He describes this default mode network as several regions of the brain that we "default to" when we're multitasking or distracted. It's also an area of the brain that becomes active when a smoker is craving a cigarette. So quieting this network in the brain may help reduce cravings.
Brewer is incorporating his research into technology. His team is in clinical trials of a cellphone app based on mindfulness principles. The 21-day Craving to Quit app talks people through daily breathing and meditation exercises to help them overcome their cravings. In one exercise, the app uses the analogy of fire, in which a smoker's craving is described as a fire and every cigarette smoked is adding a log to the fire. It tells smokers to draw a line around the craving, don't act on it, and it eventually burns down.
Brewer has found this mindfulness approach is more effective than some of the top anti-smoking programs.
"We found mindfulness is actually twice as good as the American Lung Association's Freedom From Smoking group, which is a gold-standard treatment," he said. "So we're seeing a clear clinical signal here: It's helping people with addictions."
In an online community where smokers communicate about using the app, Brewer says many are reporting that smoking and mindfulness just don't mix. Some say that when they're really working on mindfulness, there is no appeal to smoking; in fact, they say cigarettes taste bad to them.
Brewer expects that mindfulness can help with other addictions and other disorders.
"It's really about helping people realize when they get caught up in something," he said. "You can get caught up in the Yankees being better than the Red Sox — something that we really believe is true. This is not just about addiction, it's about when we get caught up in our experience."
Research: The Brain Rewires Itself To Accommodate Addiction
Meditation is just one focus of the research taking place at the University of Massachusetts Medical School. Much of it is being done at the school's Brudnick Neuropsychiatric Research Institute, which has a center devoted solely to addiction research. The researchers are measuring activity in the brain, brain chemistry and other things, and mostly what they're uncovering is that the brain plays a powerful role in addiction. So, they conclude, any addiction treatment is going to have to take that into account.
One study found the part of the brain responsible for craving, and that the brain actually rewires itself to accommodate addiction.
Dr. Joesph DiFranza, a family doctor and professor of family medicine and community health at the medical school, studies the brains of smokers using MRIs. He says what happens in the brain when someone craves a cigarette is the same thing that happens when someone is hungry: The brain will not quiet down until that need is met.
"We put people in the [MRI] who haven't smoked overnight and these specific areas of the brain become activated," he said. "The more the person reports they're craving a cigarette, the more activation there are in these regions of the brain. This is not something that we understood even a year ago. We thought craving was [based] on cues."
DiFranza found something else surprising: that addiction affects the connections in the brain, sometimes permanently. In some cases he says the brain is actually supporting the addiction. His work found that as cravings increase, there is a weakening in the connections from the anterior cingulate (the part of the brain where cravings appear to originate) to the frontal cortex (the part of the brain responsible for self control).
"They've lost about two-thirds of the nerve fibers connecting the part of the brain responsible for the self control to the part where the craving is generated," the doctor said. "So people face some major obstacles when they quit because their brain is actually hard-wired now to support that addiction."
In a yet-to-be-published study done by Andrew Tapper, associate professor of psychiatry and interim director of the medical school's Brudnick institute, scientists identified the area in the brains of mice responsible for withdrawal.
"We were able to cause nicotine withdrawal symptoms, even in an animal that had never seen nicotine before," Tapper said. "That was the 'aha' moment that linked that particular brain region and a certain group of neurons to nicotine withdrawal symptoms directly."
Tapper hopes his research helps scientists figure out how to reduce activity in that part of the brain, alleviating withdrawal symptoms. But what scientists don't know is why some people become addicted, while others do not.
"I think it's becoming clear that addiction is a disease," Tapper said. "So there are certain groups of people that if they start smoking, drinking or doing drugs, they will have a tough time quitting and they can't help it. This is a disease in my mind like cancer or any other disease."
What this means, the scientists say, is that any addiction treatment will have to be individualized and take into account that addiction changes the brain.
Dr. Jean King, professor of psychiatry and associate provost for biomedical science research, says with addiction it's not likely that there will ever be one "cure."
"You can't go in like certain diseases and you fix it. This is a disease that you fix it now and somebody could in 10 years go back to drugs. That's what's so insidious. It's the disease that never really quits," she said. "When our patients come back and say, 'I've tried this and it's not working,' then it's our job as scientists to figure out how to give them options. Wherever the problems are, that's where we need to go, so all people with addiction have an opportunity to be healed."
And for many of those struggling, like Farley-Dimino, treatment is ultimately going to have to address the root of addiction.
"Substance abuse is a symptom and a solution for a larger problem, which is this discomfort, So people use substances to get out of that discomfort," she said. "I think it's the human condition."
Maybe neuroscience will tackle that someday as well.