Nucleus accumbens ablation, evil and unnecessary?

[Neuroprotection]

Out of all the failed treatments for drug addiction tested so far, perhaps the worst and most hideous of them is a form of brain surgery called nucleus accumbens ablation. it is what the name suggests, surgical destruction of parts or all of this important brain region. of course, the nucleus accumbens is a major reward centre of the brain and is vital for both natural and drug reward. The idea is that surgically destroying it blocks the motivation for drug use as well as the pleasurable effects of drugs.
I thought naltrexone implants were a bad idea until I heard of this. reports on the outcome of this surgery, mainly carried out in China are difficult to understand and I can’t really ascertain The after effects of the surgery. there was mention of lethargy, depression and memory impairment as common side-effects but I don’t know how it would affect patience ability to feel natural or drug-related pleasure.
Can anyone help me understand this? am I missing something or is this just an evil treatment developed by a bunch of psychopaths?

 

[Skorpio]

It looks like china banned it in 2004 based on a study I read. Also it produces only 75% abstinence.

Horrifying

A Randomized Blinded Trial of Nucleus Accumbens Ablation to Treat Opiate Dependence in Humans: Location Correlates with Outcome

Background: Opiate addiction remains intractable in a large percentage of patients. Multiple studies identify a central role of the nucleus accumbens (NAc) in addiction; several studies note decreased addictive behavior after interventions in this area. In China, ablation of the NAc was common...

www.cureus.com

 

[Rectify]

Not Evil, Just Stoopid.

 

[TheUltimateFixx]

It's misguided. The simplistic premise being there is some precisely located 'pleasure button' in the brain which drugs activate. Pleasure, whether drug-related or otherwise, isn't processed in such a mechanistic way. The brain is a much more complex organ, and drug interactions with it are likewise complex. That's not even to mention that addiction isn't functionally 'caused' by some direct physiological action of a drug, it's a habituated behaviour driven by various motivations.

PS the patients who underwent this did not stop desiring drugs.

 

[Neuroprotection]

It's misguided. The simplistic premise being there is some precisely located 'pleasure button' in the brain which drugs activate. Pleasure, whether drug-related or otherwise, isn't processed in such a mechanistic way. The brain is a much more complex organ, and drug interactions with it are likewise complex. That's not even to mention that addiction isn't functionally 'caused' by some direct physiological action of a drug, it's a habituated behaviour driven by various motivations.

PS the patients who underwent this did not stop desiring drugs.

Correct. Actually, I read an article claiming that there were several reward centres in the brain and that the nucleus accumbens was linked to just one of them. like you said, though, it really is a misguided approach especially if it affects the well-being of these people. do you know of any information on how people who received this surgery experience natural reward/ pleasure from things like food and sex? also, it’s rather worrying because the nucleus accumbens plays a role in stress resilience as well as reward.

 

[Neuroprotection]

as has been pointed out already, nucleus accumbens ablation has thankfully been stopped. Though it’s not perfect, I think transcranial magnetic brain stimulation is very promising and can be directed at the nucleus accumbens. if I remember correctly, it is reversible and certainly non-invasive so can be used along with psychotherapy for addiction treatment.

 

[Neuroprotection]

Maybe I am completely wrong or thinking too deeply about The following, but please let me know what you think. i’ve noticed two distinct strands in drug addiction research/ treatment. One strand focuses on eliminating the pleasurable effects of drugs or making them aversive to the user. this is logical and quite sensible, but unfortunately, it generally disregards The importance of well-being and optimal reward function needed to convince a person to remain sober. this is where high dose naltrexone fails in the treatment of opioid and alcohol addiction. LDN is an exception but then again, it’s mechanism of action is different from The full Mu opioid receptor blockade produced by large doses.

The second strand and the one I favour, focuses on reducing the immediate harm of drugs, while simultaneously working to target the negative emotions which drive drug use and addiction.
An example of what I mean could be highlighted by those studying the kappa Opioid receptor for addiction treatment. some researchers propose pharmacological activation of this receptor whilst others suggest blocking it and both have some good evidence supporting them. activating Kappa receptors produces dysphoria and aversion and decreases dopamine release in the nucleus accumbens. those who favour activating the receptor claim that it should blunt the rewarding effects of addictive drugs, whilst also producing an aversive punishing effect analogous to disulphiram in alcoholism. those that focus on blocking the receptor, whom I am in agreement with, Point out that Kappa blockade has antidepressant affects, increases nucleus accumbens dopamine activity and enhances reward learning as well as inducing stress resilience. theoretically, this should work to reverse the anhedonia and depression that push people to return to drug use even years after quitting.
I know it’s a little simplistic, and in reality researchers/professionals May have mixed opinions, but I think it’s something interesting to discuss nonetheless.

 

[Skorpio]

Kappa receptor agonists can also result in the internalization of those receptors, and therefore decrease the magnitude of dynorphin signaling.

 

[Neuroprotection]

Kappa receptor agonists can also result in the internalization of those receptors, and therefore decrease the magnitude of dynorphin signaling.

Yes, I’ve heard about that too. I think there’s also a belief that hallucinogenic kappa opioid agonists can provide a therapeutic psychedelic experience, whilst the dysphoric affect can reset the rewards system. however, the overarching and most common idea i’ve come across regarding the kappa opioid agonists is there punishing affect and their ability to shut down the reward system response to psychostimulants in a manner similar to how naltrexone shuts down The response to opioids. Unfortunately, whilst naltrexone can induce depression and often does at high doses, The Kappa agonists are even worse as they strongly suppress all components of the reward system, not just the opioid component. antagonists on the other hand can improve well-being and lift mood decreasing the perceived need for relapse. of course, it’s a very complex issue and different strategies work for different people, So perhaps a mixture of trial and error along with psychological assessment of addiction patience to ascertain what drives their drug use could be very helpful.

 

[Neuroprotection]

Brain surgery and its affects are very interesting and equally terrifying. surgical procedures to destroy the amygdala have actually been carried out in schizophrenics and refractory epilepsy patients to treat uncontrollable rage and violent behaviour. in my opinion, this surgery is actually ethically justified as long as all other medical options have been exhausted. regardless, while I would never want to undergo brain surgery, I would gladly choose destruction of the amygdala over destruction of the nucleus accumbens.

 

[sekio]

I think there’s also a belief that hallucinogenic kappa opioid agonists can provide a therapeutic psychedelic experience,

I dunno, none of my friend group that used Salvia divinorum back in the day got any sort of therapeutic benefit out of it.
Personally, I would compare the experience of smoking (I believe) 50-100mg of 20x Salvia to being suddenly and rather impolitely being cracked over the head with a crowbar, and the same dose scared the jeebies out of my poor apprentice psychonaut GF at the time (who immediately hid under some blankets and started crying quietly).

The treatment modality where I live (Vancouver, Canada) has basically accepted that users of hard drugs are going to use them regardless, so while the standard array of supports for detoxing and using less, while dealing with the root issues leading someone to use drugs, do exist, but they are limited in what they can do.
If you live in a homeless shelter, dropped out of high school, have potentially undiagnosed/unmedicated conditions like ADHD, the only jobs available to you are basically minimum wage, physically taxing, sometimes demeaning jobs, and despite your housing, medications, and food being paid for, and welfare/disability providing a little under the poverty line (I think it's $1000-1500/month), there's no real incentive or desire to bother saving for anything (average detached home is >$1M, rent for a 1BR is >$3000/mo). So a lot of people blow it all on alcohol and drugs.
The social workers are helpless to fix most of these things, and unfortunately therapy doesn't pay your rent.
However, the local health authority has a program they call "safe supply" where, no joke, addicts are provided with pharmaceutical substitutes for their drug of choice, delivered daily, free of charge. If you are a crack or cocaine user, you can get a dozen or so 10mg methylphenidate tablets. Fentanyl? A dozen 8mg hydromorphone (brand name Dilaudid, only excipent is lactose, so the pills are injectable) - or alternatively several Kadian 100mg morphine sulfate extended release capsules (in addition to methadone). Benzodiazepines? 2mg clonazepam tablets. Amphetamines? I believe they give 10mg dextroamphetamine tablets. Abuse several of these? No problem, you can get all of them you like.

The logic is threefold, first, by providing clean drugs of known dosages, you help reduce overdoses and polydrug toxicity. Second, by providing the drugs at no cost, they (in theory) allow people to spend their welfare more productively. Third, this helps reduce the influence of street drug dealers, at least in theory.
In practice, a lot of users now trade or sell their pills for street dope (against all logic) because the carfentanil present in some street "down" is so potent even 50mg hydromorph isn't gonna touch it. (Ironically this is cleaning up the street drug supply because now dealers have a bunch of hydromorphone tablets, etc.)