Summary and Analysis

This study seems to make the following argument: In some cases of brain damage, problems with addiction seem to lessen so therefore we should explore causing brain damage to patients to cure them of addiction.

Would anyone ever reasonably expect that brain damage would not cause changes in behavior?

It is a frightening direction which at a minimum opens the door to research that intentionally inflicts brain damage to examine the possibility of it reducing a patient’s addiction. Such myopic thinking about addiction overlooks the wealth of data available on the many factors that contribute to addiction – family, social, financial, psychological and religious – and hypothesizes an approach guaranteed to have unintended and potentially disastrous consequences.

Excerpted from Nature Medicine

To better guide neuromodulation therapies, we need to know which brain regions are causally involved in addiction remission in human patients.

A unique source of information that can help answer this question is cases where brain damage such as a stroke results in remission of addiction in a patient. These cases are valuable because they provide a causal link between therapeutic benefit and human neuroanatomy. For example, lesions involving the insula are more likely to disrupt nicotine addiction than lesions that spare the insula. However, lesions disrupting addiction have been reported outside the insula in many different brain locations, leaving localization unclear.

Recently, it has been possible to link lesions in different brain locations to a common neuroanatomical substrate using the human connectome, a map of human brain connectivity. When lesions result in therapeutic benefit, this approach can identify effective therapeutic targets.

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