More information about text formats
JJ Kuhn and colleagues (2007) report a remarkable change in abuse and dependence behavior using DBS neurosurgery.(1)
First, before DBS could become a potential therapeutic option in alcohol dependence, several factors should likely be considered as suggested by the authors. A key consideration in extending DBS to alcohol dependent patients would be the fact that many patients seeking treatmen...
First, before DBS could become a potential therapeutic option in alcohol dependence, several factors should likely be considered as suggested by the authors. A key consideration in extending DBS to alcohol dependent patients would be the fact that many patients seeking treatment for alcohol dependence have comorbid psychiatric disorders (which is also the case in the current study).(2)In this difficult to treat population best success is obtained by treating both the psychiatric and substance
use disorders concurrently, especially because alcohol dependent patients with comorbid anxiety disorder at alcoholism treatment onset are at a significantly greater risk for relapse to drinking.(3) Unfortunately, the
authors in this study did not observe a significant reduction in either anxiety or depressive symptoms. If indeed DBS has the potential to treat addiction but does not successfully address an underlying psychiatric
comorbidity than patients may still be at a greater risk of relapse, while being subjected to invasive neurosurgery.
Second, additional challenges could surface in the selection of patients for DBS in an alcohol dependent population. Presumably, only refractory patients would be considered for such a therapeutic option, and therefore a definition of treatment resistance in alcohol dependence would have to be established. Indeed, this definition may be difficult to establish if patients also suffer from psychiatric disorders or by the fact that patients do not always adhere to alcohol management programs.(4)
Since DBS requires postoperative procedures for device set-up as well as follow up across the lifespan, a thorough examination of the patient’s past compliance with treatment may be expected to demonstrate commitment
to a DBS program. The observation of a positive outcome due to DBS in one patient with alcohol dependence is an interesting result. The ethical aspects of performing DBS surgery in alcohol dependence and other behavioral and mental disorders need to be identified and addressed
thoroughly in parallel with such advances.
Emily C Bell and Eric Racine
1. Kuhn J, Lenartz D, Huff W et al. Remission of alcohol dependency following deep brain stimulation of the nucleus accumbens : valuable therapeutic implications? J Neurol Neurosurg Psychiatry 2007; 78: 1152-53.
2. Schneider U, Altmann A, Baumann M et al. Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment : the first Multicentre Study in Germany. Alcohol Alcohol 2001; 36:219-23.
3. Kushner M G, Abrams K, Thuras K L, et al. Follow-up study of anxiety disorder and alcohol dependence in comorbid alcoholism treatment patients. Alcohol Clin Exp Res 2005; 29: 1432-43.
4. Swift R. Emerging approaches to managing alcohol dependence. Am J Health-Syst Pharm 2007; 64:S12-22.