ADDICTION X PFC J DEAN

Weakness in an area of the brain called the prefrontal cortex is at the heart of addiction, a new paper argues.

The prefrontal cortex lies at the front of the brain, above and behind the eyes.

The area is involved in long-term goal-setting, self-regulation and helps us control our impulses or, in the case of addiction, fails to.

The people most vulnerable to addiction have abnormal functioning in these areas.

One treatment that can target the prefrontal cortex is transcranial magnetic stimulation, which can help reduce cravings.

Another option is training up working memory capacity, which can boost the function of the prefrontal cortex.

Both approaches may help vulnerable people make better decisions.

Professor Antoine Bechara, the study’s first author, said:

“Addiction is a disease of decision-making.

The majority of people have intact brain mechanisms of decision-making that keep them resilient to succumbing to an addiction.

The question is, who is more vulnerable and how do we best determine that?”

Weakness in the prefrontal cortex can be caused by genetic factors, but can also be down to head injury, child abuse or other environmental causes.

Professor Bechara said:

“There are several factors that create the situation where the prefrontal cortex is suboptimal or weak, and the decision-making capacity doesn’t develop normally.

These are people who become more susceptible to becoming addicted not just to opioids but other drugs they have access to.”

More Americans now die of opioid overdoses than in car accidents.

In 2017, the number of people who died of drug overdoses in the US was 70,237.

Two extreme positions have been taken up in response to the opioid crisis, said Professor Bechara:

“First, the pharmaceutical companies sold the idea that opioid medications will only be used by people in pain and people won’t become addicted.

That’s not true, because you have no way of telling who is susceptible to becoming addicted and who is not.

The overreaction by doctors is another extreme; because of the fear that everyone is going to be addicted to opioids, they are not prescribing them to people in chronic pain who may need them.

There are a lot of people who could benefit from controlled administration of those medications, which work very well to treat pain.”