Abstract
Substance use disorders (SUDs) are a growing public health concern with only a limited number of approved treatments. However, even approved treatments are subject to limited efficacy with high long-term relapse rates. Current treatment approaches are typically a combination of pharmacotherapies and behavioral counselling. Growing evidence and technological advances suggest the potential of brain stimulation techniques for the treatment of SUDs. There are three main brain stimulation techniques that are outlined in this review: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). The insula, a region of the cerebral cortex, is known to be involved in critical aspects underlying SUDs, such as interoception, decision making, anxiety, pain perception, cognition, mood, threat recognition, and conscious urges. This review focuses on both the preclinical and clinical evidence demonstrating the role of the insula in addiction, thereby demonstrating its promise as a target for brain stimulation. Future research should evaluate the optimal parameters for brain stimulation of the insula, through the use of relevant biomarkers and clinical outcomes for SUDs.
Highlights
Substance use disorders (SUDs) are chronic relapsing brain disorders, characterized by seeking a drug where use becomes compulsive or difficult to control, despite harmful consequences (American Psychiatric Association, 2013)
Sutherland et al proposed a framework to understand the large-scale brain networks dynamics in addictions. They showed that under nicotine deprivation, the salience network (SN) would switch to default mode network (DMN), direct attention resources toward internal withdrawal symptoms, while under nicotine administration, the SN would switch to executive control network (ECN), direct attentional resources toward external stimuli and executive functions (Sutherland et al, 2012; Lerman et al, 2014; Sutherland and Stein, 2018)
We suggest that it can be of great importance to investigate the role of motivation in patients undergoing insular stimulation, which may further increase the effectiveness of the treatment
Summary
Substance use disorders (SUDs) are chronic relapsing brain disorders, characterized by seeking a drug where use becomes compulsive or difficult to control, despite harmful consequences (American Psychiatric Association, 2013). Given considerable growth in understanding the brain mechanisms underlying addiction, there is an obvious potential to target specific neural regions with brain stimulation techniques. This has fueled a mounting body of research supporting brain stimulation’s efficacy and safety in manipulating underlying neuronal processes and reducing addictive behaviors (for recent reviews see Coles et al, 2018; Hanlon et al, 2018b). We discuss possible limitations of the body of knowledge, as well as future directions
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