Brain surgery for addiction?

Gerod Buckhalter was addicted to opioids for 17 of his 33 years. A prescription for opioid painkillers after a shoulder injury at age 15 led to a heroin addiction that he couldn’t shake. His best attempts to kick his drug habit never lasted more than three months.

Now, Buckhalter has become the first patient in a study exploring whether surgery can solve drug addiction, according to CNN. The study at West Virginia University’s Rockefeller Neuroscience Institute uses a technique called deep brain stimulation, involving probes implanted in the brain’s reward center meant to counteract addictive cravings. The experimental surgery touches on the long-standing question of whether addiction is more of a disease or a choice: Christian medical professionals and counselors argue that drugs do physically affect the brain but the patient is still responsible to choose a new lifestyle, something a surgery can’t guarantee.

Drug and alcohol addiction affects many Americans, with 40.3 million people ages 12 and up struggling with a substance abuse disorder in 2020, according to the National Survey on Drug Use and Health. More than 100,000 people died from drug overdoses in the United States over a 12 month period ending in April 2021, according to the Centers for Disease Control and Prevention.

The research team at the Rockefeller Neuroscience Institute hopes its experimental surgery will restore healthy brain function to areas damaged by addiction. Deep brain stimulation has already successfully treated symptoms of Parkinson’s disease. To qualify for the $50,000 procedure, patients must have completed several rehabilitation programs without a successful recovery and overdosed multiple times. Funded by a $750,000 grant from the National Institute on Drug Abuse, the clinical trial now includes four patients.

For Buckhalter’s surgery, Rockefeller director Dr. Ali Rezai inserted a piece of wire barely a millimeter wide into the 33-year-old’s brain. Then, he showed Buckhalter images of piles of drugs and other pictures to induce the craving that had controlled him for 17 years. Rezai moved the electrical probe based on Buckhalter’s response to ensure it sat in the correct position.

Once the probe is implanted, researchers can record brain activity in real time. The goal eventually is to find indicators that warn doctors and patients of an impending relapse, allowing doctors to adjust the strength and placement of the electrical current.

Buckhalter’s surgery, which took place 2½ years ago, appears to have had success: He’s been sober since then. He also goes to counseling, takes medication, works a steady job, and receives support from a sober living home. A second phase of the trial with more than a dozen people will further test its ability to keep people off drugs.

But the surgical approach raises the question of whether brain stimulation replaces a person’s own ability to overcome addiction. Anthony Duk, a Christian psychiatrist with Inland Psychiatric Medical Group in Southern California, argues the procedure is only effective if the patient can eventually live life without the probe. If not, doctors are only switching the object of his addiction. They haven’t helped patients become a whole person, but have “shackled them to us,” Duk said.

Duk prescribes medication for those suffering from addiction, but does so with a plan to taper them off and change their lifestyle. Medication is a small part of a healing process that includes therapy, community accountability, exercise, and journaling, he said.

Still, recovery is difficult. Studies show that 40-60 percent of people recovering from a drug or alcohol addiction will relapse. One study reported a relapse rate of up to 91 percent for opioid addicts. Duk estimates from his 20-year practice that only 5 percent of his psychiatric patients fully recover—which he defines as having no symptoms, adjusting one’s lifestyle to prevent symptoms, and living without medication. He said the last criterion is the most difficult: Many of his patients stay dependent on medication. People can only heal if they choose to do daily activities that they may not want to do, he said.

Addiction counselor Mark Shaw, the director of counseling at Grace Fellowship Church in Florence, Ky., also worries about surgery trying to “medicalize the immaterial.” Shaw founded the Addiction Connection, a network of Biblical counselors and ministries that offer training for helping those struggling with addiction. Shaw recognizes the physical aspects of addiction—dopamine highs lead to intense cravings and compulsive behaviors—and he works with doctors. But he believes only the Holy Spirit can truly change a person’s thoughts and desires. Shaw said one drug addict he knows was arrested 13 times and only began the path to recovery after God “gripped his heart” in the back of a police car. People need the greater hope of the gospel, he said.

Of the three other people in the Rockefeller trial, one had success similar to Buckhalter. Another patient relapsed and had his probe removed. For the fourth, it’s too soon to tell.

Buckhalter, too, agrees deep brain stimulation wasn’t the only component to his recovery—he also cites post-surgical medication, counseling, and his sober living home. He told CNN, “When it comes to staying sober, it’s just as important as the surgery.”