By both training and experience, substance use disorder (SUD) counselors treat addiction—in all its forms, with any substance—as a chronic condition. It’s a monkey that never comes off the back of the patient, a whisper in the core of the brain that is always present. Counselors train their patients to resist it, to overcome it, to ignore it… but they still struggle with how to teach them to truly escape it.
It’s a functionally practical model in a world where drugs and other substances are easily available and relapse rates range between 40 percent and 60 percent on average. For certain chemically addictive substances, like opioids, relapse can run as high as 91 percent.
This is also in line with the current medical understanding of the sources of addiction. It’s a mysterious mix of genetic susceptibility, environmental factors, and individual lived experience. There are no known treatments to overcome all those contributing factors.
The experience of most patients and their counselors tells them that addiction can be beat, but never permanently. Every day is another day to manage the pull.
But what if that wasn’t true?
Evidence Points to Where Addiction Lives in the Brain—and How to Stop It
That traditional view of addiction as a complex blend of environmental and genetic factors is one that mirrors the current scientific understanding of various developmental and medical conditions, including autism spectrum disorder, Alzheimer’s disease, and even many forms of cancer.
Understanding that environmental and genetic factors both fuel certain diseases hasn’t stopped efforts to isolate the physical source of those conditions in hopes of developing a more permanent cure.
A study recently published in Nature may point to the source when it comes to at least one form of addiction, though.
A multinational research team conducted an analysis of cigarette smokers who experienced strokes that damaged the brain. They found that a certain subset of those individuals mysteriously quit smoking immediately after the brain damage occurred. They reported no craving, and they never relapsed.
While certain kinds of behavioral or functional controls can be linked to specific regions of the brain, the stroke damage among patients in the dataset had occurred in many different locations. Instead, the common connection among those individuals who stopped smoking entirely was that the damage in their brains involved a specific pattern of connectivity to the insula, a somewhat mysterious part of the cerebral cortex thought to deal with consciousness, emotion, and the senses.
New Data Comes Together with Old Treatments to Offer Potentially Permanent Cures for Addiction
The results of the study offer a new target for a technique called TMS: Transcranial Magnetic Stimulation.
TMS has been approved for treating depression since 2008, and OCD (Obsessive-Compulsive Disorder) since 2018. It involves non-invasive but targeted magnetic stimulation that induces small electrical currents in the brain. It’s a safer and more painless update on electroshock therapy, one that delivers cognitive change when applied precisely.
Previously, TMS experiments in smoking cessation were aimed largely by guesswork. But now, electrical stimulation of the insula network is being used, and showing promising results for the new technology.
The Brain Has Long Been Seen as a Path to Addiction Therapy
Brain-altering techniques aren’t entirely new in addiction treatment. Various drugs have been found to have useful impacts on cravings, such as bupropion for nicotine or naltrexone with alcohol.
Commonly, chemical interventions work by blocking certain neurotransmitters or creating other sporadic effects that can only last for as long as the chemical stays in the body.
Identifying connections in the brain that may be responsible for addiction opens up non-chemical interventions that may be more targeted and more permanent than pills.
Transcranial magnetic stimulation has the potential to permanently change the function of certain brain features, in the same way that stroke lesions. And that unlocks the door to at least the potential of permanent cures to some sorts of addiction.
Opening the Door to Permanent Addiction Cures Sparks Debate in the Substance Abuse Treatment Community
To be entirely clear, there’s absolutely no doubt in the functional reality today that addiction is experienced by most people as a chronic disorder. Even if it is, in fact, a curable condition, we’re decades away from any practical treatment that once and for all eliminates addiction for any individual.
If such a treatment becomes available, it will utterly revolutionize the entire field of SUD counseling.
The idea of addiction as a chronic issue is deeply engrained in the current approach to treating substance use disorders. There’s even a whole body of science and research on different types of relapse and stages of recovery that build in the inevitability of relapsing.
Importantly, the view of addiction as a chronic condition is useful as a psychological technique in treatment. With relapse a real and even likely possibility, it’s important to prepare clients for the risk. By reminding them consistently that a relapse is just a part of the process, rather than a failure of treatment, they can stay engaged and motivated.
Some of the worst features of historical substance abuse treatment came from seeing addiction as curable, and relapse as a moral failing.
So there are strong, time-tested reasons to keep relapses in perspective and view SUD recovery as a perpetual process. But it may also be important to keep that perspective from letting counselors work toward a future where recovery from addiction may finally be final.
Substance Use Disorder Degrees Both Drive New Understanding and Distribute It to Counselors
These kinds of complex debates are exactly why the most advanced credentials in the field of addiction counseling require a master’s degree in substance abuse counseling or higher.
Conducting the kind of research that builds data to fuel these kinds of treatment approaches is a critical way out of the American addiction crisis. It happens in doctoral studies such as those that students in PsyD (Doctor of Psychology) or PhD in Addiction Counseling go through. Spending as much as half of their four years of study on research and investigation, they are the individuals asking these questions and driving the answers.
It’s also through graduate-level programs that the results of this research are chewed through and turned into actual treatment and therapy. Master’s programs deliver both state-required training for certification and advanced skills in the latest therapy techniques. They also encourage original thinking and innovation—which is exactly what will be needed for ground-breaking developments like true addiction cures.
For all the reliance today on the chronic disorder model of treatment, if and when cures actually become available for addiction, it will be the most advanced students in substance abuse counseling who come up with new models that deliver the treatment that enables those cures.