In the early 2000’s I was invited to a “Think Tank” concerning our field. A few weeks before the gathering, we were told, “Look forward in your career, out 20 or 30 years, and come ready to say what you would wish we would have in our field”.
When we met, there were two ideas I named.
- The first wish I named was genetic testing at low cost, with fast results, during intake, specific to pharmacotherapy. Some patients have a liver (genetically) rendering them a fast metabolizer of certain medications. I would like to have this specific information available during admission, so we could be more effective, quicker, for the patient concerning the specificity and sufficiency of their medication regimen (vs. struggling over mere self-report information, etc.). I never thought I would live to see the day in our clinical work where we do have this, and we do now.
- The second wish I named we still do not have yet: pocket-sized fMRI. I stated I would use this for everyone in group therapy, with real-time clinical supervision and in-ear feedback for the clinician, live, during group. The point here is the same point above concerning neuroscience – that it would be helpful to have a real view of neurological function happening in real time while the patient is undergoing care. We could look at neurological improvement (structure and function), with regard to healing and not just with regard to use or problems, only.
It could happen. With fMRI for clinical outcomes all we would need to do is use it with the right timing relative to the onset of care. Computers used to be room sized. They are a lot smaller now. It could be that fMRI could eventually be pocket-sized, and simply in the shirt pocket of each patient in group. But we do not have it yet. And more to the point, we do not have comprehensive measures that are currently available being used, and certainly not used over decades – so in today’s routine addiction treatment, we are flying blind.
Social and Cognitive Neuroscience
I would like to outline what I consider a rather brilliant piece of work by Mark Galanter11 that came out in 2014. I think this is nothing short of a radically improved and innovative research agenda for the next decade or two. What he has done is taken the functional components of recovery and broken those functional components into a list of operationally defined markers of activity (that are behavioral and clinical). He also listed the associated brain region for each of those aspects of working a recovery program. In short, he has listed what it is to think and to do a personal recovery program, both by functional component and brain region. He has a lot more to say in that paper, but that is the essence of his notion. In summary, he is defining social and cognitive neuroscience for getting better.
How is this important?
Well, we all remember NIDA declaring the 1990’s the “Decade of the Brain”. NIDA was doing important work (which began elsewhere in the 80’s) around cue associations and related brain activity and responses. Many of us have seen those classic brain imaging slides; they were in routine use for patient education and education of clinical professionals. But the limitation in that work is that while that work is important, it is pathology-focused, merely examining the problem, and we simply want the resulting activity in these brain regions to go away. I wish, by contrast, that we had this kind of work done in the “do” direction concerning healing and working a personal program. That is, with the neurological function we are capable of studying, it would be great to have patients assessed with regard to getting better (rather than such work only examining reactivity after exposure to drugs or drug use).
For the super-skeptics I would like to introduce the name Shepard Siegel from McMaster University who looked at neuroanatomy and neurological function related to drug use problems over his entire career.12 He sliced very thin in the design and specificity of his experimental questions, and spent his career examining parameters of problem-oriented neurological function and neurological structures; it was brilliant work.
I am simply emphasizing it would be nice to have analogous information concerning getting better and thus over time, the particular indicators within the Stages of Healing.
11Galanter, M. (2014). Alcoholics Anonymous and Twelve-Step Recovery: A model based on social and cognitive neuroscience. The American Journal on Addictions. 23: 300-307.
12Siegel, S & Ramos, B.M.C. (2002). Applying Laboratory Research: Drug Anticipation and the Treatment of Drug Addiction. Experimental and Clinical Psychopharmacology. 10(3): 162–183.
In case you missed it, Part 7: CURRENT PRACTICAL PROBLEMS; PRACTICAL EXAMPLES is here.
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