Understanding risk factors for addiction could help doctors better respond to the opioid crisis.
Addiction is a brain disease, but there has been surprisingly little research into the brain structures that can contribute to the disease.
Now, study authors are arguing that a better understanding of how brain development and damage can contribute to addiction is important to help identify people who are most at risk.
“Addiction is a disease of decision-making,” Antoine Bechara, a professor of psychology at the University of Southern California told the school’s news service. “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?”
Weak Prefrontal Cortex Plays A Role
Bechara is the lead author of a paper published in the journal Psychological Science in the Public Interest. His paper examines the role of the prefrontal cortex and the insula in increasing a person’s risk for addiction. The researchers note that a “weak prefrontal cortex”—the area of the brain associated with decision making—can increase risk for addiction.
Weakness in that area of the brain can be caused by genetic factors. However, environmental factors including early childhood abuse can also inhibit the development of the prefrontal cortex. When the area is under-developed, a person can become susceptible to substance use disorder.
“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,” said Bechara. “These are people who become more susceptible to becoming addicted not just to opioids but other drugs they have access to.”
The authors would like to see further research into whether brain scanning can predict which individuals are at risk for addiction. They also point out that brain stimulation could potentially help treat addiction.
Who’s At Risk?
Understanding who is at risk for developing addiction could help doctors better respond to the opioid crisis, by finding a middle ground amid what Bechara calls the “two extreme positions” that medical providers have taken.
“First, the pharmaceutical companies sold the idea that opioid medications will only be used by people in pain and people won’t become addicted,” he said. “That’s not true, because you have no way of telling who is susceptible to becoming addicted and who is not.”
He continued, “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.”
