Everything You Need to Know About the Brain-PACER Study

Addiction is a very complex condition that is difficult to treat. It has psychological and habitual elements, but also involves long-lasting changes to the way the brain functions.

The US National Institute on Drug Abuse says:

“Addiction is defined as a chronic, relapsing disorder characterised by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs.”

Holistic addiction treatment programmes will address a number of different elements, including detoxification and managing withdrawal symptoms, providing strategies to prevent relapse and treating the psychological aspects of addiction through therapy.

Now, a major new UK-based study, known as the Brain-PACER study, is aiming to explore an innovative way to treat severe alcohol or opioid addiction using a technique known as deep brain stimulation or DBS.

What Is the Brain-PACER Study?

The Brain-PACER study is more fully known as the Brain Pacemaker Addiction Control to End Relapse study and is a research study that aims to explore the effectiveness of using deep brain stimulation to treat addiction.

A number of smaller studies have already suggested that DBS (which is routinely used to treat conditions including Parkinson’s disease and obsessive-compulsive disorder) could be a safe and effective method of treating addiction. The Brain-PACER study is a collaboration between the University of Cambridge, King’s College London and the University of Oxford. It is described as the first major, multicentre study to use DBS to treat craving and relapse in severe addiction.

Who’s Eligible?

The Brain-PACER study is being funded by the Medical Research Council (MRC) and will be carried out at sites in Cambridge, Oxford and London. The study is looking for participants who are committed to recovery from addiction but have faced repeated relapses despite treatment and therapy.

To be eligible for participation in this study, individuals must meet the following criteria:

• Aged between 18 to 60.
• Diagnosed with alcohol use disorder (AUD) or opioid use disorder (OUD) according to DSM-5 criteria.
• A minimum of 5 years with the disorder listed above.
• At least 3 unsuccessful attempts at abstinence.
• Undergone unsuccessful psychotherapy and standard pharmacotherapy.

Some other criteria may prevent individuals from participating. These include serious psychiatric disorders, neurosurgical issues like intolerance of general anaesthetics and a history of repeated falls or a major head injury. Full eligibility and details of how to apply for the study can be found at the Brain-PACER website.

How Does Deep Brain Stimulation Work in Treating Addiction?

Deep brain stimulation is a neurosurgical treatment that uses implants to deliver stimulation to key areas of the brain. It works as a pacemaker for the brain, regulating abnormal activity, hence the ‘PACER’ acronym.

Electrodes are placed in specific areas of the brain under general anaesthesia. The precise locations will depend on the condition being treated and the related areas of brain activity that need to be regulated. In the case of addiction, the electrodes are placed in areas of the brain involved in reward, motivation and decision-making.

An IPG (implanted pulse generator) or pacemaker will also be fitted under the skin of the chest. This sends pulses to the electrodes, regulating the relevant areas of the brain. Researchers are still figuring out exactly how DBS works, but all the evidence suggests that it does for certain conditions. Experts believe that the low-voltage pulses of electricity from DBS regulate abnormal nerve signals and may also trigger changes in brain chemistry.

The Brain-PACER trial seeks not only to develop a new way to treat addiction, but also to understand the brain mechanisms that drive addiction disorders. The trials will be randomised, meaning the electrical signals will not be turned on at all times. The brain activity of the participants will continue to be monitored, however, hopefully providing fresh insights into how addiction affects the brain.

Potential Benefits and Ethical Considerations

In terms of addiction, it is believed that the electrical impulses from the pulse generator will help to regulate abnormal brain activity brought about by substance misuse and dependency. This may help to reduce cravings and improve self-control by modulating brain circuits involved in these behaviours. In turn, it is hoped that the process will help individuals to recover from their addiction, especially where other types of treatment have been tried unsuccessfully.

The benefits of addiction recovery can be huge and far-reaching. Addiction can affect physical and mental health, as well as almost every aspect of the addict’s life, as well as those around them.

There are some ethical considerations to DBS, however. Even though it is considered to be minimally invasive surgery, individuals should be able to give informed consent and not be coerced into such treatment. There may also be ethical concerns about the manipulation of the reward centre and the implications of this moving forward.

The Future of Addiction Treatment in the UK

While the Brain-PACER study will investigate the impact of DBS on people with alcohol and opioid problems, the technique could also potentially help people with other types of addiction.

It could provide an effective way to treat addiction for individuals who have not been able to fully benefit from other types of therapy. The study itself could also help improve understanding of how addiction affects the brain, potentially paving the way for other innovative treatments in the future. Staying informed on developments in recovery and addiction treatment can be important, but it’s also worth remembering that existing treatments are highly effective for many people.

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If you or a loved one is currently struggling with substance misuse or addiction, it is always best to seek professional help and advice as soon as possible. We can offer free and confidential advice and support to help you find the right treatment for your needs.

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