Physiological Mechanisms of the Effectiveness of Bilateral Stereotactic Cingulotomy against Strong Psychological Dependence in Drug Addicts

It is now generally believed that psychological dependence in drug addicts is determined not only socially, but also physiologically. At the Institute of the Human Brain (Russian Academy of Sciences), bilateral stereotactic cryocingulotomy has been used for treatment of drug addiction since 1998. To date, the surgery has been performed on 348 patients, which has made it possible to study long-term consequences of the surgery, perform the necessary psychological studies, and summarize the results. Interviewing of 187 patients with catamneses of more than two years has shown that 45% of them have entirely abstained from addictive drugs after the surgery and 17% have entirely abstained from drugs for more than two years after one or two instances of drug-taking within the first two months after the surgery; there are no data on 13% of the patients. The remaining patients exhibit either a partial improvement (they have found at least temporary work and have decreased the drug dosage and the frequency of intake) or show no change (13 and 12% of the cases, respectively). The results of catamnestic study have demonstrated that the surgery is effective against heroinism and rarely causes complications. Apparently, the physiological mechanism of the therapeutic effect is the suppression of the mechanism of error detection. The duration of the resultant destabilization may vary depending on the individual characteristics of the patient and environmental factors. Therefore, this period should be included in the duration of treatment and patients must follow the rehabilitation regimen.