Addiction and Cancer

Introduction

A link between addictive behaviors and cancer was clearly established over the past decades, from well-known relationships such as tobacco and lung tumors to less known connections between alcoholism and several different cancers.

From a molecular pathology perspective, evaluation of addiction-related tumors is an aspect of clinical practice, as well as a topic of research in the laboratory.  For example, smoking cigarettes due to a nicotine addiction induces a change in cellular morphology along the central airways of the lung called squamous metaplasia that is evident under the microscope and can be a forerunner of squamous cell lung cancer.  If suspicious lesions are present on imaging studies or a patient develops symptoms of lung cancer, then histological evaluation of a biopsy or surgical specimen for the presence, extent, and sub-type of lung cancer needs to be performed by a pathologist.

These phenotypic, microscopic assessments of histopathology are complemented by molecular testing that provides information on the DNA mutation status of tumors, which is useful as a guide to targeted therapy.  This is an active area of basic and applied research as investigators seek to learn more about the molecular pathophysiology of tumors in order to develop targeted drugs and devices to treat them.

Avoneaux Med is interested in the link between addiction and cancer, and is specifically interested in use of technology to lessen this burden on patients, their families, and the health care system.  One such approach is the use of virtual reality (VR) technology to prevent and/or treat addictions, including alcohol, drugs, and nicotine.  The Institute works with scientists, clinicians, and people in recovery to advance VR tools and strategies for this purpose.

The information provided below is excerpted from a short research article originally published in 2014 by the Institute, which is a guide to current efforts in this space.

Observations from People in Recovery

Individuals who achieve long-term recovery through meeting-based programs represent an opportunity to investigate the neurophysiological elements that underlie abstinence from addiction.  Many such meeting-based programs exist, each with a different format and protocol but all sharing utilization of recovery meetings in the curriculum.

A frequent account from participants who have achieved years- or decades-long intervals of continuous abstinence in a meeting-based program is the profound effect of the environment that occurs when they are generating (telling) or receiving (listening) information.  Subjective reporting of a pronounced decrease in anxiety and an elevation in mood during the meetings is common, and phrases such as “changing my brain’s channel” and “recharging my mental batteries” are heard frequently, with the impact lasting on the order of two to five days.

Many who take part in meeting-based programs report the effect is a fundamental element of recovery, an essential aspect of maintaining abstinence that goes well beyond educational material or the benefit that a social support system provides.  When questioned, members will describe a deeply influential change in mental state that occurs during the meetings and continues for a period of time afterwards, which dramatically decreases their interest in and desire for addictive substances.

The personal accounts are accompanied by a striking objective behavioral change – from abuse of a substance(s) to sustained abstinence, for years and decades, with meeting attendance typically self-structured at two-to-five-day intervals to match the duration of the effect.  These anecdotal descriptions from members of recovery programs raise the possibility a measurable neurophysiological correlate to the subjective experience might exist.

If one views recovery meetings through the lens of a clinical investigator, observations can be synthesized into a testable hypothesis:

Recovery meetings induce a time-limited neurophysiological effect, a recovery state,

due to generation and reception of information, rendering participants resistant to relapse

At present, investigation into the neurophysiological changes that occur as part of abstinence, during meetings specifically and in recovery more generally, is relatively uncommon due in part to barriers involved in carrying out these studies.  The translational research challenges in studying members of recovery programs within a meeting environment are daunting and include the following:

1. The academic community has historically considered recovery groups as outside their purview and not amenable to scientific study.
2. Many clinicians and investigators are supportive of these programs but keep a respectful distance, thus careful observation and research efforts are limited.
3. There are obstacles based on the structure of recovery programs and the protection of patient confidentiality.

Today, a distinct separation between the clinical, scientific, and recovery communities exists, thus the cognitive processes induced by meeting environments, which appear to underlie successful abstinence, remain largely unexplored and undiscovered.

Virtual Reality – Bridging Disciplines and Connecting Silos

VR technology may be useful in overcoming barriers to translational research and in revealing the fundamental digital environmental code that actuates and maintains long-term abstinence.

One way forward is to use VR and concomitant neuroimaging to mimic a recovery group meeting and study members who are immersed in the environment.  Virtual meetings would obviate the need to create real-world experimental meetings and avoid issues around meeting-to-meeting irreproducibility.  Instead, well-designed and controlled VR-based scripts could be created to test the effect on subjects, using neuroimaging as an objective measure of response.  Such an experimental approach would only require participation of members of recovery groups who volunteer to participate as individuals, not as official members of a recovery program, a concept that is aligned with both the letter and spirit of these organizations.

Importantly, VR environments are digitized representations of the world, thus in conjunction with high-level computational tools they would allow the effect of recovery meetings to be stripped to the core and understood – [Digital Computer Input ≈ Neurophysiological Imaging Output].  Most useful perhaps would be to view the problem as one of signal transmission and utilize a mathematical treatment to allow the structure of the messaging conveyed during recovery meetings to be understood and modeled – freed from difficult translational research space and abstracted into understanding the essential elements within a meeting environment that induce the effect – a digital recovery code.

Addiction Remission – A Digital Recovery Code

A VR-based strategy could be useful in advancing treatment methods:

First, it may generate fundamental basic knowledge that investigators, clinicians, or members of the lay public use to design new therapies, including methods that cannot yet be predicted or go in directions that are unanticipated.

Second, it will allow determination of which informational aspects that induce abstinence are best transmitted via high dimensional (real-world, VR) as opposed to low dimensional (book, audio, video, on-line) formats.

Third, VR itself may become a useful therapeutic intervention for immersive recovery meetings, especially as the most effective elements of the digital recovery code are identified and then iteratively emphasized in future scripts.

Fourth, a deeper understanding of the environmental elements that actuate recovery may be successfully incorporated into real-world meeting formats.

And finally, the spectrum of neurophysiological responses to the VR meeting environment that occur can be measured across a population, in concert with DNA sequencing, to stratify persons into distinct response groups so that personalized meeting formats (both virtual and real-world) can be targeted to individuals based on their neurophysiological response and genomic profile.

Conclusion

Addiction remains a tremendously difficult societal problem, with staggering personal, economic, and health care consequences, including cancer.  Studying the neurophysiological basis of long-term remission using VR environments may prove useful in understanding the recovery process.  Ultimately, the goal is to identify the neurophysiological underpinnings of successful abstinence so that improved interventions for patients with addictive disorders can be developed.