Getting a clearer picture

August 24, 2011
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NCAD will feature leading proponent of neuroimaging as clinical tool
Getting a clearer picture

Addiction professionals who have worked with Daniel G. Amen, MD, say the growing public profile of a physician who in recent months has become a PBS fixture should in no way obscure the seriousness of his message for the professional community.

“He's published at least 40 articles on neuroimaging,” says Robert Johnson, DO, medical director at the Sierra Tucson treatment facility. “He's grounded; his mission is to bring neuroimaging out of the laboratory and into practice.”

Amen, a board-certified psychiatrist and the medical director of Amen Clinics, Inc., on Sept. 20 will present the plenary session topic “Unchain Your Brain” at this year's National Conference on Addiction Disorders (NCAD), to be held Sept. 17-21 in San Diego. Amen, who has co-authored a new book with the same title, says he simply wants professionals who treat individuals with behavioral health disorders to introduce the brain into the clinical conversation.

“I tell them not to forget about the actual physical health of the brain when they treat people who struggle,” Amen says. “As crazy as it sounds, the brain is often completely left out.”

Changing assumptions

Amen traces his interest in neuroimaging to his work in a dual diagnosis treatment unit in the early 1990s, where he was struck by the extent of brain damage that clients had experienced in their lives.

“I developed ‘brain envy’; I concluded that with a better brain, these people's lives would be better,” Amen recalls. This would require adoption of a new treatment paradigm, involving showing clients how to take actions in their lives to enhance their brain function.

As soon as professionals begin to place the brain at the forefront of their analysis, all else about treatment changes, Amen believes. Suddenly the importance of environmental exposures and other factors take a prominent role in informing assessment and treatment.

“This should be part of the educational dialogue,” Amen says. “It should go right down to what you feed people in treatment centers.” Or, in the case of how 12-Step support groups are structured, the conversation should focus on how the important support can be sabotaged in the tobacco, caffeine and sugar it's customarily served with, he says.

A testimonial on the Amen Clinics website states, “The day is coming when mental health professionals that do not understand the basics of brain function will not be meeting the standard of care that patients are expecting. Physicians, no matter what their area of specialty is, will find their level of patient care will only be improved.”

Amen Clinics, with operations in Newport Beach and Fairfield, Calif., Bellevue, Wash., and Reston, Va., says it possesses the world's largest database of functional brain scans in psychiatry, with nearly 60,000 scans. Amen is an assistant clinical professor of psychiatry and human behavior at the University of California, Irvine School of Medicine, and has written and produced four fundraising shows for public television that feature his lecture material.

The Amen Clinics operation employs single-photon emission computed tomography (SPECT) technology, an imaging technique using gamma rays and offering a three-dimensional view of the brain. Sierra Tucson's Johnson says his center uses the same technology that Amen Clinics does, and adds that Amen has provided training to Sierra Tucson staff.

Amen says that getting counseling and even medical professionals on board with the idea of prioritizing brain science can pose a challenge.

“Counselors are not used to thinking about temporal lobes and the prefrontal cortex,” he says. “We still evaluate and treat people like we did in the 1800s when Abe Lincoln was depressed,” when a head injury he suffered as a youth went largely ignored.

Amen credits treatment organizations such as Sierra Tucson and Hanley Center for championing the use of scanning technology as part of the evaluation process. Amen assists the Florida-based Hanley Center with reading the scans that patients receive early in their treatment stay, and also is involved with general staff education for the organization.

Sierra Tucson's approach

Johnson believes data collected from neuroimaging can have significant value, as long as treatment organizations don't overreach.

“We don't use it to diagnose,” he says of Sierra Tucson's approach. “This will never wrap over the DSM's diagnostic categories.”

In addition, not all patients in Sierra Tucson's programs receive a SPECT scan; it is left to the attending physician for each patient to determine whether a scan has the potential to uncover some useful information. “We scan about 20 to 25 percent of our patients,” says Johnson.

The fact that patients often arrive at Sierra Tucson following failed treatment experiences elsewhere makes the scanning technology especially attractive to the organization. “People look to us as their last best hope,” Johnson says. “We believe therefore that we need to look for factors that might have been previously missed.”

He cites the example of a former client with complex post-traumatic stress disorder (PTSD) who had been abducted as a child and held for several years. During an extended-care phase after primary treatment, the client became informed of the availability of the SPECT procedure and underwent a scan. The procedure uncovered an issue resembling temporal epilepsy, and the client received a new medication as part of ongoing treatment. More than a year later, the client was working part-time and was in a relationship-accomplishments that had been elusive in the past, Johnson says.

Johnson says that despite a growing body of scientific evidence, he sees attitudes about neuroimaging remaining mixed in the professional community. Last spring's American Psychiatric Association (APA) annual meeting featured a prominent session debating the value of neuroimaging in treatment.

“Some professionals still believe that while neuroimaging may be helpful for looking at group differences, it is not for looking at individual patients,” Johnson says.

But he adds that that does not describe Sierra Tucson's experience. The organization at present is concluding a clinical study of 200 individuals that is seeking to determine how effectively SPECT technology can uncover traumatic brain injuries in patients, he said.

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