Drug Addicts Swear by Brain Surgery

ST. PETERSBURG — Sitting on the sofa, smiling and relaxed in her track suit and slippers, Yelena, 22, looks as if she is enjoying a holiday break. Only the snow-white bandage on her shaved head shows that this jovial economics major underwent a brain operation just two days earlier.

"There was no alternative," she said firmly. "It was that or the cemetery. ... Or an overdose."

Yelena had been shooting up half a gram of heroin every day since 1998.

Earlier this year, she and her husband, Igor, 20, both decided to go for a costly, relatively new type of surgery — a bilateral cryocingulotomy — at St. Petersburg's renowned Institute of the Human Brain in hopes of putting an end to their drug addiction.

Now Yelena has plenty of plans: After her one-month stay at the institute, she is set on finding a job, buying her parents a new apartment and going on vacation.

The operation - first performed in 1998 - aims to help people kick the habit by destroying a tiny part of the brain that researchers at the institute have identified as central to addiction.

Although this method is well established as a treatment for epilepsy, Parkinson's disease, brain tumors, depression and other ills, the Health Ministry's chief toxicologist, Alexander Karpov, stressed that - in terms of treating drug addiction - the operations are still at the highly experimental stage and official studies have yet to be conducted.

"You need a long trial period before you can draw conclusions. ... So it's too early to say how effective [the operation] can be."

The technical side of the procedure does indeed smack of science fiction: After a small hole has been drilled in the patient's skull under local anesthesia, a metal frame bearing a mobile "wand" is attached to the head. The tip of the wand, which has been immersed in carbon dioxide at a temperature of minus 70 degrees C, is passed through the hole to freeze the isolated area of the brain - located in the cingulum - with the help of computerized images.

"We look at what part of the brain is activated when you are craving something," explained the institute's director, Svyatoslav Medvedev. "And then we destroy that part by freezing it. The patient remembers what it's like to take drugs but he doesn't have the desire for it anymore."

Asked if she has felt any craving for heroin in the two days since her operation, Yelena's face goes blank: "No, nothing."

The institute, founded under the auspices of the Academy of Sciences in 1990, has a strict admissions policy. The patient must be at least 17 with a history of abusing hard drugs - such as heroin or other opiates - for at least three years and must display a real desire to be cured. Patients come from all over Russia and, also, from "good families," according to the institute's deputy director, Andrei Anichkov.

Twenty-year-old Sveta, one of the first drug users to have had the operation at the end of 1998, has faith in the cure.

"It was a total success," she said. "I haven't had any cravings since then. And it wasn't very painful. It couldn't have been worse than what I had gone through already."

Sveta's sister, Tatyana, 33, is also happy with the results.

"She is more like she used to be. But she is also stronger," says Tatyana of her sister. "She has become more adult, more mature. Now she can talk about drugs openly and with total indifference."

According to Medvedev, 70 percent of former patients have managed to stay off drugs for six months after the operation. He tries to be realistic about more long-term results, however, saying that only 3 percent to 7 percent of drug addicts worldwide manage to achieve full rehabilitation.

"The key to success is their own will," he said. "It's got to be someone who still says - right on the operating table - that he wants to be cured."

But the patients' own will is not enough, says toxicologist Taras Dutko of the State Center of Toxicology in Moscow.

"More research is needed to study the long-term effects. Now they are not being registered anywhere," he said. "And there are very few people who go for these operations, so there is little information. We need greater control."

Yury Polyakov, the institute's head psychiatrist, confirmed that there is a data base with patients' records; however, it is difficult to monitor patients for whom the operation was not successful and who have resumed taking drugs.

"They don't want to get in touch with us. So we often find out from their parents or we hear about them from other sources," he said.

The institute's six surgeons have seen both success stories and tragedies come out of the 100 or so operations they have performed since 1998. Many patients have fared as well as Sveta. But others have got back "on the needle" and some have begged for a second operation. The institute's position, however, is clear-cut: "We tell them, 'This is your last chance,'" Medvedev said.

All the institute's patients have fatal diseases such as AIDS and hepatitis B and C.

"The death rate [among drug users] is very high. This is why we don't have anyone over 30," he said.

He added that the institute could not give out contact details of such patients for ethical reasons.

The total cost of the operation and related expenses is $4,000 to $10,000. These fees make up the bulk of the institute's funding. According to Medvedev, the Health Ministry allocates 3 rubles per patient per day for medicines and 1 ruble 40 kopeks for food.

"Even at $10,000 it's worth it," said Sveta, whose parents paid for her treatment. "It has changed my life completely."