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."