Deleting Drug Addiction

Since it received FDA approval in 2008, transcranial magnetic stimulation (TMS) has proven to be an effective treatment for depression, but now, a team of researchers are preparing to answer a question many have been asking for the past several years: Can TMS also be used to treat drug addiction?

TMS is a noninvasive way to stimulate the brain's neurons. During treatment, a device that generates electromagnetic pulses is placed near a patient's head. These pulses affect neural activity, sometimes speeding up the firing of neurons, sometimes slowing the process down depending on such variables as the frequency, duration, and pattern of the pulses.

Italian addiction physician Luigi Gallimbert has treated more than 300 cocaine-addicted patients using the technique. He was prompted to investigate the idea by a 2013 study out of the National Institute on Drug Abuse (NIDA) that demonstrated how stimulating the brains of drug-addicted rats could help them kick the habit.

The rats were genetically modified to allow their neurons to be controlled with light and trained to pursue cocaine so persistently, they would withstand repeated electric shocks in order to get their fix. When the NIDA researchers stimulated the area of a rat's brain in charge of impulse control, the animal's addiction was almost immediately quelled.

The co-authors of the study, neuroscientists Antonello Bonci and Billy Chen, posited that targeting the corresponding area of a human brain — a part of the prefrontal cortex — could counteract the hold of drug addiction in people. Bonci suggested that this stimulation could be done via TMS, and that's exactly what Gallimberti decided to try.

With a small group of just 32 participants, he tested out the efficacy of TMS to treat cocaine addiction, and encouraged by the success of this small study, he began offering the TMS treatment at his clinic for about $118 per session, dropping the fee entirely for those who couldn't afford it. Eventually, Gallimbert and a group of fellow researchers, include Bonci, conducted a nonblinded treatment study of 16 cocaine users with promising results.

Straight to the Source

Right now, some experts are skeptical of TMS, asserting that it offers little more than a placebo effect. "I have colleagues who I respect and who I think are honest who swear by it — who think it works. I don’t," Walter Brown, a psychiatrist at Brown University, told Science. "I have no doubt that some people with cocaine addiction treated with TMS will get better. But it won’t be the effect of the treatment, in my opinion."

While it might not put to rest claims of the placebo effect, more research is being conducted to see whether TMS has the potential to treat people who suffer from drug addiction.

The Medical University of South Carolina embarked upon the first randomized, double-blind trial of the procedure's effect on drug addiction last year, and the National Institute of Psychiatry in Mexico City began a similar study earlier this year. NIDA is currently in the midst of a pilot study focusing on cocaine addiction ahead of a large controlled trial in 2018 that will include 60 cocaine users.

A million people in the U.S. alone are addicted to cocaine, with a further 13 million addicted worldwide. While TMS could potentially help treat all kinds of addictions, it could be particularly beneficial to people who are addicted to cocaine. Not only is the drug notoriously hard to kick, with the one-year relapse rate said to be around 80 percent, it also doesn't have a single FDA-approved treatment option, unlike such drugs as nicotine, alcohol, heroin, and synthetic opioids.

If these upcoming trials yield promising results, however, cocaine addicts could have access to a treatment that's not only relatively inexpensive but also noninvasive.

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