Addiction treatment models have many things in common, but treatment ultimately must be personalized to the individual with a substance abuse disorder to be effective. Everyone washes up on the shore of addiction having gotten there by a unique path, and addiction treatment must be individualized as well.

Treatment programs also have their own advantages and disadvantages. For example, while medication-assisted treatment can help people with heroin or other opioid addictions to successfully recover, not everyone has access to them, and in some cases, the treatment medications themselves can be abused. Likewise, while 12-step programs have helped people overcome addictions, they don’t work for everyone.

A new potential treatment modality that shows promise for the treatment of cocaine addiction (which has no FDA-approved treatment and high relapse rates) is transcranial magnetic stimulation (TMS).

Transcranial Magnetic Stimulation: What It Does and How It Works

TMS is not new, though the only condition it has FDA approval to treat is treatment-resistant depression. In the 1990s, researchers, who had previously used TMS to understand how the brain’s motor cortex controls muscles, began experimentation with repetitive TMS (rTMS), applying closely-spaced pulses to an electromagnetic coil placed near the scalp at the front of the head.

They found that slower stimulation (such as one pulse per second) rendered neurons less excitable and faster stimulation (at rates from five to 20 pulses per second) made neurons more susceptible to firing. Each appears to have different applications, with low-frequency TMS appearing to dampen neurological activity that results in auditory hallucinations in people with schizophrenia. By contrast, high-frequency TMS is believed to boost sluggish neurons into action in the brains of depressed people, offering them relief from depression symptoms.

Treating the “Cold Circuit”

On the left side of the brain, behind the hairline in most people, is the left dorsolateral prefrontal cortex (abbreviated as DLPFC). This is a key component in the brain’s “cold” circuit, also known as the executive control network, which overcomes impulses. This part of the brain is believed to connect to deeper brain structures that are underactive in people with cocaine addiction, and rapid TMS attempts to stimulate this region into action. Preliminary, small trials have shown promise, but researchers believe much fine-tuning will be required to maximize the effectiveness and efficiency of this type of addiction treatment.



Treating the “Hot Circuit”

The so-called “hot” brain circuit is responsible for transmitting craving and reward-oriented impulses, and it is pathologically overactive in people with cocaine addiction, especially when the person with the addiction is triggered by cues like the sight of cocaine or cocaine paraphernalia.

Researchers with the National Institute on Drug Abuse (NIDA) aim to curb the activity of the hot circuit by using continuous, rather than intermittent TMS. Indeed, early research has found that continuous TMS applied to the hot circuit does appear to decrease neural activity in that brain circuit and quash activity in related brain regions activated by drug use cues. A double-blind trial began in August 2016 to test this theory of cocaine addiction treatment.

Could Deep Brain Stimulation Be Another Treatment Modality?

While TMS is a non-invasive therapy (though it can be temporarily uncomfortable), deep brain stimulation (DBS) requires that electrodes be placed in specific brain regions by neurosurgeons. It is not approved for addiction treatment, and no plans yet exist to study it for that purpose, since it involves invasive surgery.

However, in people with addictions who had to have DBS to treat other medical conditions like obsessive-compulsive disorder or movement disorders, patients have reported reduced consumption of substances they had abused, including alcohol, heroin, and nicotine. Studies in rodents have also shown promise, documenting that DBS reduces consumption of alcohol and cocaine.

Recent and ongoing studies of TMS offer a reason for optimism in the successful treatment of cocaine addiction, though it may take years to determine how best to deliver this treatment for that purpose. That does not mean that people with cocaine abuse problems should give up. In-patient treatment that addresses each person holistically and under medical supervision is still the gold standard for addressing addiction, for cocaine and other abused substances. If you are in the grip of cocaine addiction or any other type of addiction, we encourage you to reach out for help by contacting us at any time.

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