Cocaine use in the U.S. is skyrocketing once again: The number of Americans aged 18 to 25 who admitted to trying cocaine for the first time increased by a whopping 61 percent from 2013 to 2015, according to the most recent National Survey on Drug Use and Health. We’re seeing serious repercussions as a result: The federal Substance Abuse and Mental Health Services Administration reported that the number of overdose deaths in the U.S. involving cocaine in 2015 was the highest since 2006, and the second-highest since 1999.
But despite more and more people falling victim to cocaine dependency, there isn’t a single treatment yet approved by the FDA for cocaine addiction.
There may be a new hope, though — albeit a controversial one.
A recent story published in Science Magazine discusses the work of neurologist Antonello Bonci, whose research at the National Institute on Drug Abuse in Baltimore points to transcranial magnetic stimulation (TMS) as a possible treatment for compulsive cocaine users. TMS is described as a noninvasive method of triggering neural activity applied by running electric current through a coil held near the scalp.
In layman’s terms, it’s zapping the brain with electricity.
Already an approved therapy for depression (and not to be confused with electroconvulsive therapy), Bonci argues that TMS also can be applied to strengthen impulse control and restore normality to a reward circuit that becomes abnormally active when cocaine users are presented with cues that trigger their addiction.
To figure out how viable of a fix TMS really is, we spoke with Bonci about what goes on in the brain of a coke addict, and how brain zapping could help ease addictions across the board.
Why is cocaine such a hard drug to kick in the first place?
Dozens and dozens of chemical receptors within different brain regions are changed after cocaine exposure. Some regions will give you cravings; some regions will give you the ability to plan to procure the drug; some regions will give you the pleasure response when you take the drug; and some regions will give you the aversive effects when you miss the drug. It’s a complex network of behaviors that altogether make sure that once a person is addicted to cocaine, their entire brain rewires itself to ensure their main concern is to procure cocaine no matter what’s in the way: Their family, their job, their friends.
If you have a disease that’s localized to a single gene, a single factor and a single cell, it’s much easier to find a cure or treatment. But when one drug is affecting so many brain regions, so many chemicals, so many receptors and so many proteins, you start to understand why it’s so complicated to figure out how to treat it.
That’s a short answer to a beautifully complex problem.
How come there are no FDA-approved treatments for coke addiction so far?
There have been many clinical studies [on the subject], but each one just adds more and more data as to why and how cocaine changes the brain. The complexity of how cocaine affects the brain keeps on increasing, and it’s not easy to translate it all into an effective therapy. It’s extremely expensive to develop medications as well.
So what are the options currently available for coke addicts who want to kick their habit?
They have psychological support and cognitive-behavioral therapy.
Why would TMS be a better solution?
Transcranial magnetic stimulation is a technique that’s been approved for use since 1985 for the treatment of medication-resistant depression. It’s a wonderful technology because it’s noninvasive: It creates an electromagnetic field that — just by putting this probe on top of the head in a certain position — stimulates brain cells. You can find hundreds of clinical trials that have used TMS for a variety of conditions, including memory impairment, cognitive dysfunction, insomnia and different kinds of substance abuse — nicotine, alcohol, heroin and now cocaine. The list goes on and on.
How does it actually help coke addicts to reduce their cravings?
There’s evidence that humans who are addicted to cocaine have altered frontal regions of the brain, which are the regions that we all use for proper decision making. For example, if you have a normally functioning frontal cortex, you know that you shouldn’t run a red light. But after chronic cocaine exposure, people have dysfunctional frontal regions, which we think has to do with their ability to make proper decisions — one being the decision to take cocaine.
Based on that evidence, we ran a rodent study. After chronic cocaine exposure in the rats, we measured the ability of their frontal regions, and we observed that their frontal regions were hyperactive. In rats, we could do what can’t be done in humans — we used a technology called optogenetics to stimulate the relevant parts of their brains. As soon as we stimulated the very hyperactive frontal regions, these compulsive cocaine seekers would — within a few minutes — lose interest in taking cocaine.
Based on that logic, we decided to use TMS in chronic cocaine addicts to stimulate their frontal regions and hopefully reduce cravings and relapse. That’s how the TMS study we published a year and a half ago came about.
What were the results?
It was a small clinical trial, but we saw that seven out of 10 patients would experience reduced cravings. It’s not for everybody — you see varied results even between those who did have reduced cravings — but after five to 15 TMS stimulations (normally performed once per day, for about 30 minutes) they usually saw results. Some of the patients will even tell you exactly which TMS session had them stop caring about or craving cocaine, which is incredible.
It should be said that we still don’t have the results from a double-blind study (which is currently being performed). This means we can be very optimistic about TMS, but we need to make sure these clinical trials aren’t simply seeing a placebo effect. We need to have definitive answers before we can understand how effective TMS really is as a treatment for cocaine addiction.
Are there any negative side effects to the treatment?
If the person applying it isn’t professionally trained, it’s possible to experience the most dangerous side effect of TMS: Seizures.
If TMS were approved by the FDA, how available would it be? Could broke addicts afford TMS, or would it be reserved for rich celebrities in rehab?
Any hospital, any small clinic and any healthcare center could buy a TMS machine. The cost of a machine is generally around $50,000 to $70,000, but you could treat hundreds of people for many, many years with it. It would actually be one of the cheapest treatments if you think about it — you wouldn’t have to take a pill every day for the rest of your life.