Cocaine addiction is tough to treat, with only a few options available. Behavioral therapies can help, but many people still face cravings and relapse.

However, new research shows that repetitive Transcranial Magnetic Stimulation (rTMS) might be a promising option. It shows its potential long-term benefits for treating cocaine addiction.

What is Cocaine-Use Disorder?

Cocaine-use disorder happens when someone can’t stop using cocaine, even though it causes problems. Cocaine is a strong drug that affects the brain and is very addictive. People with this disorder often feel a strong need for the drug and can’t control their use. Even when it hurts their health, relationships, or job, they keep using it. This makes it hard for them to stop, even when they want to.

The disorder is classified as a substance use disorder (SUD) and is diagnosed based on specific criteria set by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These criteria include a combination of behavioral, cognitive, and physiological symptoms.

In simple terms, cocaine-use disorder disrupts daily life, making it difficult for a person to function without the drug. It’s more than just occasional recreational use – it’s a severe dependence on the substance.

How Prevalent is Cocaine-Use Disorder?

A report from the National Survey on Drug Use and Health (NSDUH) estimates that around 5.5 million Americans aged 12 and older were current users of cocaine in 2019. About 874,000 people in the U.S. also had a cocaine-use disorder in the past years. 

How Does Cocaine Affect the Brain?

Cocaine affects the brain’s reward system by causing a surge of dopamine, the chemical that makes us feel pleasure. With continued use, cocaine changes the brain, making it harder to feel pleasure without the drug. This leads users to need more cocaine to get the same high. This can lead to addiction.

Cocaine use can cause a temporary feeling of euphoria, more energy, and alertness, while also reducing appetite. However, these effects don’t last long and are often followed by a crash. Afterward, users may feel depressed, anxious, and irritable.

And long-term use can cause serious physical and mental health problems, like heart issues, breathing trouble, paranoia, and hallucinations. There’s also a high risk of overdose, especially when cocaine is combined with alcohol or opioids. Mixing these substances increases the danger even more.

How Does Cocaine-Use Disorder Affect Mental Health?

Cocaine-use disorder can seriously affect mental health. Many people with this addiction also struggle with issues like depression, anxiety, or bipolar disorder.

It can be tough to treat these mental health problems alongside addiction. That’s why it’s important to find effective treatment options. One option that can help is rTMS therapy.

What is rTMS?

rTMS is a procedure that doesn’t require surgery or putting anything inside the brain. A magnetic coil is placed on the scalp to send short pulses. These pulses travel through the skull and reach specific areas of the brain. They focus on areas that deal with addiction and impulse control.

How Do rTMS Target the Brain?

rTMS focuses on stimulating the prefrontal cortex, a part of the brain that helps control cravings and decision-making. For people with cocaine-use disorder, this area might not work well, making it difficult to resist drug use. rTMS works by stimulating the prefrontal cortex to restore normal brain activity. This can lead to better impulse control, reducing cravings.

How Does rTMS Affect Dopamine Levels?

rTMS can help balance dopamine levels, reducing the urge for drug use. This is especially helpful for those with cocaine addiction. It can be important in breaking the cycle of dependence.

Recent Study: Long-Term Outcomes of rTMS in Cocaine-Use Disorder

The study titled “Long-Term Outcome of Repetitive Transcranial Magnetic Stimulation in a Large Cohort of Patients With Cocaine-Use Disorder” looked into the effects of rTMS on individuals with Cocaine-Use Disorder (CocUD).

Cocaine addiction is known for its damaging effects on the brain. Currently, there’s a lack of effective medications to treat it. Some earlier research suggested that rTMS stimulation of the prefrontal cortex could reduce addictive behaviors.

However, these studies involved small groups of participants. They also had limited follow-up periods. This new study, in contrast, observed a larger group of 284 people over nearly three years.

How Was the Study Conducted?

Participants underwent three months of rTMS, followed by a long-term follow-up of up to 2 years and 8 months. The cohort consisted predominantly of men (268 out of 284), and most were frequent cocaine users — either daily or several times a week. 

Researchers tracked cocaine use through self-reports, family input, and regular urine tests. The study aimed to see if rTMS could reduce cocaine use. They focused on whether it would lead to changes over time. The results would show how effective rTMS might be.

The outcome: A noticeable drop in the frequency of cocaine use. Specifically, the median time to the first relapse was 91 days. Additionally, even when the frequency of rTMS sessions was reduced, there was no spike in cocaine relapses. On average, patients reported using cocaine less than one day per month. Serious side effects related to rTMS were rare, aligning with previous smaller studies.

What Were the Results?

One finding from this study was that the reduction in cocaine use wasn’t just temporary. The benefits lasted throughout the follow-up period. This means rTMS could be a long-term treatment option for cocaine use disorder, not just a short-term fix. The study also had a large sample size and a long observation period. This gave stronger evidence of rTMS’s effectiveness. It also helped address gaps found in earlier research.

This study looked at rTMS treatment for cocaine addiction, but the brain area targeted (the left dorsolateral prefrontal cortex) could be important for treating other addictions too. These might include heroin, methamphetamine, nicotine, or cannabis addiction. This suggests the potential for rTMS in broader substance use disorder treatments.

What Are the Study’s Limitations?

While the study offers promising insights, it’s important to note that it had some limitations. As a retrospective observational study, the data were based on chart reviews, which could introduce bias. For example, the reliance on self-reports for drug use might not be entirely reliable. However, adding family reports and urine screenings helped mitigate this issue.

Moreover, the study only tested one brain region (left DLPFC) and one set of stimulation parameters. Thus, the findings may not generalize to other stimulation sites or protocols. Further, the study wasn’t designed to compare the effectiveness of rTMS with other conventional treatments, such as psychotherapy. However, the authors compared their findings to a similar cohort receiving standard care and observed that rTMS resulted in longer durations of abstinence.

Why Is This Important?

This study provides helpful information showing that rTMS could be included in treatment plans for cocaine addiction. While it’s not a cure on its own, it can complement behavioral treatments, which are still the most effective. rTMS might work best when combined with therapy. Together, they could offer a more complete approach to treating addiction. This combination could help improve outcomes for those seeking recovery.

What Are the Next Steps?

As with all research, the findings here are just a starting point. More robust randomized controlled trials (RCTs) are already underway, as noted by the authors. These trials will aim to confirm rTMS’s effectiveness in larger, more diverse populations. If successful, rTMS could become a go-to neurobiological treatment for cocaine addiction and possibly other substance use disorders.

This study offers promising news about rTMS as a long-term treatment for cocaine addiction. It emphasizes the need for ongoing research to give more choices to those battling addiction. Addiction is known to be a very challenging condition to treat. With more studies like this, there could be better options for people in the future. Continued exploration in this field is necessary for improving treatment outcomes.

What Makes the TMS Institute of Arizona Unique?

The TMS Institute of Arizona offers advanced rTMS treatments designed to meet each person’s needs. Our team comprises experienced professionals using state-of-the-art equipment to provide the best care. We create personalized plans that ensure a supportive and caring environment.

It’s not just about providing rTMS — it’s about finding the right approach for each individual. Whether you’re facing addiction, depression, PTSD, or another condition, we work closely with you to track progress and adjust as needed. This is a partnership. Your well-being is always our priority.

How Do You Know if rTMS is Right for You?

The first step is a consultation. Our TMS Arizona will assess your medical history, current condition, and treatment goals. This isn’t a cookie-cutter approach. We consider the nuances of your situation to determine whether rTMS fits into your broader treatment plan. 

Find real relief — contact us today.

References:

Brandt, L., Chao, T., Comer, S. D., & Levin, F. R. (2020). Pharmacotherapeutic strategies for treating cocaine use disorder—what do we have to offer? Addiction, 116(4), 694–710. https://doi.org/10.1111/add.15242

Madeo, G., Terraneo, A., Cardullo, S., Gómez, L. J., Cellini, N., Sarlo, M., Bonci, A., & Gallimberti, L. (2020). Long-Term Outcome of Repetitive Transcranial Magnetic Stimulation in a Large Cohort of Patients With Cocaine-Use Disorder: An Observational Study. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00158

Schwartz, E. K. C., Wolkowicz, N. R., Joao, R Ross MacLean, & Mehmet Sofuoglu. (2022). Cocaine Use Disorder (CUD): Current Clinical Perspectives. Substance Abuse and Rehabilitation, Volume 13, 25–46. https://doi.org/10.2147/sar.s337338

Important: The information in this article reflects current studies and does not replace professional medical consultations. Contact a healthcare professional for personalized care.