Addiction

Could TMS Therapy Be Used to Treat Addiction?

November 1, 2019

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Despite addiction being so widespread and affecting such a significant portion of the population, many people fail to understand that substance use disorders are a type of mental health condition that affects the brain on a physical level. Though these disorders have been studied by the scientific community for many years, treatment options for addiction remain rather limited. 

Researchers from the Medical University of South Carolina investigated the efficacy of transcranial magnetic stimulation (TMS) in treating addiction by applying TMS therapy to subjects with drug and alcohol substance use disorders. Continue reading to find out more about:

  • Addiction and how it affects the brain
  • TMS therapy as a treatment 
  • The study, its results, and what they mean

Addiction and the Brain

In 2017, 19.7 million adults (ages 12 and over) reported having a substance use disorder during the National Survey on Drug Use and Health. Furthermore, substance abuse and addiction cost America an estimated $740 billion annually in healthcare and crime-related expenses, as well as lost workplace productivity. This means that addiction affection American society as a whole, both directly and indirectly. 

Bar graph showing how different mental health conditions can increase a person's risk of addiction.
Did you know that having a mental health condition increases a person’s risk of developing an addiction? Image courtesy of Our World in Data.  

According to Harvard Health, addiction exerts power over the brain in three definitive ways:

  1. Intense cravings for the object of addiction.
  2. Loss of control over its use.
  3. Continued involvement with it regardless of consequence. 

To be clear, addiction is more complex and congenital than simply wanting to do something or feel a certain way. In fact, its impact on the brain can be seen in structure as well as function. 

Pleasure and Reward in the Brain

The reward circuit in the brain releases the neurotransmitter dopamine when we experience pleasure. Though this system is intended to reinforce good behaviors that will make us happy, addiction warps the process. While some addictive substances directly produce dopamine, others create an influx of dopamine by affecting other neurotransmitters like serotonin and GABA or hormones like endorphins. 

Illustration depicting dopamine and serotonin pathways in the brain.
Our brain’s reward system is located in the limbic system, which is also responsible for behavioral and emotional responses. Image courtesy of Sovereign Health

The National Institutes of Health writes, “Drugs or alcohol can hijack the pleasure/reward circuits in your brain and hook you into wanting more and more. Addiction can also send your emotional danger-sensing circuits into overdrive, making you feel anxious and stressed when you’re not using the drugs or alcohol. At this stage, people often use drugs or alcohol to keep from feeling bad rather than for their pleasurable effects.” 

What Causes Addiction?

At one point in time, medical professionals thought that addiction only occurred with the use of alcohol or powerful drugs. However, neuroimaging and modern research show that a person can get addicted to pretty much anything—gambling, sex, exercise, food, shopping, and other pleasurable or rewarding activities. 

Genetics

While anyone can develop an addiction, genetics can create a higher risk for substance use disorders, as demonstrated by addiction studies featuring twins and adopted participants. Researchers estimate that genes account for 40 to 60 percent of a person’s vulnerability to addiction. 

Environment

A person’s environment also contributes to their likelihood of having an addiction. This can include the environments that they are exposed to in school, at home, and in their social lives. Environmental factors that can increase the risk of addiction include: 

  • Authoritarian parenting
  • Physical and/or emotional abuse
  • Peer pressure
  • Glorification in the media 

Treating Addiction

While there’s no denying the devastation that it causes, addiction is a disease that is fully treatable with the right resources. That being said, treating addiction is a long-term process that requires a lifetime of work. 

The National Institute on Drug Abuse emphasizes that treating a substance abuse disorder isn’t just getting a person to stop using drugs or alcohol—it’s also addressing a person’s needs in other areas as well. For this reason, no treatment plan is universally effective, and it’s generally accepted that treatment must be adjusted with the passage of time and as they evolve. 

Infographic depicting the components of treating drug addiction
As you can see, effective treatment might start with stopping the use of drugs and/or alcohol, but it certainly doesn’t end there. Image courtesy of the National Institute on Drug Abuse

Counseling and medication are the two dominant branches of treatment for addiction, and each one comes in different forms. 

Types of Counseling-Based Treatments

  • One-on-one therapy
  • Group therapy or support groups
  • Therapeutic communities
  • Residential programs
  • Inpatient treatment
  • Recovery housing

Types of Medication-Based Treatments

When it comes to medication-based treatments for addiction, medication is typically used for two purposes: managing withdrawal symptoms and preventing relapse. Of course, a third reason to introduce medication to addiction treatment is to treat a co-existing condition that might be contributing to the addiction or obstructing recovery from it. 

Managing Withdrawal Symptoms

Detoxification from drugs and alcohol can be a grueling, painful process, beginning with withdrawal symptoms. For this reason, different medications and medical devices are frequently used to help manage these symptoms. It’s important to note that managing withdrawal symptoms is not the same as a comprehensive treatment, but it can be the first step. 

Infographic showing drug withdrawal timelines, including when withdrawal starts, when symptoms peak, and the total duration.i
Substances vary in terms of how quickly withdrawal symptoms start and how long they last. The most common symptoms include nausea, muscle cramping, intensive cravings, agitation, anxiety, and depression. Image courtesy of American Addiction Centers

Preventing Relapse

There is a variety of medications available to treat addiction to different substances, including opioids, tobacco, and alcohol. These drugs are designed to help restore healthy brain function and reduce cravings. Again, taking these kinds of medications is not a substitute for actual treatment, and patients who do not receive treatment beyond medication will likely resume drug or alcohol use. 

TMS Therapy as a Treatment

TMS is a form of brain stimulation that uses magnetic pulses to penetrate the skull and create structural changes in the brain. Right now, TMS is being used to treat depression and obsessive-compulsive disorder (OCD) as an additive or alternative to medication and therapy. 

Though its effects are largely internal, TMS is non-invasive and is administered while the patient is fully conscious. Two of the reasons that TMS is such an attractive treatment option are:

  1. TMS is highly tolerable, and while it might cause the patient some discomfort, it shouldn’t be painful. 
  2. There are little to no side effects associated with TMS therapy. The most common side effects are irritation (redness or itching) around the treatment site and a slight headache during or after treatment, which can be relieved with an over-the-counter anti-inflammatory.
Patient receives TMS therapy with Neurostar machine.
During a TMS treatment, the patient sits in a reclined position and must remain still in order to maintain the electromagnetic coil’s point of contact. Image courtesy of My Transformations

Because TMS causes a gradual change in the brain, it must be applied on a consecutive basis (typically five days a week) for a prolonged period of time, usually six to eight weeks. While every patient’s treatment trajectory is different, the average length of each treatment is thirty minutes. 

Currently, TMS is only approved by the FDA to treat depression and OCD—however, researchers are in the process of determining other conditions that might be treatable with TMS, including: 

  • Attention-deficit/hyperactivity disorder
  • Post-traumatic stress disorder
  • Autism spectrum disorder
  • Parkinson’s disease 
  • Schizophrenia
  • And more

TMS is also used quite frequently in a research setting (like the one outlined in the next section) because it facilitates neurological stimulation in a non-invasive manner that is safe for participants. In addition to learning more about mental health conditions, TMS is aiding the medical community in exploring the nervous system in its entirety and furthering our understanding of the brain and its relationship with the body. 

The Study: “Transdiagnostic Effects of Ventromedial Prefrontal Cortex Transcranial Magnetic Stimulation on Cue Reactivity” 

Although addiction has been studied as a brain disease for the last 50 years, a neural circuit-based treatment for it hasn’t been developed yet. A team of researchers decided to study the effects of TMS on the brains of participants who had abuse issues with cocaine or alcohol. 

Prior research has shown that drug cues—experiences or sensations that someone with a substance use disorder associated with using—cause heightened activity in certain areas of the brain. The researchers aimed to test whether TMS could decrease brain reactivity to drug cues by applying TMS to the prefrontal cortex and using brain imaging to view the participants’ brains responding to drug cues before and after TMS application. 

Results

In a summary of the experiment, ScienceDaily writes that “Brain imaging before and after TMS revealed that when alcohol users viewed images of alcohol-related cues, such as a liquor bottle, the single TMS session significantly reduced their drug cue reactivity. The same was true for cocaine users when viewing images of cocaine-related cues.” 

Figures from the study showing the results.
The researchers used real treatments (blue) and sham treatments (red) of a type of TMS known as continuous theta burst stimulation (cTBS). Image courtesy of ScienceDirect

While these findings are encouraging, the researchers do not know if the efficacy of the TMS on drug cues will translate to real-life behavior. In other words, just because TMS might be able to reduce the brain’s response to drug cues, it isn’t clear whether it can reduce actual drug and alcohol use. 

Significance of the Results 

As stated before, there is not yet a neural circuit-based form of treatment for addiction. The results from this study indicate that TMS could be a non-invasive method of stimulating the brain to counteract the neurological effects of addiction in the prefrontal cortex. 

Senior author Colleen Hanlon, PhD., says that “[With this study,] for the first time, we demonstrate that a new non-invasive brain stimulation technique may be the first tool available to fill this critical void in addiction treatment development." 

Hanlon goes on to say that the study’s results are beneficial not only for those struggling with substance abuse disorders but also for the field of neuroscience as a whole, as neuroscientists still have limited information about addiction, the way it works, and how to treat it. 

A Promising Future for Substance Abuse Treatment

When addiction strikes, it doesn’t just impact one person—it also affects everyone around them. Fighting a substance abuse disorder is difficult enough on its own, but to make matters worse, treatment options for addiction are pretty minimal. Though still in the beginning stages of research, TMS therapy for addiction appears to be a possibility that might emerge in the near future. 

However, if you or a loved one suffers from depression (tied to substance abuse or not), you don’t have to wait to start treatment with TMS because it’s already widely available in the United States. Furthermore, most insurance companies now cover TMS as a treatment for treatment-resistant depression. If you have depression that isn’t getting better with medication or counseling, talk to your doctor today about finding a TMS provider near you. 

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