Treating cocaine addiction with TMS - the evidence

Addictive substances like cocaine, alcohol, and nicotine increase Dopamine levels in the brain, affecting areas that control pleasure and movement. Normally, Dopamine is released in response to rewards, such as the smell of delicious food, and then recycled back into the releasing cell, stopping the signal between nerve cells. However, addictive substances block this recycling, leading to a buildup of Dopamine, which disrupts normal brain communication and creates intense pleasure. Over time, repeated use can alter the brain's reward system, potentially leading to addiction. As the brain adapts to the excess Dopamine, individuals may need larger and more frequent doses to experience the same high and to ease withdrawal symptoms.

Currently, there are no FDA or NICE approved treatments for cocaine addiction. Various medications have been tried, such as Risperidone (an antipsychotic), Topiramate (an anticonvulsant), Disulfiram (for alcoholism), and Modafinil (a stimulant for narcolepsy). However, none have proven effective and each has side effects. Psychological treatments like Cognitive Behavioral Therapy (CBT) and Contingency Management (rewarding patients who stay substance-free) are more promising. These combined approaches are the most effective but require a commitment of six months or more.

TMS uses magnetic fields to stimulate the brain, altering activity in the cortex. This process involves a brief, strong magnetic pulse that safely reaches the brain's neurons. High-frequency TMS boosts brain activity, enhances nerve connections, and releases dopamine. Over time, it affects deeper brain areas linked to cravings and addictive behaviors.

A recent review analysed 12 studies on TMS treatment for cocaine addiction and found it effectively reduces cravings and the amount consumed, with no serious side effects reported.

At Smart TMS, we treated 22 patients with cocaine addiction using TMS over the DLPFC for two weeks. We used a self-reported craving score (0-10) to track changes, with 10 indicating severe cravings. Our results showed that 83% of patients experienced at least a one-third reduction in cravings. Additionally, one-third of the patients were completely free of cravings after treatment. Moreover, one-third of those who initially tested positive for cocaine had negative test results by the end of the treatment.

There is no single cure for cocaine addiction. We prefer using TMS instead of psychotropic drugs to address cravings in cocaine dependence. Based on published studies and our clinical experience, we are confident that TMS is safe for treating cocaine addiction. After just two weeks of TMS treatment, cravings for cocaine can be completely eliminated. This breakthrough is crucial in treating cocaine dependence as it tackles the main cause of relapse. We suggest following TMS treatment with a course of CBT or Contingency Management, or at least attending Narcotics Anonymous, to support long-term recovery.

Psychological support can be beneficial for maintaining long-term abstinence from cocaine. Additionally, based on our experience and the Madeo (2020) study, we recommend two TMS sessions per month (on the same day) for 12 months as a maintenance treatment.

Dr Leigh A Neal MB BCh FRCPsych MRCGP MD
Consultant in Psychiatry and Neuromodulation
Medical Director: Smart TMS