960 8 SEPTEMBER 2017 • VOL 357 ISSUE 6355 sciencemag.org SCIENCE
Luca Rossi tried to hang himself in a bedroom in Perugia, Italy, in 2012. Suspended by his belt from a ward- robe, he had begun to choke when his fiancée unexpectedly walked in. He struggled to safety, defeated even in this intended last act. The 35-year-old physician had ev- erything to live for: a medical career,
plans for a family, and supportive parents.
But Rossi* was addicted to crack cocaine.
He had begun his habit not long after medi-cal school, confidently assuming that he
could control the drug. Now, it owned him.
Once ebullient and passionate, he no longer
smiled or cried. He knew he might be endangering his patients, but even that didn’t matter. He was indifferent to all except obtaining
his next fix. “It pushes you to suicide because
it fills you with your own emptiness,” he says.
In the first months after his near suicide, Rossi didn’t drop his $3500-a-month
habit. Early in 2013, he learned that his fiancée was pregnant. Frightened by impending fatherhood, he smoked even more. He
Then, in April 2013, Rossi’s father, a chem-
ist, happened upon a local newspaper article
describing work just published in Nature.
Neuroscientists led by Antonello Bonci
and Billy Chen at the National Institute on
Drug Abuse (NIDA) in Baltimore, Maryland,
had studied rats trained to seek cocaine
compulsively—animals so powerfully ad-
dicted that they tolerated repeated electric
shocks to their feet to get their fixes. The
rats had also been genetically engineered so
that their neurons could be controlled with
light. When the researchers stimulated the
animals’ brains in an area that regulates im-
pulse control, the rats essentially kicked their
habit. “They would almost instantaneously
stop searching for cocaine,” Bonci says.
He and his Nature co-authors suggested
that targeted stimulation of the analogous
region in the human brain—an area in the
prefrontal cortex, which sits behind the
forehead—could help compulsive cocaine
users. In that Italian newspaper article,
Bonci explained that transcranial magnetic
stimulation (TMS), a noninvasive method of
triggering neural activity, might do the job.
Rossi’s father began a frenetic quest for
help that led him to Luigi Gallimberti, a
prominent Italian addiction physician who
runs the private Villa Maria Clinic in Padua.
Father and son presented themselves there,
and the father handed Gallimberti the article. “My son is a cocaine addict,” he said.
“Can you help him?”
IN THE YEARS SINCE Rossi visited that Italian
clinic, TMS has attracted interest among a
small cadre of researchers and physicians
who are using it to target cocaine addiction, even as skeptics raise their eyebrows.
After an initial study of 32 people hooked
on the drug yielded encouraging results,
Gallimberti began offering the treatment in
his clinic; he and his colleagues have now
treated more than 300 addicted people.
More rigorous tests of TMS’s ability to
blunt the drug’s grip are now underway. Last
year, a group led by neurobiologist Colleen
Hanlon at the Medical University of South
Carolina (MUSC) in Charleston launched
the first randomized, double-blind trial of
the method as a therapy for cocaine addic-
tion. In May of this year, scientists at the Na-
tional Institute of Psychiatry in Mexico City
launched another. And in Baltimore, NIDA
investigators are completing a pilot study
in cocaine users to prepare for launching a
large, controlled trial next year.
TMS isn’t new to medicine; it is already
an approved therapy for depression. But in
applying the treatment to drug addiction,
investigators are moving into new territory.
Although using TMS in depression has provided leads, no one knows for certain how
best to apply it to cocaine-addicted brains—
and the answers may vary among patients.
“There is so much that we don’t know about
TMS that I won’t be surprised if the current
therapeutic trials don’t work,” says Michael
Fox, a physician and brain network imaging
expert at Harvard Medical School in Boston,
who uses TMS to treat depressed patients.
Fox nonetheless believes that “there’s a huge
amount of promise” in deploying TMS to
Hanlon and others agree. “Basic science research in drug abuse in the last 3 to
5 years has told us, ‘Look, there is a potential for a treatment here,’” she says. And for
the roughly 1 million addicted to cocaine in
the United States and for another 13 million
users worldwide, the need for a therapy is
Powerful magnetic pulses that modify
brain activity may loosen the drug’s grip
By Meredith Wadman
*Luca Rossi is a pseudonym.