Brief summary
Cocaine use disorder (CUD) is considered to be a health problem because of the millions of people who are using it worldwide. The article states that excessive cocaine use will cause changes in the prefrontal Cortes (PFC) (Terraneo, p.37). The reason for this is because PFC plays a significant role in the addictive cycle such as the inhibitory control, reinforcement learning as well as cravings. Many types of research that have been conducted show that the loss of inhibitory control is brought on by drug behaviors. The article looks at the animal studies that have been carried out in the recent years that resulted in providing conflicting results of how compulsive cocaine use will reduce the activities of the prelimbic frontal cortex activities. In short, the researchers wanted to find their own results and thus conducted a study by using the repetitive transcranial magnetic stimulation. This tool was used to test whether the dorsolateral prefrontal cortex stimulation will cause humans not to use cocaine.
In this experiment, the participants were thirty-two cocaine-addicted patients. They were assigned to different experimental groups such as the control group that uses the pharmacological agents and the rTMS. This study’s first stage took a duration of 29 days, and the follow-up continued for 63 days (Terraneo, p.38). All the participants that completed the first stage showed slight improvement especially for those who underwent the rTMS treatment but there was a little improvement for those who underwent the control group treatment. Most of these participants urine were drug-free, and the cravings for the drugs had reduced. The findings of this research showed that rTMS treatment is effective in fighting cocaine addiction in patients.
Background and perspective
The world is experiencing a lot of cases of cocaine addiction. Therefore, scientist and medical practitioners need to research on the problem and how it affects the prefrontal cortex. Drug-seeking behaviors are brought on by the damages made to the prefrontal cortex. This fact can be observed from one of the research that has been conducted recently on rats. In the study, it indicated that the group of rats that had prolonged use of cocaine continued to have persistence need to use the drug especially after being administered the mild foot shocks. Mild foot shocks are used in experiments in order to bring stress to the rat. Stress has been stated to be among the causes of cocaine use. The study showed that prolonged cocaine use leads to the decrease of ex vivo excitability of the deep layer pyramidal neurons located in the prelimbic cortex, which was found to be more in compulsive drug seeking animals. The study also observed that when the in Vivo Optogenetic prelimbic cortex was stimulated, it reduced the compulsive cocaine seeking for the rats (Terraneo, p.38). Therefore, the findings from the animals testing brought about the assumption that stimulation of the functioning parts of the brain region could reduce cocaine consumptions by humans.
In other studies, the researchers used the fluorescent tracer dye while conducting experiments on mice. The animals were given methamphetamines for ten days (Sulzer). The result of the research indicated that there was some parts of the mice brains had suppressed activity. Another thing that the study discovered was that when the participants stopped using the drugs normal function of the brains were unable to return. However, when the mice had withdrawal syndrome, the dose was administered, and healthy functions of the brain returned. In looking at this study, many researchers believe that if the same things could occur in humans, then there is a possibility for the formulation of an effective method of fighting the addiction. This method should be able to target the part of the brain that has been affected.
Previous research has indicated that cocaine stimulates the nerve cells; therefore, dopamine is released. Dopamine is stated to be the neurotransmitters that cause the nerve impulse to fire up. Therefore, when this transmitter is produced in excess, then it will cause the nerve cells in the cortex not to produce the glutamate that brings about excitation on humans. Hence, it will bring about addictive and compulsive behaviors since the brain has been compromised (Li).
Methods and results
In the article, the study used two different treatment options, which are the control group and the rTMS. The location of the experiment was at the neuroscience outpatient clinic in Italy. The participants were patients with Cocaine Use Disorder and were seeking outpatient program for treatment. They were grouped into two where one group was tested with the experimental treatment, and the other group was given the control group treatment. The study had three stages which are the screening, treatment, and follow-up. The first stage was all about the assessment of the patients. The second stage was talking about the procedures of treatments. In the experimental group, the stimulator device used by the researchers were the MagPro R39 with the Cool-B70 (Terraneo, p.42). With the instrument, the resting motor threshold was measured with the visual twitch. The coil is stated to have been positioned at the place where the mortar cortex area is located. Then afterward the coil was moved to the place where the lowest stimulator intensity could be identified. Linear methods were used to register the MRI of the participants to that of the MNI navigator.
In doing this, the TMS coil center was put at the MNI coordinates. The angle of the coil handle was facing forty-five degrees. In the control treatment, the study used the pharmacological treatment. These medications usually treat the symptoms of CUD patients once they stopped using drugs. Examples of the commonly used drugs are pramipexole and bupropione, which help with the anxiety symptoms. The hydroxybutyrate medication aid with sleeping problems for the patients. During the period of the study, the patients were not allowed to take any alcohol. The third stage was the sixty-three day follow up in which, the same treatment could continue to be administered, or a new treatment plan could be started if there are no changes.
Results
Out of all the participants, only twenty-nine were able to complete the first stage. In the experimental treatment, one out of the sixteen people was unable to complete the whole process. The control treatment had thirteen participants; however, ten of them changed their treatment options to the experimental. The other two continued with the approved medication and showed a good response, but one of them discontinued the treatment in the final stages. A few of the participants reported discomforts at the beginning of the rTMS treatment. Apart from these minor problems, treatments went on smoothly. Three people who were undergoing the experimental treatment were tested positive for the urine drug screen.
While the two participants in the control group tested positive for the urine drug screen. Positive outcomes from the research indicated that eleven people from the rTMS treatment did not relapse as well as the three individuals from the control group treatment (Terraneo, 44). Multivariate analysis was conducted where the logistic regression model was adjusted for age because of the age difference between the participants. Therefore, it ensured that the outcome of the study was able to remain important. Three of the patients who were in the control group and defected to the experimental treatment showed positive drug screen. The comparison of their changes was made through the logistic regression model in which, the researchers observed that there were no significant changes. The depression subscale indicated that there was no difference between the two groups in treatment. In the first stage, both groups showed improvements in the depression levels of the patients.
Analysis of the results
The results show that the depression level for both the patients who are using the experimental treatment and the ones using control procedures are the same because they showed improvement. This indicate that both options of treatment will be useful for the cocaine use disorder patient. In the study, there were a lot of positive improvements from the patients notably the experimental treatment that saw improvement of nearly all the patients. While in the control group treatment the patients switched their medication in the second stage. Those who continued with the pharmacological treatment showed improvements however, one of them left (Terraneo, p.43). The questions that comes to mind is why do patients using medication drop out before the treatment ends, while most of those in the experimental treatment continued until the end?
At the end of the research, one can be able to see that the experimental treatment was the most effective. The reason could be that people in the society have hope in new methods because the old ones seem not to be working. In this case, the medication method proved to be unsuccessful because most of the patients changed their minds and began using the experimental treatment. While others dropped out of the treatment. Another problem that can be observed from the study is about the validity of the experimental treatment on how it will end of cravings for cocaine use. I agree with the findings of the research. The reason is that of the in depth way the researcher dug into the topic and the experiment. In the end, the results of the study show that the experimental treatment seems to be working (Shen).
In conclusion, Transcranial magnetic stimulation of dorsolateral prefrontal cortex reduces cocaine use as observed in the study. According to the research, it shows that prolong use of cocaine damages some part of the brain such as the prefrontal cortex. Therefore, the addict will not be able to have control of his or her usage of drugs. The control group treatment is valid, but the experimental treatments have proven to be better. However, there is a need for more studies to be conducted that will demonstrate that the TMS is a better option and has no effect. The reason for stating this fact is because of the number of cases reported in the first stage about the discomfort that the patients felt after the stimulation had administered to them.
Work cited
Shen, Ying. 10-Hz Repetitive Transcranial Magnetic Stimulation of the Left Dorsolateral Prefrontal Cortex Reduces Heroin Cue Craving in Long-Term Addicts. Elsevier, 2016. Print
Sulzer, Daid. "Can the Brain Be Rebooted to Stop Drug Addiction?" Scientific American (2014). Print
Terraneo, Alberto. "Transcranial magnetic stimulation of dorsolateral prefrontal cortex reduces cocaine use: A pilot study." Elsevier (2015): 37-44. Print
X, Li. "Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex reduces nicotine cue craving." Society of Biological Psychiatry (2013): 714-720. Print
Yamamoto, Dorothy J. "Influence of dorsolateral prefrontal cortex and ventral striatum on risk avoidance in addiction: A mediation analysis." Elsevier Ireland Ltd (2015): 10-17. Print
