Could Ultrasound Help Treat Addiction?

0:28Searching for a home?

0:33For most of his life, Joe Hilton has struggled with addiction and substance abuse, starting when he was just a kid in West Virginia. Growing up at an eight-year-old's birthday party, there would be five or six coolers. Only one of them would have juice boxes and stuff like that, and the rest of them would be full of beer. At 9, 10, 11, 12 years old, I'd sneak a beer. From beers in the cooler, he moved on to stealing the ends of his dad's joints, then to smoking marijuana with a friend, and eventually to harder drugs. Once I did heroin, I'm like, that's supposedly the worst drug ever, so why not try everything else?

1:18I like to say my drug of choice was more of anything. It didn't matter. Joe's 39 now, and he's tried to get sober many times over the years. He's attended group meetings run by Alcoholics Anonymous and Narcotics Anonymous, inpatient programs, sober living homes. But he says none of them stuck long term. Joe even ended up in prison at one point. His wife left him, and he lost custody of his daughter. I never really was good at putting the tools into practice. If I'm not around it, then I don't think about it until I do wind up bumping into somebody that has drugs. And that's how I've relapsed every time.

2:01Neuroscientists have long defined addiction as a brain disease. And while the U.S. drug crisis has led to overdose deaths that have hovered around 100 ,000 per year in recent years, the tools available to treat addiction haven't changed much in decades. But last summer, Joe Hilton took part in an experiment run by doctors at West Virginia University's Rockefeller Neuroscience Institute to treat addiction using focused ultrasound. The same technology that's used to treat neurological conditions like Parkinson's disease and essential tremor. But in this case, WSJ health reporter Julie Warnow says researchers are trying to see if it could help treat addiction by resetting parts of the brain associated with cravings.

2:42If you have a highway that gets you from your reward center, let's say, to the part of your brain that's responsible for decision making, and you have tons of on-ramps to that highway, then it's a lot easier to get on the highway. If all of a sudden you put up some stop signs and you have to take a lot of different back roads, that might prevent a lot of really poor decision making. From the Wall Street Journal, this is the future of everything. I'm Danny Lewis. Today, we're talking about how this experimental treatment could lead to new tools for treating drug addiction. Stick around.

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3:59Julie, for starters, what is focused ultrasound? How is it different from the ultrasound scans used in pregnancies? Ultrasound, you know, I think of as just like a technology we use to be able to see inside our bodies, right? Focused ultrasound is that you're essentially taking sound waves and focusing them on a point in the body that you can kind of vibrate with the sound waves and then treat a condition that way. And before we get into talking about this experiment you reported on at West Virginia University, which Joe Hilton was a part of, how does this new treatment with focused ultrasound work?

4:41Focused ultrasound is something that's been used on a number of other medical conditions. You know, it's sort of the new frontier for a lot of disease. And this doctor in West Virginia is kind of where the opioid crisis really took off during the time when people were taking pain pills and overprescribing them and becoming addicted. And now they've watched that turn into heroin crisis and then a fentanyl crisis. And so he thought, well, what if we could apply this technology to these patients that are in our addiction treatment centers? Instead of thinking about having one ultrasound probe that can look at a baby inside a womb, in this case, you have 1 ,000 different probes that can deliver the ultrasound energy to a specific pinpoint area in the brain.

5:36That's Dr. Ali Razai, the director of the Rockefeller Neuroscience Institute at West Virginia University. In the case of people with severe addiction as part of the study we're doing, the ultrasound energy resets or reboots the brain's area involved in addiction and drug cravings. The reward center in the brain called the nucleus accumbens, roughly three inches from the top of your head down deep in the brain, we all have this part of the brain as a normal part of our desires and behaviors that lead to pleasures like eating and drinking and interacting with families and others. But this area over time can get dysregulated that can change in the functioning of this part of the brain and turn it into a part that is an addictive reward center.

6:22And it's always chasing after the next fix or the next drug. It causes you to be obsessively thinking about the drug. And this is a part of the brain that's driving that behavior. Julie, you followed Joe Hilton, the patient we heard from earlier, as he went through this procedure. What was his life like before it? Joe Hilton was in the residential treatment facility that's sort of attached to this hospital system where these doctors are working out of. And he told me, you know, that it had been several weeks since he had used any drugs. He was still waking up in the middle of the night, sweating, having cravings when he thought about drug use, having triggers.

7:02And so it was still sort of a tortuous sobriety. I would get real antsy, fidgety. My hands would start sweating and I would start thinking about how good it would feel to use. Before the treatment, I bumped into a guy that I was in treatment with and I stopped and gave him a ride. And for the next three weeks, every day, all day, I was hoping that I'd bump into him again because I knew he'd be able to get drugs. So then the procedure itself, they shaved his head and this massive team of doctors descended on him. They have this helmet that they created that this energy goes through in order to send those focused ultrasound weaves into his nucleus accumbens.

7:52Again, that's the part of the brain associated with addiction. It looks like a giant space helmet with lots of like things attached to it. It really is very sci-fi to see, especially because then the next thing that happens is they roll him into the MRI room and install him inside this machine and give him a little joystick. And as they shoot these ultrasound waves at him, they're asking him about his cravings. They are showing him through these goggles images of exactly the drugs that give him those sweats, that give him those cravings, that make him anxious. So he's seeing pictures of heroin being cooked in a spoon, of a person injecting drugs into their veins.

8:45And then he has to hit this joystick to say what his cravings are. And I watched this man go from saying that his cravings were almost intolerable to not having essentially any cravings at all. Right directly after the treatment, after a couple days, how do I explain it? Like just the want to do drugs wasn't there anymore. The want to for me to use drugs is very, very, very minuscule now compared to what it was. Coming up, what's the next step for using this technology to treat addiction? That's after the break.

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10:08Julie, Joe Hilton said he felt a pretty remarkable change after just one treatment. How does it compare to more traditional addiction therapies? When it comes to these really difficult drugs like heroin, fentanyl, meth that are highly addictive, we really haven't changed the way that we're treating those addictions for a significant period of time. We have the same few drugs for opioid addiction. We have 12-step programs. We have talk therapy. And yet this residential treatment center in West Virginia, where Joe Hilton was attending, two thirds of their patients are relapsing within a month. The issue is that we still don't treat this like a brain disease, which is really what it is.

11:00You have a disordered brain that has created lots of pathways that really shouldn't be there, that are triggered by the drug that you're addicted to. And so when you try to tell people to think their way out of it, what they're really doing is recreating other pathways in their brains sort of slowly on their own. And this is a way to speed that up. It takes away the craving and allows them to focus on the things that will create those new pathways instead. Pretty dramatically, it sounds. Yeah, and Dr. Reza is very careful to explain that it's not a miracle cure. It's more like let's take away the thing that makes it the hardest to get better and see if people do a better job of getting better.

11:49So if you were going for a run and every time you went out the door to go for a run, you were running uphill, you might be more likely to give up. But if you were on flat land, you might have a better chance of eventually making that goal of running a half marathon or a marathon, right? It's just such a frustrating process to be fighting these cravings all the time. This treatment is currently in clinical trials, and Joe is one of just 30 or so people who have been through it so far. What's next for it? Dr. Rizai is training other clinicians around the country who are interested in taking on patients like this in their communities and contributing to the body of research as well as treating other communities.

12:39One of the ideas is to eventually create a helmet and system that's portable and cheaper, where, you know, at a futuristic time, you could imagine showing up to a little kiosk somewhere and someone does this procedure and then you go on with your day. Right, because Dr. Rezae says the focused ultrasound beams used in the trial need to be very precise and targeted. Plus, doctors need an MRI to see how the patient's brain is responding in real time. So you need equipment like that sci-fi helmet, which Dr. Rezai calls a halo, that Joe Hilton wore during his session. We have to hit a target deep in the brain, and we can't be off a couple of millimeters.

13:22What we do is we put a small little halo device with four little pins that get attached to the scalp, and that halo gets attached to the ultrasound device on the MRI table, so you're not moving your head so that we're not missing our target. In the future, the goal is not to have that because you need to do it in any clinic room in the future, but that's to be developed. You certainly wouldn't want to try this at home, so to speak. They're not doing anything that is irreversible. It's not the same as if you're getting brain surgery, right? And they decided, let's take the reward center out or change a chunk of your brain.

13:57It's more like when you reset your computer and for some reason it just fixes all the bugs. Julie, is Dr. Rezai looking to treat other forms of addiction using this technology? That's the interesting part about this part of the brain, the nucleus accumbens. It's a little agnostic about what you're addicted to. So you can, for lack of a better word, individualize this to what your issue is. So they're also researching how it might affect food addiction, for instance. and many people deal with multiple drug use, like I'm not just using fentanyl, I'm also using meth and I have an alcohol problem.

14:37The procedure really isn't different based on what the addiction is, which is very different than the addiction treatment space now. How so? The addiction treatment space now, beyond 12-step programs, is very specialized. If you have an alcohol addiction, you're going to have a really different pathway than somebody who's dealing with fentanyl. And if you have a problem with an eating disorder, for instance, you would have a different treatment pathway. And those practitioners are different from one another. And so in a world in which people often are, in reality, struggling with multiple addictions, this is an exciting potential breakthrough.

15:17I can understand why Dr. Rozi would want to be very careful about making clear this isn't a miracle cure, like you said. Everybody wants to think that you can take this supplement or that you can, you know, take this drug and it's going to fix everything. And the brain is more complicated than that. You can bat down something, but you still are going to need to change a lot of your activities and behavior in order to prevent those superhighways from just getting all the cars back on them. I did talk to one of Dr. Rezae's patients who was in one of the original uncontrolled trials, and he ended up having a relapse.

15:58And the way that he described it to me was that if you start walking down the same roads that you were on before over and over again, those cravings can still come back. You can't get rid of the highway, but what you can do is find ways to not use it anymore. Julie Wernow is a health reporter for The Wall Street Journal. As for Joe Hilton, he says he's still feeling relief from the addiction cravings. He's in a sober living home, attending 12-step meetings, and taking addiction medication. And he is reunited with his wife. They're working together through Child Protective Services to return his rights to his daughter so the family can live together.

16:36The Future of Everything is a production of The Wall Street Journal. Stephanie Ilgenfritz is the editorial director of The Future of Everything. This episode was produced by me, Danny Lewis. Special thanks to Julie Wernow and section editor Dagmar Ahland. Michael LaValle and Jessica Fenton are our sound designers and wrote our theme music. Catherine Millsop is our supervising producer. Like the show? Tell your friends. And leave us a five-star review on your favorite platform. Thanks for listening.

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