A UT Health San Antonio researcher is studying new ways to fight addiction that may ultimately work together to improve outcomes. One of those therapies already has federal approval for the treatment of major depressive disorder. It's called transcranial magnetic stimulation (TMS).
"We already know that this can be effective for treating depression," said Brett Ginsburg, PhD, director of UT Health San Antonio's Biochemical Pharmacology Analytical Laboratory. "We're starting to get a signal that these same targets may be relevant to people with substance use disorders." Ginsburg, who is also a professor in the Department of Psychiatry, said the theory behind this is that some substance use disorders might be driven by misfires in the area of the brain responsible for executive control. "These are the things that allow us to plan for the future and make thoughtful evaluations that are based on something beyond just raw emotion or a need at the moment," Ginsburg explained.
TMS involves the use of an electromagnet to try to get executive functioning back in sync. "It targets the specific brain region we're interested in, and it pulses a magnetic field into that part of their brain at a very high rate of speed," Ginsburg said.
Researchers use an imaging technique called brain-mapping to target specific areas of the brain using robot navigation. Ginsburg's study has isolated three different areas thought to be involved in alcohol and other drug cravings, and participants have been sorted randomly into three groups, each with a different brain target. The TMS is intended to re-synchronize the misfiring executive function in a process called re-entrainment.
"We think that by re-entraining that general brain firing pattern, we can get it synced again so that the executive control can strengthen again, and better choices can result. More deliberative choices, more rational choices, more health-conscious choices," Ginsburg said.
Ginsburg's TMS research was originally funded through the Wellcome Leap Untangling Addiction project, which asks, 'What if we treated addiction like we treat cancer — as a curable, biological illness?' That sponsorship has ended, and Ginsburg is looking for new funding sources to carry the research forward. It has shown great promise, he said, "With people drinking substantially less, even up to three months after just 10 days coming into the clinic and getting TMS treatment." Ginsburg acknowledged that ten days might seem like a short course of treatment, "But we can help people get back up on their feet, and that gives them the time and the ability to do the really hard behavioral work that it's going to take to reorder a disordered life."
Creating an opportunity to begin to reorder a disordered life is also the goal of another study led by Ginsburg, one that approaches alcohol use disorder by paying participants to stop drinking. "This is an incredibly effective way to get people to drink less," Ginsburg explained. "We already know this from decades of research."
The study measures a biomarker that tells researchers whether participants have been drinking. It's called phosphatidylethanol, or PEth, and if their PEth level goes down, participants get paid. If it drops again the following week, they get paid more. "The longer they keep this streak alive of drinking less, reflected in lower and lower amounts of this chemical in their blood, they get more and more money," Ginsburg said.
During this period of abstinence, study participants can begin to make different choices and build lives that don't include alcohol. "We're hoping that over time they're developing new outlets and finding new things to do with their time besides drinking," Ginsburg said.
Ideally, these studies lead to the development of a standard of care that could involve using therapies like these together to create sustainable sobriety. For example, a substance use disorder treatment program could encourage sobriety with a financial incentive while a patient undergoes TMS to re-entrain their brain.
"We can get them up on their feet with the intervention and then hopefully maintain them with the longer-term behavioral intervention," Ginsburg concluded, "While they develop skills they need to really reorder their life."
Science & Medicine is a collaboration between TPR and The University of Texas Health Science Center at San Antonio that explores how scientific discovery in San Antonio advances the way medicine is practiced everywhere.
