Welcome to the Resolve to Solve with Miles O'Brien podcast, where we g behind the scenes of the Arizona PBS documentary series Resolve to Solve with Miles O'Brien.

We are discussing the challenges, the discoveries and the things you might not get from watching the television series alone.

I'm your host, Elise Hu, and joining me is the veteran science journalist himself, Miles O'Brien.

On this episode, we meet a neurosurgeon using sound waves to rewire the brain to fight addiction.

Can't wait to talk about it.

Miles O'Brien.

Welcome in Hi, Elise.

How are you?

I'm great.

Thank you so much for joining me.

This is such an exciting and promising treatment.

Let's start by talking a little bit about the problem itself that you're tackling, because this is the first episode that doesn't cente around an environmental issue.

I wanted to make sure Resolv to Solve wasn't solely focused on things like the climate or the extinction crisis.

There are other problems we face, and in the category of human health, there are some interesting ideas out there that I wanted to share with people.

And we begin this hour with a look at the problems of addiction.

Think about the problem of addiction.

50 million Americans five zero 50 million Americans battle addiction at some level with something that's an extraordinary public health crisis, right?

Which is often well, we discuss it in bit and pieces, but we really don't have a holistic bag of solutions for this, do we?

There's all kinds of reason why we're contending with this, but in the category of solutions, it's difficult to come up with well, there are no easy fixes, are there?

And yet I happened upon Ali Rezai, a neurosurgeon who heads the Rockefeller Neuroscience Institute at West Virginia University in Morgantown.

His whole approach to medicine as a neuroscience is to try to find ways, not to use a scalpel, and to imagine nonmedical approaches to things, engineering solutions, that kind of thing.

And I first met him years ago when he was involved in sort of bypassing a quadriplegic spinal cord where the injury occurred, an it made it possible for him to completely quadriplegic young man who dove in to a shallow sandbar.

Horrible story.

And he was able to kind of bypass the injury in his spinal cord in order for him to play Guitar Hero, which was stunning to me.

And so I just started following his work and so forth, and that eventually he was at Ohio State at the time.

He ended up going to West Virginia because they had set up this huge neuroscience institute focused on these kinds of problems.

And he got interested in neuromodulation which is a fancy way of saying, you know, kind of vibrating your brain.

And when you vibrate your brain without injuring it, you can change the well-worn patterns of thought one way or another, or negative things that are occurring.

It can address things like essential tremors, Parkinson's disease, that sort of thing.

And so he's beginning this ide of applying this using focused ultrasound sound waves to see if we can rewire or shake the brain of people suffering from addictions in a way that has a positive outcome.

Let's take a look at a clip.

He replaces the scalpel with sound.

High frequency sound waves, better known as focused ultrasound.

Doctors have used focused ultrasound since the 1950s to destroy tumors and kidney stones.

As the technology became more precise, they started aiming it at the brain.

It is now FDA approved to treat essential tremor and Parkinson's disease.

Ali Rezai helped pioneer that work.

He wondered if focused ultrasound could also reset the circuits hijacked by addiction.

Miles, you mentioned that Dr.

Rezai used to be in Ohi but then went to West Virginia.

West Virginia has a real history of an addiction crisis.

Can you tell us a little bit about that and why this was a great place, actually, for this kind of research to happen?

Well, it's kind of the center of two problems, sadly, opioid addiction.

I think anybody who's followed that story knows that a lot of what happened with opioids was focused in West Virginia.

There's a lot it's a long story there but we don't have to go into it.

But there are tremendous number of people who are suffering with that.

And in addition, obesity is also a huge problem in West Virginia.

So these were the two addictive behaviors that Ali Rezai wanted to begin wit as he started his clinical trial to see if focused ultrasound aimed at the nucleus accumbens portion of the brain, the the part of the brain that drives our interests and ultimately addictions.

If aiming it there could address this.

Miles, say a little bit more about the factors that led West Virgini to be a real capital for these.

Well, we could go.

Yeah we could.

There's been a lot said and reported about the predatory nature of the pharmaceutical company at the core of the problem with opioid addiction, the Sackler, for various reasons, West Virginia became a place where a lot of these pills were over prescribed over the years.

And it has laid the groundwork for a huge opioid addiction crisis.

And then when you look at West Virginia too it is one of the poorest states in the nation, and obesity tends to go along with that.

People live in food deserts.

They don't have access to good whole food.

They have processed food a their main staple or fast food.

And so obesity is a huge problem there as well.

So Ali Rezai moved ther and looked out his front window.

He could see these two problem metaphorically and and realize these were the problems to tackle, to to really go after a solution, you need to understand the problem.

And the people struggling with it were right there.

When we think about addiction, we often think of drugs or alcohol.

But you chose to start this episode with binge eater or somebody who had suffered from binge eating disorder.

Why did you make that decision?

Because exactly what you just said.

People always think about drugs and alcohol and nicotine.

Binge eating is something that we think less about, but it's it's a significant problem.

It's a big part of it's not the whole reason for the obesity crisis, but it's a big part of it.

That addictive behavio is in the same part of the brain as it would be for somebody who's addicted to methamphetamines, for example.

It's all the same circuits i the brain, and it's reinforcing that negative behavior, that loop which occurs in the brain, whether it's food or drugs or nicotine or alcohol or for that matter, gambling, which is also a focus that Rezais looking at.

So Dr.

Rezai is using his innovative solution for treating addictions of across the gamut.

Essentially, the addiction is addiction.

It's a key point, right?

You know, we don't we think about you know, I think we also as a society, we put drinking in a separate category.

That's an addictive thing, a very addictive thing.

So I think that, you know, to to address addiction as a whole, ball of wax is what he's after.

What kind of medical interventions have been attempted previously for addiction?

Well, you know there are some methods out there to help, you know, opioid addicts.

I mean, you know the methadone, right?

Pharmaceutical.

Yeah, pharmaceutical.

You know, more pharmaceuticals, in other words.

Right.

So pick another pill, take another pill to fix it for this pill.

And that's kind of his point is that this i this is not getting us anywhere.

I don't know the stat off the top of my head on what you know how methadone helps.

I know it helps people.

So I'm not trying to minimiz that in any way, shape or form.

And, you know, there are many more people who have access to methadone than they do to this tin little trial in West Virginia.

But there's got to be a better way.

There's got to be a way that can not have people shift from one drug to another.

Or in the case of, you know, binge eating, you know, it's a very interesting problem because in other addiction stories, you want to strive for abstinence, right?

If you're a heroin addict, you want to you want to fine tune the brain.

So you don't want heroin.

Well, you don't want to fine tune the brain, so you don't want food.

That would be a bad thing, right?

And so that was one of their big worries there.

So there aren't a lot of tools in the toolbox when you look at the pharmacological solutions anyway.

And maybe something like this addresses it in a more fundamental way.

And what's interesting is so far at least one session seems to have erased thes pathways in a long term manner.

We don't know for sure it's still new, so we can't say anythin beyond the scope of the study.

But so far these people who I have talked to after on session have had no recurrence.

Well, that's in and of itself a very striking possibility.

And ultimately, when you hav a potential solution like that, you really have to see if it's scalable.

And Miles, we should bring up the point that so often we think of or conventional wisdom thinks or treats addictions as some sort of personal or moral failing, and therefore we should just stop.

Or have the strength and willpower to stop.

What does medicine or what is the work of these scientists show otherwise?

Well, it is you know we do society in general views addiction that way.

Why don't you just quit?

Buck up.

You can do it.

You know, just get tough.

It's it's a it's an illness.

It's a disease.

It's a disease of the brain.

And we would never say that to somebody who has cancer.

Why don't you get rid of your cancer?

You could do it.

Buck up.

Get rid of it.

So there's this moment in the piece where we were sitting in right in front of the ultrasound machine where Lindsay Williams, our former binge eater, and she can say former now with great pride, was sitting there with Ali Rezai and they were talking about her experience and just sort of doing a debrief.

And she became very emotiona when she started talking about almost the instantaneous relief that she felt.

She literally was looking at pictures, which she would otherwise cause her to be like Pavlov's dog wanting to eat a pizza or a sweet.

And she's having her brain modulated at that time, and all of a sudden she didn' care about it almost instantly.

It's a stunning idea when you think about it.

And what she said was with tears flowing, that all her life she felt like she had been judged by everybody around her, that she, you know just stop eating kind of thing.

And she knew, she knew in her her heart of hearts that she didn't she wasn't doing anything wrong.

She had no control over this problem.

And in that instant, when that ultrasound wiped it away, it confirmed what she had known all along.

And as she said it literally and figuratively took all this weight off of me.

And it was it was a momen where it really made me realize how profoundly judgmental society is of people who are struggling with this, and how taking aside focused ultrasound we all have to really work hard and recognizing this for what it is an illness which people cannot control.

You got to actually bring the camera cre inside one of these procedures.

So let's talk a little bit about Erin before we see the clip of her procedure.

Yeah.

Erin is a remarkable woman with a remarkable mother and daughter, and their story is told in this as well.

But Erin has been a heroin, opioid and later crystal methamphetamine addict for 40 plus years.

I don't know how many people live that long with the amount o drugs she's put into her system.

It's stunning.

She had 14 overdoses that sh remembers, there are probably others she doesn't.

She There was one tim she was flatlined several times.

One time she had a heartbea of like five beats per minute.

Oh my gosh.

You know, she was she really, by all accounts, should be dead.

But she's not.

And she was really at wit's end.

And that's kind of where we met her.

How are you?

Yeah, I love you.

We were there on game day.

As she arrived, she was quickly surrounded by a team of about two dozen healt professionals there to perform a symphony conducted by Ali Reza There's her hat right there.

It began with the only painful invasive part of the procedure, the halo.

It's designed to keep her head perfectly still.

Okay.

There.

We good?

She'll remain inside the MRI throughout the procedure, giving the tea a real time view of the precise area of the brain they're targeting.

She has significant asymmetry between her right and left side of the brain.

We're just trying to fine tune it to capture more of the nucleus accumbens.

The nucleus accumbens sits deep inside the brain, working with the chemical messenger dopamine.

It's part of the reward system that motivates us to seek life's pleasures, from food and sex to th satisfaction of a job well done.

But addiction hijacks that same circuitry, trapping the brain in compulsiv loops that are hard to escape.

Could it be possible to break that cycle?

Not with drugs or surgery, but with something as simple as sound?

We are not destroying brai tissue, but we are modulating it like a deep brain stimulation does with the pacemaker.

We're doing it without surgery.

The stakes are high.

There is no room for error.

A lot of very precious brain territory that have a lot of different functions are close by, so you don't want to impact those areas.

To refine their aim, they merge real time MRI data with earlier brain scans.

So we're almost there right now.

Then we're going to start delivering energy test energy and slowly see what happens.

So we're almost ready to go.

Inside the MRI Erin wears special goggles At first calming images are projected onto them.

Then they introduce pictures that trigger cravings for drug use.

So we want to really exquisitely fine tune that nucleus, to drive it, to want this drug And that activates a specific place in Erin's brain.

The helmet Erin wears contains more than a thousand ultrasound transducers.

Individually, they are too weak to cause significant effects on other brain regions, but when they are synchronized and focused on a single point in the brain, they converge like sunlight through a magnifying glass.

The energy builds up at the focal point, modulating the brai just enough at the right spot.

What was it like bringing the crew, the camera crew, into the hospital?

It was really intense, you know, because, listen, this is experimental, right?

These are people.

These are courageous people.

They are at wit's end, but they are ultimately taking a big ris which may or may not help them, you know, could harm them.

There was one person in this study who suffered kind of micro hemorrhages in his brain and had an adverse impact.

He's had memory problems and has suffered from incontinence since then.

So it hasn't been flawless.

But they they were willing to take that risk.

And you know, when we tal about solutions in our series, we tend to focus on th the scientist or the researcher.

But it's really important to remember that none of this happens withou individuals stepping up as well.

And I just marveled at the courage of these two women who were willing to take that risk.

So you have somebody who is at absolute wit's end, but has showin a tremendous amount of courage.

And and you're right there as this kind of their life shifts or not or something bad happens.

I sometimes feel like we, you know, we do this for a living where we at these kind of critical, intimate moments in people's lives.

And I almost feel like we don't deserve to be there because it's really it's scary stuff.

But she was all in.

She wanted not only to try this and of course, although she had a successful result, but it was very important to her and her family that peopl see this, to give them some hope that there are solutions out there, that maybe this addiction crisis can be addressed, you know, some way, maybe down the road in a in a way that has permanent effect.

Wouldn't that be amazing?

Well, let's talk a little bit about the outcomes for the two individual who did participate in the story and the study, both Lindsay and Erin.

So Lindsay suffered from binge eating disorder and then Erin suffered from various drug addictions.

So how did things turn out for each?

Well, we followed up just in April before we kind of started putting the scripts to bed, and we're still in touch with them to make sure everything's goin okay.

Everything is going okay.

Lindsay is 70 pounds lighter.

Wow.

She is.

She had a record year for her real estate business.

She's very successful broker and her life is on a different track And this is an important point.

In both cases, there is an element of depression which goes along with the addiction.

And her depression she feels has been addressed well.

And this idea that food is talking to her, which she talked about food noise frequently, she would really walk through the kitchen and the junk food would be saying, you know, kind of eat me.

It's I'm delicious.

Come on.

Come on over here, Lindsay.

All that is gone.

And Erin, we went up to Vermont.

She's now back hom with her daughter and her mother working in the antique store, the family antique store.

And she said, you know, literally after 40 years of addiction, it doesn't even occur to her anymore.

She said, it's been zapped.

The word zapped out of my brain.

I can only take what they tell me at face value if that really is the case.

This is something that really should be pursued because it could have a tremendous impact on people's lives.

As you mentioned briefly, this isn't flawless.

Of course there are some negative outcomes for some patients.

How are those managed?

Well, I stood down his study for eight months after that individual had those micro hemorrhages and they changed the the protocol.

They reduce the the hig end of power on the ultrasound.

And they started a new protocol where they more gradually increased the intensity of it so they could watch to see what was happening.

I mean, this is the thing when you're doing, you know, clinical trial at an early stage, these things unfortunately can happen.

But he, you know, they've they've started back up an they're continuing their work.

They're moving into issue related to gambling and alcohol.

And so the studies continue.

And his efforts to shrink it all down.

So it doesn't require, you know more than a dozen professionals and a multi-million dollar fMRI machine.

Those efforts are in work right now.

And he hopes to have some sort of prototype there before too long, which can be which would require, of course, another set of trials.

Any challenges that you and your team faced in trying to tell this story?

I think the biggest challenge was being just very as respectful as we could for this kind of very intimate nature of this story.

These are people's deepest, darkest challenges, biggest failings, and treating them with the dignity and respect and not falling into the trap of being judgmental about it, was something I was really trying to be cautious about.

And then the other side of it is to, you know, if it sounds to good to be true, it probably is.

That's what your mother always says.

So I really wanted to make sure that as we di our due diligence on this story, there was no nothing out there that would make us think that this was some sort of, you know, cold fusion idea.

But it checks out.

The data is checking out.

So far, it is still early.

We have to keep that in mind a we watch this and consider it.

It's still only available to a tiny handful of people, but it's encouraging enough that I think we should consider payin a little more attention to it.

Yeah, well, it's really fascinating and a major feeling that we return to again and again in this episode was the feeling for addicts of that sort of helplessness and overwhelming worry.

And as you mentioned, the depression that comes along with a lot of our addictions.

Can you speak to those feelings for the folks that you got to meet?

And how can we, who our loved ones or who have loved ones who might be suffering, how can we better support each other?

I get a little misty when I think about this, but I think it's really important for all of us to always keep that sense of understanding in us and around us when we deal with our friend and loved ones who are addicted.

I have a dear friend who died just a couple of years ago of addiction.

Methamphetamine was the drug of choice and his family cut him off.

And it was it was very profoun for him and he felt very alone.

In the case of Erin McNulty her mother is an extraordinary example of neve shutting the door on an addict.

And I am not trying to tell people how to handle their addiction crises within their families, because in some cases, these negative effect can have very negative effects on other people in the family.

And there are circumstances where you do have to create an arm's length relationship at best with addicts.

But Linda McNulty, when Erin was dealing with the throes of heroin addiction and was on methadone at the time, the closes methadone clinic to their house in Vermont was 150 miles away in Massachusetts.

I actually close to 200 miles.

I think she drove down there every day with Erinto get her a bit of methadone, and she never shut the door on her daughter.

So it's it's important tha I think we all keep that in mind when we when we view addicts, that they are helpless and that how we help them i these are individual decisions.

But if we can figure out ways to help them in constructive ways, ultimately it was Linda who saw the story about Ali Rezai and said, I want to get Erin in that.

And she and her daughter made that happen.

They understood that, that Erin couldn't stop.

There was no, you know, bucking up.

There was no quitting on her own.

Right.

They saw it for what it was.

And as long as we all remember that with our loved ones, because we all are touched by this, I think we will help them better.

Lovely note to end on Miles O'Brien.

Thank you so much.

You are so welcome.

Yeah, you didn't have to go as far.

All you had to do is get to Morgantown, West Virginia.

But emotionally Yeah.

Yeah, exac Yeah.

Emotionally it was something.

Yeah.

Resolve to Solve with Miles O'Brien is a co-productio of Mobias Media and Arizona PBS.

You can watch the show at azpbs.org/resolvetosolve.

This podcast is a productio of Central Sound at Arizona PBS.

Our video editors are Matthew Anderson and Macie Logan.

We get audio support from Joe Miller and Daniel Bevc.

Our producer is Anna Williams.

Executive producers Alex Kosiorek, Carol Yancho, Sco Woelfel, and Miles O'Brien.

I'm your host Elise Hu.

Thanks for joining us.