The Use of Neuromodulation in the Treatment of Cocaine Dependence.

Cocaine related disorders are currently among the most devastating mental diseases, as they impoverish all spheres of life resulting in tremendous economic, social and moral costs. Despite multiple efforts to tackle cocaine dependence, pharmacological as well as cognitive therapies have had limited success. In this review, we discuss the use of recent neuromodulation techniques, such as conventional repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and the use of H coils for deep rTMS for the treatment of cocaine dependence. Moreover, we discuss attempts to identify optimal brain targets underpinning cocaine craving and withdrawal for neurodisruption treatment, as well as some weaknesses in the literature, such as the absence of biomarkers for individual risk classification and the inadequacy of treatment outcome measures, which may delay progress in the field. Finally, we present some genetic markers candidates and objective outcome measures which could be applied in combination with TMS treatment of cocaine dependence. We anticipate future research in this area combining genetic and physiological markers, neurodisruption, and clinical behavioral measures.