Cannabis is used by up to half of the U.S. >1 million people living with the neurologic condition of multiple
sclerosis (MS), which is the most common chronic and progressive CNS disease to affect adults of working age.
Growing evidence shows that cannabis use actually worsens MS disability for many, and specifically contributes
to the commonly (>75%) disabling feature of cognitive impairment. However, for the many patients seeking to
reduce or discontinue their use, there are few if any accessible interventions available, leaving both clinicians
and investigators to only counsel for its discontinuation.
To meet this critical need, our expert team connects our extensive work in the use of noninvasive brain
stimulation in MS to its established applications in the treatment of substance use disorders. Although the neural
circuitry contributing to this cycle of addiction is well known, there are no neural circuit based therapeutics
available for cannabis use disorder (CUD) treatment. We propose a novel and readily scalable approach that is
highly accessible due to its telehealth delivery that allows all study procedures to be completed form home.
Our innovative approach will use repeated sessions of transcranial direct current stimulation (tDCS)
applied to the dorsolateral prefrontal cortex (DLPFC) as a target of negative affect that is identified as a key
component in perpetuating disordered substance use. A core feature of Koob & Volkow’s 3-stage model of
addiction, negative affect both results from disordered use and drives continued use. We therefore hypothesize
that reducing distress in this context will lead to reduced cannabis use. We overcome a major limitation in the
clinical evaluation of tDCS to date with our remote protocol, enabling access to treatment and providing extended
treatments for adequate evaluation of its cumulative benefits.
We will recruit a readily available sample of patients with MS and CUD, to evaluate 20 daily (M-F)
sessions over one month, using RS-tDCS as a tool to decrease distress (Aim 1) and reduce cannabis use (Aim
2). As tDCS is ideally paired with a concurrent activity to increase benefit and to maintain consistent “brain state”
to evaluate its effects, stimulation will be paired with guided mindfulness meditation. In the context of this
evaluation, we will collect cognitive and symptomatic measures towards our ultimate objective of evaluating its
effects on disease burden. We will collect follow-up outcomes at one-, two- and three-months post-intervention.
Public Health Significance: We will pioneer our RS-tDCS telehealth intervention for individuals seeking
to discontinue cannabis, evaluated in people living with MS and applicable across the many patients with chronic
brain disorders for whom cannabis may contribute to their disability. With the COVID-19 pandemic driving
unprecedented rates of substance use disorders, the need for scalable, remote therapeutics that can be coupled
with telehealth behavioral techniques is even more critical.