West Virginia is the opioid overdose death capital of the United States. The opioid overdose death map was shared by Dr. James J. Mahoney, director of West Virginia University’s Rockefeller Neuroscience Institute Addictions Research Program, in a Zoom presentation on June 4, 2025. His state leads the country in opioid overdose deaths.

West Virginia is also leading the country in opioid addiction research. In an article at AddictionNews last week, we showed how Harlan Country, Kentucky, went from the OxyContin capital of the U.S. to the recovery capital of the U.S., thanks to opioid settlement funding. Similarly, West Virginia University (WVU) has become the center of cutting-edge research into addiction and recovery.

Dr. Mahoney’s presentation is entitled “Technological Advances in the Assessment and Treatment of Addiction.” The hour-long program is available online at this link. A big thank you to the team at the Osher Lifelong Learning Institute — OLLI at WVU — for putting this presentation together. OLLI is a wonderful program that allows academics to share their research with the general public, often for free or at low cost.

After explaining the scope of the opioid epidemic and the array of tools the Rockefeller Neuroscience Institute (RNI) is testing against addiction, Dr. Mahoney narrowed down to a rather amazing discussion of low-intensity focused ultrasound neuromodulation. Using a helmet to keep the patient’s head stable and to focus an array of ultrasound beams, an area in the nucleus accumbens is targeted for low-intensity focused ultrasound (LIFU). The procedure is done on an outpatient basis with an MRI machine.

Fourteen patients with severe substance use disorders were recruited for the study out of the Center for Hope and Healing, a 28-day residential drug treatment facility operated by RNI. While they were undergoing the procedure, patients were awake and shown images designed to induce cravings for their drugs of choice. After each image, they were asked to rank their level of craving. Dr. Mahoney knew he was onto something big when patient cravings flatlined during the procedure.

The cravings were rated again after the procedure and at regular intervals for the next 90 days. The charts, below, show a remarkable and persistent reduction in cravings. Figure 1 shows the cravings flatlining for heroin, opioids, and fentanyl. Figure 2 shows cravings flatlining for alcohol, cannabis, cocaine, benzodiazepines, and methamphetamines.

Figure 1: Reduction in cravings after low-intensity focused ultrasound neuromodulation and addiction treatment therapy. Source: West Virginia University Rockefeller Neuroscience Center. Used under Fair Use: Commentary.

Figure 2: Reduction in cravings after low-intensity focused ultrasound neuromodulation and addiction treatment therapy. Source: West Virginia University Rockefeller Neuroscience Center. Used under Fair Use: Commentary.

Patients also underwent standard drug addiction treatment during the first 90 days, checking in weekly for urine tests and questionnaires. They were supported by a team including a doctor, a therapist, a case manager, and a medication manager. They participated in cognitive behavioral therapy sessions and peer groups.

Patients reported being astonished that they simply no longer craved the substances. Previously, images of drugs or drug use would cause them to break into a sweat from desire. Relapses after LIFU neuromodulation were few and brief, with almost all the patients back to abstinence at 90 days. When they indulged, it was usually due to their environment, not cravings.

With these stunning results, Dr. Mahoney and his team are pursuing further studies. They have followed these 14 patients for a year now. The results have not been reported yet, but are still stunning. In addition to reduced cravings, patients report less thinking about drugs and fewer dreams about drugs. They report no change in other pleasures, such as having an appetite. They report a better mood, a greater ability to focus, and an increase in social engagement.

The RNI now has a randomized, controlled trial of LIFU neuromodulation with 11 patients, including one or more placebo patients (who receive “sham” neuromodulation). Patients know they could receive placebo treatment, but they also receive all the other standard addiction treatment, including medication, therapy, and peer groups. The preliminary results, according to Dr. Mahoney:

• 90% reduction in substance cravings
• Greater than 70% clean urine screens (most recent visit)

The RNI is conducting another study with 31 patients with severe substance use disorders, and longitudinal studies to track effectiveness for one year and beyond. Near the end of his presentation on LIFU neuromodulation, Dr. Mahoney dropped a major teaser: Results of the first human trial of neuromodulation for binge eating disorder.

The trial started in October of 2024. It used images of problem foods and eating triggers while four patients received neuromodulation. We don’t yet have any of the details about how these patients were recruited, their BMIs, ages, or genders. And the sample size of four persons is certainly small. Figure 3 shows the remarkable and persistent results.

Figure 3: Reduction in cravings after low-intensity focused ultrasound neuromodulation and addiction treatment therapy. Source: West Virginia University Rockefeller Neuroscience Center. Used under Fair Use: Commentary.

From binge eating at least once daily to binge eating not at all 90 days later is really something to get excited about. We will continue to follow the research regarding LIFU neuromodulation and the amazing work of Dr. Mahoney and the RNI.

Written by Steve O’Keefe. First published June 12, 2025.

Sources:

“Technological Advances in Addiction Assessment and Treatment with James Mahoney,” Osher Lifelong Learning Institute at West Virginia University, YouTube video, June 4, 2025.

Image Copyright: nexusplexus.