Neurocircuit Strategy to Decrease Cocaine Cue Reactivity

Recruitment & Eligibility

Inclusion Criteria

Age 18-65 2. English fluency 4. Meet criteria for cocaine use disorder (CUD), as determined by DSM-V criteria, using the Structured Clinical Interview for DSM-V.
Enrolled in an intensive outpatient treatment program (MUSC Center for Drug and Alcohol Programs Intensive Outpatient Program (CDAP-IOP) or currently engaged in treatment for substance related problems.
Able to read and understand questionnaires and informed consent 7. Lives within 50 miles of the study site. 8. Is not at elevated risk of seizure (i.e., does not have a history of seizures, is not currently prescribed medications known to lower seizure threshold) 9. Does not have metal objects in the head/neck. 10. Does not have a history of traumatic brain injury, including a head injury that resulted in hospitalization, loss of consciousness for more than 10 minutes, or having ever been informed that they have an epidural, subdural, or subarachnoid hemorrhage.
Does not have a history of claustrophobia leading to significant clinical anxiety symptoms.

Exclusion Criteria

Past head injury or primary neurological disorder associated with MRI abnormalities, including dementia, MCI, brain tumors, epilepsy, Parkinson's disease, or demyelinating diseases
Any physical or intellectual disability affecting completion of assessments
Any contraindication to MRI
Current or past psychosis
ECT in last 6 months
Among females, pregnancy at screening will be exclusionary. Females of child bearing potential must agree to undergo a pregnancy test 72 hours prior to the fMRI scanning session and regularly before and during the medication trial. They must further agree to notify the study physician or PA if they become pregnant during the study.
Clinical Institute Withdrawal Assessment (CIWA-Ar) scale will be used to assess alcohol withdrawal. Individuals with CIWA > 8 will be excluded.
Individuals with unstable medical illness (e.g., hypertension, diabetes, myocardial infarction)
Has current suicidal ideation or homicidal ideation.
Has the need for maintenance or acute treatment with any psychoactive medication including anti-seizure medications and medications for ADHD
Suffers from chronic migraines
Any physical or intellectual disability affecting completion of assessments

Study & Design

Arm && Interventions

Group	Intervention	Description
Placebo + Theta Burst Stimulation	Theta-burst stimulation (TBS)	-
N-acetylcysteine + Theta Burst Stimulation	Theta-burst stimulation (TBS)	-
N-acetylcysteine + Theta Burst Stimulation	N-acetylcysteine	-
N-acetylcysteine + Sham Theta Burst Stimulation	N-acetylcysteine	-

Primary Outcome Measures

Name	Time	Method
Magnitude of change in brain functional connectivity	5 weeks	Measure the effects of N-Acetylcysteine on MRI brain functional connectivity
Magnitude of change in fMRI brain response to images from NAC	5 weeks	Measure the combined effects of neural stimulation and N-Acetylcysteine on brain response to drug-related cues.
Magnitude of change in fMRI brain response to images from TBS	5 weeks	Measure the effects of neural stimulation on MRI brain response to drug-related cues

Secondary Outcome Measures

Name	Time	Method

Recruitment & Eligibility