rTMS Cocaine Addiction Treatment ‘Epiphany’

by Isabel Leming, TMS Technician

Isabel Leming shares her experience of treating a patient for cocaine addiction at Smart TMS London with the Transcranial Magnetic Stimulation clinic. 

The treatment journey involved a particular life-changing epiphany moment where cravings quite suddenly stopped at the 7th session.

isabel leming“Following my TMS training I have begun to develop novel and significant relationships with each patient as they go through their journeys with us. Having this rapport with patients’ means that many are more open with explaining how they are feeling, their progression and how they think they are getting on etc. Other people also use it as an opportunity to talk about things that are happening in other areas of their personal life e.g. work, travel, family etc.

“I therefore begin to learn a lot about each patient and often observe and manage some very emotional displays. Watching each patient progress through their treatment in their own individual way is extremely fulfilling. Some patients come to important life decisions or reach some important moments of clarity. This feels like such a rare, significant and powerful thing to be sharing with someone, and one that I think is to be cherished.

“This post focuses on one patient who experienced a particularly powerful, life-changing moment whilst receiving treatment – One, which she personally referred to as “an epiphany”. This particular patient was being treated for cocaine addiction.

“Prior to this “epiphany” the patient came to the clinic one morning, just as she did any other day, very chatty, polite and charming and the session began just as any other would. However, just a few minutes in to the treatment session, the patient alerted me that she was suddenly experiencing an incredibly strong craving for cocaine. She was able to describe the whole craving event: she explained how she could smell, taste and even feel the drug in her hands, as though she was really holding it, moving it between her fingers. This craving lasted just a couple of minutes, but was extremely intense, much more intense than any other craving she had experienced over the past 2 or 3 weeks. Once the craving passed, the session was completed without further incident.

“The patient returned, usual time, the next day and in as good of a mood as ever for her session. She reported having no further cravings after leaving the clinic the previous day. Her urine test was also confirmed to be negative for cocaine.

“However, once again, just a couple of minutes in to the rTMS treatment session and the same time as the previous day, she again alerted me that she felt a bit awry. She found that there was a mental block that was stopping her from thinking about cocaine. As though it did not even exist. She began trying to think about it more than more, but found she was not able to recall any memories of ever having taken it. Nor could she remember any of the feelings or sensations that encompassed it – how it made her feel, how it looked, how it felt to touch, what affect it had on her etc. She could not associate anything with it at all. After a couple of minutes, she went on to explain that she felt as though she was losing a part of herself, a part of her that had played a big role in her life for the last 18 years. She described feeling an overwhelming sense of sadness and grief – one which she likened to being as intense and real as when she lost her father, just a couple of years earlier. This of course made her very anxious and she found it very difficult to process everything. She began to become frustrated and scared. She expressed feeling uncertain about her desire to break her drug addiction – questioning if it was really what she wanted. She was unsure and felt lost wondering about what she was going to do without cocaine because it had been such a big part of her for so long.  It felt however, as though this doubt was a result of the intense feelings of sadness she was experiencing and not an absolute uncertainty about her desire to beat her addiction. One of her close friends was also present during the session and she began to ask him if it was the right thing, looking to him for support and guidance. Once the TMS treatment had finished she took a few minutes to slow down, take it easy and take-in what she had just experienced.

“This episode was experienced during the patients 7th session. This is significant because it supports a particularly ground breaking piece of research, which reported the 7th session as being the time in which a remarkable drop in cocaine craving was seen.

“We spent a few minutes talking through everything that had happened, how she felt about it and how we could support her moving forward. She explained that she wanted to talk through everything with a close friend of hers as it had bought up some feelings relating to some personal matters that she did not feel 100% comfortable discussing at that particular time. She needed some time to reflect.

“The following day she returned to her clinic for her next session. She appeared a lot more settled, relaxed and comfortable with the new circumstance she found herself in. She explained that she felt at peace and held a new understanding that this “epiphany” was positive- a sign that she had regained control.

“She has since progressed very well with her treatment: she has not tested positive for cocaine and has also shown reductions in levels of anxiety. Each time the patient comes in for a session she reports back to us with how she has been feeling since her last session, whether she has experienced any side effects and how she feels she is progressing. This particular patient consistently presents very well, very rarely reporting cravings for cocaine and she continues to feel benefits from her TMS treatment. She is scheduled to have one more session followed by a break over the Christmas period, when she will return in the New Year.  If at this point her cravings continue to be in remission then she will have completed her course of treatment and will be discharged.

“Following a patient’s discharge we ask them to keep in contact with us and keep us up to date with their progress. If the patient’s cravings were to return, then we ask that they come back to the clinic for additional sessions, before they suffer a full relapse. Whilst it is the case for some patients that they return to the clinic for more treatment in order to prevent a relapse, this is not the case for everyone. Many of our patients continue to improve and feel the benefits of their TMS treatment long after their discharge from the clinic and thus have never needed to return.”

Isabel Leming, TMS Technician

Isabel is a member of the Smart TMS team of technicians. Her qualifications and experience prior to working at Smart TMS include:

  • Behaviour Support Worker, North Bristol NHS Trust, working on a neurology/stroke ward
  • Role Play Therapist, behavioural outreach service and learning support within education
  • Researcher at The University of Glasgow
  • Research masters in Brain Sciences, 2015, The University of Glasgow
  • Bachelor of Science (BS) in Psychology and Sport, 2014, The University of Stirling

Smart TMS

Smart TMS was established in 2015, dedicated to providing TMS treatment in London at their South Kensington/Brompton Cross centre. The company opened a second clinic in Birmingham in September 2017 and also has a base in Northampton.  The first Irish clinic was opened in Dublin in October 2017.  Smart TMS is planning further locations for Manchester and Bristol in 2018.


For any queries or for patients wishing to book an appointment at one of our UK clinics, please contact us:

Tel:  0345 222 5678

Email: info@smarttms.co.uk

Irish patients may contact Our Dublin Clinic direct on:

Email: info@smarttms.ie

Tel:  353 (01) 254 2514

Website: www.smarttms.ie