A case report of focused ultrasound neuromodulation of the bilateral nucleus accumbens for methamphetamine use disorder.
James J. Mahoney, Daisy G. Y. Thompson-Lake, Manish Ranjan, Jennifer L. Marton, Jeffrey S. Carpenter, Pierre-François D'Haese, Tasneem Arsiwala, Jacob Suffridge, Daniel L. Farmer, Victor S. Finomore, Padma Tirumalai, Sally L. Hodder, Ali R. Rezai
Experimental and Clinical Psychopharmacology 2026 · 10.1037/pha0000793
Abstract
Nearly 2 million people had a diagnosis of methamphetamine use disorder (MUD) in 2023 and overdose deaths involving psychostimulants are increasing. Given that there are no currently approved U.S. Food and Drug Administration medications for MUD, novel treatments are needed to complement standard of care behavioral treatments. Neuromodulation using transcranial focused ultrasound (FUS) has the capacity to noninvasively and precisely target subcortical structures, such as the nucleus accumbens, a structure integral to the reward neurocircuitry. Previous findings in individuals with opioid use disorder have demonstrated the potential of FUS in reducing substance craving and use; however, to date, no study has examined the effects of FUS for primary MUD. The objective of the current case study was to evaluate the safety and impact of nucleus accumbens FUS on methamphetamine craving (via a cue-induced craving paradigm) and use (via urine toxicology and self-report) in a man in his mid-20s with primary MUD. The participant received a 20-min session of low-intensity FUS (220 kHz) neuromodulation and completed follow-up visits 1-, 7-, 30-, 60-, and 90-days postprocedure. Results demonstrated that the FUS procedure was safe and well-tolerated. Cue induced craving acutely reduced during the procedure with sustained complete suppression throughout the 90-day follow-up (baseline craving rating was nine out of 10 [where 10 represents maximum craving]; craving at follow-up visits were consistently zero out of 10). Methamphetamine negative urine toxicology was observed during all follow-up visits, contrasting his pre-FUS use patterns of multiple episodes of use per week. While promising, larger, sham-controlled, randomized studies are warranted to determine the potential of FUS for MUD. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Abstract via europepmc.
Exposures
Exposure 1: Bilateral NAc FUS, four 5-min active blocks
Target: nucleus accumbens — “bilateral nucleus accumbens”
Device: Insightec · Insightec · ExAblate Neuro Type 2 ✓
| Waveform | pulsed | |
|---|---|---|
| Fundamental frequency (kHz) | 220 | ✓✓✓ |
| Pulse duration (ms) | 100 | ✓✓✓ |
| Pulse repetition frequency (Hz) | 0.333 | ✓✓✓⚑ |
| Duty cycle (%) | 3.3pulse duration × PRF gives 3.33% | ✓✓✓ |
| Sonication duration (s) | 300 | ✓✓✓⚑ |
| Free-field pressure (kPa) | not reported | |
|---|---|---|
| Free-field Isppa (W/cm²) | not reported | |
| Free-field Ispta (W/cm²) | not reported | |
| In-situ estimate | not reported | |
| In-situ pressure (kPa) | not reported | |
| In-situ Isppa (W/cm²) | not reported | |
| In-situ Ispta (W/cm²) | not reported | |
| Pressure, domain unspecified (kPa) | 2,000 | ✓✓✓⚑ |
Four 5-min (300 s) blocks of active FUS (eight subspots alternated; 70-100 W; duty cycle 3.3% per subspot; 100 repetitions; repetition time 3 s; pulse duration 100 ms) to bilateral NAc, 20 min of active FUS in total, after one 5-min zero-energy block.
Flags from extraction
exposures[0].timing.pulse_repetition_frequency_hz— Paper gives a repetition time of 3 s, recorded as 0.333 Hz (unit conversion); PRF not stated directly. Duty cycle is stated 'per subspot' with eight subspots alternated.exposures[0].unspecified_domain.pressure_kpa— 2 MPa is an estimate at 100 W; the paper does not say whether it is free-field or in situ.exposures[0].timing.sonication_duration_s— Each 5-min block of 100 repetitions at 3 s; 20 min of active FUS in total; 70-100 W varied across blocks.blinding— Participant was not told the order of zero-energy and active blocks; no blinding of investigators described. Recorded as single.