In early 2024, Linda sat exhausted in her living room in Vermont, taking a rare break from her seven-day workweek at her antiques shop near Burlington. For weeks, she had been searching for her 45-year-old daughter, Erin McNulty, who had spent years struggling with severe methamphetamine addiction. Erin’s substance use had begun in high school with alcohol and marijuana, eventually progressing to heroin and cocaine. Despite multiple stints in rehabilitation, overdoses, and maintenance treatment with suboxone, her addiction spiraled out of control when she was introduced to meth. While flipping through channels on television, Linda caught a segment featuring clinical trials at West Virginia University, where neurosurgeons were testing focused ultrasound to alter brain circuits associated with severe addiction and Alzheimer's disease.
Reaching Deep Brain Structures Without Cranial Surgery
The pioneer behind the medical trial, Dr. Ali Rezai, executive chair of the WVU Rockefeller Neuroscience Institute, spent years performing traditional deep brain stimulation, which required drilling holes into the skull to insert electrical leads into deep brain tissue. The novel approach utilizes focused ultrasound, best known for fetal imaging during pregnancy, to penetrate intact skull bone and reach target neurons without a single surgical incision. Patients complete the 20-minute procedure without invasive tissue cutting and can return home on the same day. Dr. Rezai, who trained in New York and grew up in Los Angeles, deliberately relocated his research to West Virginia, the epicenter of the American drug overdose crisis. Nearly 45 million Americans struggle with substance use disorders, and West Virginia maintains the highest per-capita overdose fatality rate in the United States, more than double the national average.
From 1950s Prototype Craniotomies to Modern Precision Beams
Using sound waves to modify neurological structures dates back to the 1950s, when brothers William Fry and Francis Fry constructed a massive two-story system that concentrated ultrasound beams into pinpoint areas. Their machine successfully ablated microscopic brain lesions in animals and Parkinson's disease patients to stop tremors, but the requirement to surgically remove portions of the skull prevented widespread adoption. By the 1970s, the pharmaceutical introduction of levodopa rendered such surgical procedures obsolete. Modern focused ultrasound equipment bypasses the need for surgical openings by emitting dozens of coordinated acoustic beams through piezoelectric crystals from multiple angles. While individual beams pass harmlessly through skin and bone, their convergence at a precise millimeter-scale target deep within the brain generates therapeutic intensity.
Resetting the Dopamine Reward Mechanism in the Nucleus Accumbens
Noninvasive techniques like transcranial magnetic stimulation are limited because their energy only reaches the outer cortical layers of the brain. Dr. Rezai targeted the nucleus accumbens, a pea-sized structure positioned deep inside the brain that serves as the central hub of reward circuitry. Chronic exposure to potent substances like methamphetamine floods the nucleus accumbens with dopamine, causing the brain to adapt to extreme neurochemical surges and generating persistent, overwhelming cravings. Low-intensity focused ultrasound aims to modify ion channel activity within these target neurons, restoring regular signaling patterns and decoupling the brain's compulsive drive for addictive substances. FDA approval for exploratory addiction safety trials was granted in 2021.
The Long Journey to Morgantown and Control Trial Testing
With support from her mother and teenage daughter, Erin checked into the Center for Hope and Healing in Morgantown, West Virginia, in April 2024. Getting to the facility required overcoming significant anxiety and multiple missed travel attempts. In October 2024, Erin entered the randomized double-blind trial stage. Following protocol, she shaved her head to prevent hair from scattering acoustic energy and lay inside an MRI scanner. To evoke neurological craving states, researchers displayed cue images of previously used substances, including methamphetamine, fentanyl, heroin, and benzodiazepines, while Erin rated her craving intensity on a 10-point scale. Unbeknownst to her, Erin received a sham procedure during her initial session to serve as a research control. Her craving scores remained elevated, and she relapsed a few weeks later.
A 20-Minute Procedure Eliminates Decades of Cravings
In January 2025, Erin was invited back to receive the active focused ultrasound treatment. The motorized MRI table positioned her head within the helmet transducer, targeting her nucleus accumbens roughly eight centimeters below the top of her skull. As the acoustic energy was delivered over 20 minutes, real-time thermal monitoring ensured local tissue safety. While still positioned inside the scanner, Erin reported an immediate disappearance of cravings when presented with drug images. Subsequent post-procedure tracking via urine testing and a mobile application confirmed sustained abstinence, with Erin noting that environmental triggers in daily life no longer evoked any drive to use drugs.
Commercial Tech Investments and Clinical Safety Parameters
Dr. Rezai's research team has administered focused ultrasound treatments to 47 individuals with substance use disorders. Early open-label data involving 20 subjects demonstrated a greater than 90 percent reduction in self-reported cravings alongside an 80 percent drop in positive urine screenings. Additional clinical trial sites have opened in Baltimore, Florida, New York, and international centers. Major technology figures have also backed commercial ventures in noninvasive neural modulation, including Sam Altman's Merge Labs, Fred Ehrsam's Nudge, Mary Lou Jepsen's Openwater, and Sanmai Technologies, supported by Reid Hoffman. Despite commercial promise, safety questions remain. In 2025, a 44-year-old trial participant experienced minor localized brain hemorrhages during an intensity escalation protocol, highlighting the necessity for standardized power thresholds and continuous thermal monitoring, as emphasized by independent researchers like Dr. Greg Fonzo of UT Austin and Dr. Kim Butts Pauly of Stanford University.
Rebuilding Life Beyond Addiction
Following her successful treatment, Erin remained in West Virginia temporarily, gaining employment at a local charitable organization and completing training as a peer support specialist. In May 2025, she relocated back to Vermont to live with her mother and daughter. She now works at the family antiques business, maintains a regular wellness routine, and reports no lingering urge to use illicit substances. Dr. Rezai emphasizes that while focused ultrasound provides an essential neurological reset, long-term recovery requires ongoing behavioral support and a stable environment.
