
Rewiring Addiction
Episode 7 | 27m 6sVideo has Audio Description
Ultrasound waves, no surgery: doctors may have found a way to silence addiction and cravings.
Ali Rezai believes he can rewire the addicted brain without a scalpel. Using focused ultrasound aimed at the brain’s reward center, his West Virginia team has helped patients battling decades of heroin addiction and binge eating silence the cravings that once ruled their lives. Miles O’Brien meets the patients, families, and scientists chasing a treatment that sounds almost too good to be true.
See all videos with Audio DescriptionADProblems playing video? | Closed Captioning Feedback
Problems playing video? | Closed Captioning Feedback
Made possible in part by support provided by Sue Hart-Wadley and Searle Wadley with additional support from Jerry Cox.

Rewiring Addiction
Episode 7 | 27m 6sVideo has Audio Description
Ali Rezai believes he can rewire the addicted brain without a scalpel. Using focused ultrasound aimed at the brain’s reward center, his West Virginia team has helped patients battling decades of heroin addiction and binge eating silence the cravings that once ruled their lives. Miles O’Brien meets the patients, families, and scientists chasing a treatment that sounds almost too good to be true.
See all videos with Audio DescriptionADProblems playing video? | Closed Captioning Feedback
Where to Watch Resolve to Solve with Miles O'Brien
Resolve to Solve with Miles O'Brien is available to stream on pbs.org and the PBS app.
Providing Support for PBS.org
Learn Moreabout PBS online sponsorship♪ ♪ ♪ ♪ MILES O'BRIEN: If you want to find a good solution, you need to fully understand the problem.
And here in West Virginia, they are all too familiar with two of the most stubborn public health crises in the U.S.-- addiction and obesity.
But where the challenges run deep, so does the resolve to solve them.
Which brings me to Morgantown.
My first stop?
The home of Lindsay Williams.
Hey, Lindsay, good to see you in person.
How are you?
- Hi, nice to meet you!
O'BRIEN: She was in her element, cooking up one of her favorite meals, brunch... WILLIAMS: Wow.
(laughing) O'BRIEN: ...with her family.
WILLIAMS: We bought this house for the hangout factor-- he has to stay downstairs.
O'BRIEN: My timing was perfect.
Just as I joined the hang in the kitchen, Lindsay unveiled the main course.
Julia Child was smiling somewhere.
Voilà!
Is that a frittata?
WILLIAMS: Yes.
O'BRIEN: This looks delicious, Lindsay.
WILLIAMS: Thank you.
It's always prettiest when it comes out.
O'BRIEN: Yeah.
All right, breakfast is ready.
O'BRIEN: Oh, this is fabulous.
So nice to meet you all.
WILLIAMS: Yes, nice to meet you, too.
O'BRIEN: And thank you for this feast, this is great.
Thanks for joining us.
O'BRIEN: What a nice group of young people you have here.
Sunday brunch, with all its beauty and banality.
Except this is a really big deal when you know Lindsay's backstory.
For most of her life, she was a carefully closeted binge eater.
I have... ...had binge-eating disorder since I was 16, um, and it wasn't diagnosed, it's not something we talked about.
O'BRIEN: Mm-hmm, mm-hmm.
WILLIAMS: Because it's embarrassing and it's shameful.
- Mm-hmm, mm-hmm.
WILLIAMS: And, um, something I didn't admit.
O'BRIEN: A successful real estate broker, Lindsay spends much of her day on the road.
Her car became the perfect place to feed a secret addiction.
She showed me the route, marked by regular stops for fast food and pastries.
WILLIAMS: I would get doughnuts, but I would lie... - Mm-hmm.
...about why.
- Mm-hmm.
You know, I was gonna pick up doughnuts and take 'em to my office, or I was gonna pick up doughnuts and take them to whatever.
I most likely was going to get in my car and eat them.
O'BRIEN: She says it was as if the food was talking to her-- beckoning, never letting up.
Doctors now have a name for it: "food noise."
She tried, but she couldn't turn down the volume.
You know those cartoons where you had, like, both the devil and the angel on your shoulders, right?
- Yeah, yeah, of course, yeah.
And one's telling you to do this, and one's telling you to do that and whatever?
"I shouldn't do this.
- Mm-hmm.
"This is not good for me.
- Mm-hmm.
I am going to gain more weight."
But it wouldn't stop me.
So the devil would win?
Always.
♪ ♪ O'BRIEN: All of this was in her rearview mirror on the day I feasted with her and her family on that frittata.
She hadn't binged in three months.
WILLIAMS: I've lost about 46 pounds in 90 days.
Wow.
WILLIAMS: It's been wild.
- That's something.
Does she look different to you?
(kids agreeing) Yeah, yeah.
That's amazing.
And are you still losing?
- Mm-hmm.
O'BRIEN: Wow.
- Yeah, without trying.
Like, I'm not on a diet.
I don't feel like I'm on a diet right now.
Right, right.
WILLIAMS: I'm just, I think, eating for the first time in my life like a normal person would eat.
Which is wild-- I mean, it's just crazy.
It seems so weird, but I'm just calm.
I have this sense of peace.
♪ ♪ (talking softly) O'BRIEN: Lindsay found her peace thanks to a team led by this man, Ali Rezai.
He is a neurosurgeon and director of the Rockefeller Neuroscience Institute at West Virginia University.
How are you?
REZAI: How are you?
WILLIAMS: Good!
O'BRIEN: They're developing a novel, non-invasive technique to rewire the brain in a way that appears to reduce the neural pathways that drive addiction.
There's many, many gaps and many needs for people with addictions.
So, we need to find technology that can help people be more in charge of their bodies and their, their likes and dislikes, and not let addiction be in charge.
They need to be in charge.
You look great.
- Thank you-- I feel good.
What do you think is the single most change that you've noticed since the procedure?
It's a lot quieter in here.
REZAI: Would you call that a food noise or... Oh, yeah.
- Yeah?
It's gone.
- Is it gone or is less?
- Gone.
O'BRIEN: Gone?
That sure sounds like a breakthrough.
Ali Rezai is most comfortable pushing the boundaries of medical research, and when it comes to the human brain, he sees nothing but opportunity.
There's so much that needs to be discovered, and there's so little known.
They call it the final frontier for discovery in medicine.
O'BRIEN: Rezai is a pioneer in the field of deep brain stimulation, DBS: surgically implanted pacemakers for the brain.
REZAI: We put a pacemaker wire deep in the brain, and it modulates the electrical activity of the neurons to improve tremor or improve pain or, or stop epilepsy.
O'BRIEN: But Rezai is a neurosurgeon who would prefer not to cut.
REZAI: Surgery, in my opinion, should be a last resort.
And, uh, the less invasive, the better.
If we develop technology that people can be treated without brain surgery, why not?
O'BRIEN: So, how does a brain surgeon operate without surgery?
♪ ♪ He replaces the scalpel with sound: high-frequency sound waves, better known as focused ultrasound.
Doctors have used focused ultrasound since the 1950s to destroy tumors and kidney stones.
As the technology became more precise, they started aiming it at the brain.
It is now FDA-approved to treat essential tremor and Parkinson's disease.
Ali Rezai helped pioneer that work.
He wondered if focused ultrasound could also reset the circuits hijacked by addiction.
♪ ♪ Erin McNulty would also like to know.
She's anxiously awaiting her turn as a participant in Rezai's study.
They had to shave her hair, but she made the best of it with a wide variety of wigs.
♪ ♪ Erin has struggled with addiction for four decades.
Mostly, it's been heroin.
More recently, methamphetamines.
She remembers at least 14 overdoses.
I remember one time, they said my heart rate was six beats per minute.
Oh, wow.
- Um... That's pretty close to dead.
Yeah.
It's so sad, you know, um, to keep using, but then you feel bad about it, and it keeps the cycle going, and... It's a death spiral, is what it is, right?
- It's a death spiral, it is.
It really is.
It's very hard to get out from under it.
Extremely.
- Yeah.
O'BRIEN: Alive against all odds, she saw this procedure as her last hope for any kind of future.
At this point, were you ready?
To... - Yeah.
I, yeah, I was more than ready.
Honestly, I really was not nervous.
I know I'm in really good hands, and everything I've been through with addiction... (inhales sharply) I was, like, you know... (laughs) Bring it on.
Like... (laughing) MAN: How are ya?
- Good.
Just ready to get this done.
MAN: All right.
Let's make it happen.
Yeah.
WOMAN: Good morning, honey.
How are you?
ERIN MCNULTY: Good.
- Love you.
O'BRIEN: We were there on game day.
As she arrived, she was quickly surrounded by a team of about two dozen health professionals, there to perform a symphony conducted by Ali Rezai.
REZAI: There's her hat, right there.
O'BRIEN: It began with the only painful, invasive part of the procedure: the halo.
It's designed to keep her head perfectly still.
Okay, very good.
O'BRIEN: She'll remain inside the MRI throughout the procedure, giving the team a real-time view of the precise area of the brain they're targeting.
She has significant asymmetry between her right and left side of the brain.
We're just trying to fine-tune it to capture more of the nucleus accumbens.
O'BRIEN: The nucleus accumbens sits deep inside the brain.
Working with the chemical messenger dopamine, it's part of the reward system that motivates us to seek life's pleasures-- from food and sex to the satisfaction of a job well done.
But addiction hijacks that same circuitry, trapping the brain in compulsive loops that are hard to escape.
Could it be possible to break that cycle, not with drugs or surgery, but with something as simple as sound?
We are not destroying brain tissue, but we are modulating it, like a deep brain stimulation does with a pacemaker.
We're doing it without surgery.
O'BRIEN: The stakes are high.
There is no room for error.
REZAI: A lot of very precious brain territory that have a lot of different functions are close by, so you don't want to impact those areas.
O'BRIEN: To refine their aim, they merge real-time MRI data with earlier brain scans.
REZAI: So we're almost there right now, and then we're going to start delivering energy, test energy, and slowly see what happens.
So we're almost ready to go.
O'BRIEN: Inside the MRI, Erin wears special goggles.
At first, calming images are projected onto them.
Then they introduce pictures that trigger cravings for drug use.
REZAI: So we want to really exquisitely fine-tune that nucleus to drive it to want this drug.
O'BRIEN: And that activates a specific place in Erin's brain.
The helmet Erin wears contains more than a thousand ultrasound transducers.
Individually, they are too weak to cause significant effects on other brain regions.
But when they are synchronized and focused on a single point in the brain, they converge like sunlight through a magnifying glass.
The energy builds up at the focal point, modulating the brain just enough at the right spot.
And then we can slowly increase the energy to effect changes in the nervous system function.
As you vibrate those key centers, what is happening?
Do we know?
REZAI: The exact mechanism is not, not known.
♪ ♪ O'BRIEN: Here's his leading theory: focused ultrasound may disrupt the abnormal patterns of neural activity that sustain addiction.
Animal studies also suggest it may alter gene expression, a process known as epigenetics.
It doesn't change DNA itself, but it may switch key genes on or off, giving the brain a chance to rewire itself and loosen addiction's grip.
REZAI: It's causing durable long-term effects now months, and that's unusual.
So it's definitely causing some cellular and gene expression and epigenetic changes.
It has to do that, but we just need to understand it better.
Shaking the Etch A Sketch, I guess, or something.
- Yes.
O'BRIEN: Erin holds a device similar to a video game controller, reporting her craving levels in real time.
Early results were promising.
You can see right there, meth and everything else down, almost zero.
And pills and heroin, so it's good.
So I think, um, so far so good.
We're optimistic.
(talking in background) O'BRIEN: And so was Erin.
Her brain changed with a single treatment.
I now realize I don't crave like I, I was.
My cravings are... I don't even think about it.
Um, unless someone brings it up in a conversation, I'm not thinking about it at all.
That's an extraordinary statement.
Your entire adult life was thinking about it, right?
Those obsessive thoughts were pretty much gone.
O'BRIEN: There's that word again-- gone.
Just as Lindsay described it.
So far, Rezai's team has treated about 50 patients in this early clinical trial.
Participants with drug addiction have reported an average 80% reduction in cravings.
For binge-eating disorder, the reduction has approached 90%.
Promising results, but this is still experimental medicine.
♪ ♪ They paused the study for eight months after one participant developed a microhemorrhage that injured his brain.
He continues to struggle with memory problems and incontinence.
♪ ♪ Rezai's team responded by lowering the maximum ultrasound power and increasing it more gradually.
It's a sobering reminder that every medical breakthrough begins with risk.
For Erin, that risk was worth taking.
She and her family believed they had little left to lose.
♪ ♪ Her mother, Linda, owns this antiques store in Essex Junction, Vermont, about a half-hour outside of Burlington.
Linda?
LINDA MCNULTY: Hi!
Oh, my gosh, this is something!
Welcome.
O'BRIEN: Nice to meet you.
- You, too.
Nice to meet you.
- Good to see you.
I see the resemblance, yeah.
LINDA MCNULTY: Thank you.
O'BRIEN: She's adopted Erin's daughter McKinley, now 18, and they are inseparable.
This is a lovely picture.
O'BRIEN: For more than four decades, Linda has lived with a constant sense of dread-- wondering where Erin was and fearing the worst.
Every single day, I would get up with it on my mind.
Um, is she home?
Did she leave during the night?
Where am I gonna go find her?
And then I'd say, "What am I gonna do with her after I find her?"
You must have been scared for her.
Very scared.
But I told Erin, she was always, always welcome to come home.
I said, "You need me, you call, I will pick you up."
And I said, "You can always come home."
I decided years ago I will never give up on one of my kids.
O'BRIEN: Linda learned about Ali Rezai in April of 2024.
It includes revolutionary treatments for a brain disease suffered by 24 million Americans: addiction.
O'BRIEN: She watched a report about his work on the CBS newsmagazine "60 Minutes."
LINDA MCNULTY: And I just sat up, like, I'm dreaming, or what is this?
And I will never forget it.
And I said, "I want that."
(speaker on TV continues) O'BRIEN: The next morning, she called the Rockefeller Neuroscience Institute.
LINDA MCNULTY: And I said my name.
She goes, "That sounds familiar."
I said, "Really?"
She says, "Well, we had 50-something emails last night "asking for Erin McNulty to come here, "interested in the procedure that was on '60 Minutes' last night."
O'BRIEN: It was McKinley, with help from her cousin.
MCKINLEY MCNULTY: And she's, like, "We gotta email, like, they're probably booking up."
And so I just sent, like, I copy and pasted the same exact email.
So you did an email blast.
- Yeah.
You kind of spammed Ali Rezai.
Yeah, yeah.
Was that... You figured you had nothing to lose at that point?
Exactly, yeah.
There's McKinley.
- Hi.
ERIN MCNULTY (on phone): Hey, hi, beautiful.
Hi, beautiful.
O'BRIEN: McKinley is close to her mom, despite growing up so concerned, anxious, and afraid for her.
What's that been like?
It definitely has been difficult to, for, just to do normal things every day.
It was a lot to deal with, but I was never... You know, I never blocked her out of my life.
I always was there for her.
Unconditional love is really important to me.
O'BRIEN: In September 2024, when they were all waiting to see if Erin would be accepted into the study, McKinley wrote another email to Ali Rezai.
MCKINLEY MCNULTY: "My mother has struggled with addiction "her whole life.
"Countless overdoses to where she was on life support "and the rest of my family was telling their goodbyes.
"Countless rehabs and detoxes, anything you can imagine.
"She cannot live without this.
"Please, I hope that you are able "to read my email and understand.
"I hope I'm not overstepping, but I need my mother in my life."
O'BRIEN: Wow.
Did you get a response?
Um, I did not, but the day after that, she got chosen.
Are you afraid to declare victory for her at this point?
No, not anymore.
You think it's real?
Yeah, I think she's got it this time.
♪ ♪ O'BRIEN: That was June of 2025, five months after Erin got the treatment.
By April of 2026, 15 months after her ultrasound reset, Erin was packing up for the move back home.
♪ ♪ I went back to the antiques store in Vermont... So good to see you.
...a little more than a year after Erin and I first met.
Welcome home, huh?
It was nice to see three generations of McNulty women reunited.
Have you had any cravings?
Honest to God, I have not had one craving.
It is... It's, like, they literally zapped it out of me.
It, it's crazy.
I have no feelings or, like, you know, urges even around the thought of it.
It just, it's not there.
It's just, like, a whole new life.
It's very peaceful, it's... Very different.
O'BRIEN: Linda and McKinley agree wholeheartedly.
MCKINLEY MCNULTY: She's not waking up in the middle of the night wondering where she is, not having nightmares and, like, waking up and thinking, like, "Oh, my God, is this real?"
You know?
It's just really rewarding to not worry.
What are your thoughts?
Complete happiness, relief that I can, you know, have some life without worrying if, you know, Erin is okay or not.
I mean, it was a 24/7 worry for both me and McKinley.
It's really a miracle.
I want others to feel it.
(chuckles) O'BRIEN: But making this promising treatment available to more people who need it is a big challenge.
This small clinical trial requires millions of dollars' worth of equipment and a team of highly trained specialists.
As it is, it can barely make a dent.
After all, nearly 50 million Americans are living with addiction.
REZAI: Right now, you can't have this in thousands of clinics or programs across the country.
So, our goal is to design and develop the next-generation system that can be used routinely.
And not as expensive and cumbersome and not requiring multiple teams.
So, we're looking at the IBM mainframe.
You're trying to build the, you know, the wearable iPod.
Exactly, a simple little device that-- exactly.
It's like a headpiece or earpiece that you wear.
If we're helping a few hundred people worldwide now with this, we need to do millions in the next few years.
O'BRIEN: This is familiar territory for Rezai.
WOMAN: Billy Allen.
Clayton Barry.
O'BRIEN: He began his career facing another epic medical challenge that affected millions: H.I.V./AIDS.
(people shouting) His family emigrated from Iran in 1977, two years before the overthrow of the shah.
His mother brought him and his two younger brothers to Los Angeles.
He was 11 and didn't know a word of English, and yet, in only four years, he was accepted at U.C.L.A.
He was 15.
A biology major, he gravitated to the hospital and started working in the immunology labs.
At that time, the AIDS crisis was starting.
And I was very fortunate to work in the lab of some of the pioneers and, who were involved in the discovery of AIDS in, in L.A.
And it was really amazing to be part of that team, trying to understand what H.I.V.
is.
So, I was front and center on so many things as a very young person.
You found your place, didn't you?
Yeah-- yeah.
You are a driven person.
Do you take that as a compliment?
Yes, I mean, I'm driven to find solutions, yes, and I'm impatient.
So, for me, if you have an opportunity to make an impact, why not do it now?
O'BRIEN: Making an impact for millions of addicts may not be a realistic goal right now, but Rezai is changing lives already, offering solutions for people who had given up looking for them.
(talking indistinctly) O'BRIEN: We watched as he gave Lindsay Williams a debrief of her procedure.
So, we want to not only see the accumbens there, the reward center, but we want to activate it.
O'BRIEN: As they did with Erin, they showed her a series of pictures designed to trigger her cravings.
In her case, junk food.
REZAI: And whether it's fatty food, salty food, savory, sweets, we want to watch what happens as we start treating.
And sometimes we make modifications in the target and the navigation.
O'BRIEN: So, as she was looking at food she loved, they were aiming beams of ultrasound at the part of her brain that lit up.
It was a targeted reboot that worked instantly.
Did things change almost in real time?
WILLIAMS: Yes.
When I was seeing those pictures, I was hungry at first.
And then I thought, "I'm not hungry anymore."
And then I thought, "No way this worked."
And I didn't want to get hopeful, because nothing is worse than getting hopeful and it not working, right?
O'BRIEN: Lindsay says she always felt judged.
But she knew her weight gain was not a moral failing or a sign of weakness.
Shaking parts of her brain like an Etch A Sketch validated everything she knew about herself.
And I had always said, "My problem is not "that I don't know what to eat "or I don't know what my body reacts to "or I don't know how I'm supposed to exercise "or what I'm supposed to be doing.
"It's that I physically can't make the change "because it's between my ears.
The problem is in my head-- I can't fix it."
It was like 30-some years of literal weight that was lifted.
(birds chirping) O'BRIEN: I caught up with Lindsay in April of 2026... Hey, how are you?
Hi.
O'BRIEN: ...18 months after her procedure.
They're good, everyone is really good.
O'BRIEN: Life was going well.
Her real estate brokerage was seeing record sales.
Her family was all good.
She was 70 pounds lighter.
And, for the first time in her adult life, she told me she could walk into a fast-food restaurant, order a meal, and eat it without the overwhelming urge to binge.
(button beeps) Is there a little bit, you know, in the back of your mind, a little bit of nervousness that you might fall back into your old patterns?
I think there was this, this fear in the back of my head, wondering, "Is this going to all be okay?"
But the anxiety level that I lived with all the time, that noise that was just constant, that's just gone.
The further out that I get, I'm, like, "No, it's fine."
Like, I think it's gonna last.
O'BRIEN: But it's too early to be certain about that.
Focused ultrasound to treat addiction is still experimental.
Only a small number of volunteers have received this treatment, and many questions still remain.
Erin and Lindsay both took big risks to help find some answers.
They aren't just patients.
They're pioneers.
Solving our biggest problems takes brilliant scientists.
But it also takes regular people with the courage to become part of the solution.
It's perfect.
♪ ♪ ♪ ♪ ♪ ♪


- Science and Nature

Explore scientific discoveries on television's most acclaimed science documentary series.
New Episode

New Episode







Support for PBS provided by:
Made possible in part by support provided by Sue Hart-Wadley and Searle Wadley with additional support from Jerry Cox.
