Transcranial magnetic stimulation in the treatment of substance addiction
Open accessAbstract
Transcranial magnetic stimulation (TMS) is a noninvasive method of brain stimulation used to treat a variety of neuropsychiatric disorders, but is still in the early stages of study as addiction treatment. We identified 19 human studies using repetitive TMS (rTMS) to manipulate drug craving or use, which exposed a total of 316 adults to active rTMS. Nine studies involved tobacco, six alcohol, three cocaine, and one methamphetamine. The majority of studies targeted high‐frequency (5–20 Hz; expected to stimulate neuronal activity) rTMS pulses to the dorsolateral prefrontal cortex. Only five studies were controlled clinical trials: two of four nicotine trials found decreased cigarette smoking; the cocaine trial found decreased cocaine use. Many aspects of optimal treatment remain unknown, including rTMS parameters, duration of treatment, relationship to cue‐induced craving, and concomitant treatment. The mechanisms of rTMS potential therapeutic action in treating addictions are poorly understood, but may involve increased dopamine and glutamate function in corticomesolimbic brain circuits and modulation of neural activity in brain circuits that mediate cognitive processes relevant to addiction, such as response inhibition, selective attention, and reactivity to drug‐associated cues. rTMS treatment of addiction must be considered experimental at this time, but appears to have a promising future.
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Supportive meta-analyses are available for rTMS in treating SUD, PTSD, bipolar disorder, and OCD.
“Supportive meta-analyses are now available for rTMS in treating SUD (Gorelick et al., 2014; Dunlop et al., 2016), PTSD (Berlim and Van Den Eynde, 2014), bipolar disorder (McGirr et al., 2016) and OCD (Berlim et al., 2013a; Trevizol et al., 2016).”
From Cortico-striatal-thalamic loop circuits of the salience network: A central pathway in psychiatric disease and treatment (2016) · cites this paper as Gorelick et al., 2014
TMS applications to investigate and modulate SUD-related networks have grown exponentially across alcohol, cocaine, methamphetamine, opioid, cannabis, and tobacco use disorders.
“there has been an exponential growth in the application of TMS to investigate and modulate these networks in populations with SUDs including alcohol, cocaine, methamphetamine, opioid, cannabis, and tobacco use disorder [11,12,25–29].”
The prefrontal cortical network, including DLPFC and OFC, supports inhibitory control, which is often impaired in SUD patients.
“these regions include the prefrontal cortical network including the dorsolateral prefrontal cortex (DLPFC) and the orbitofrontal cortex [11,12] which have important functions in inhibitory control, a neurobehavioral output often impaired in patients with SUDs.”
Low-frequency TMS (usually 1 Hz) is generally shown to inhibit cortical excitability, whereas high-frequency TMS (5-20 Hz) is shown to enhance cortical excitability.
“low-frequency TMS (usually 1 Hz) is generally shown to inhibit cortical excitability, whereas high-frequency TMS (5–20 Hz) is shown to enhance cortical excitability”
From The Insula: A Brain Stimulation Target for the Treatment of Addiction (2019) · cites this paper as Gorelick et al., 2014
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- Authors
- Gorelick, D. A., Zangen, A., & George, M. S.
- Affiliations
- University of Maryland, Baltimore (US)
- Ben-Gurion University of the Negev (IL)
- Medical University of South Carolina (US)
- Corresponding author
- Gorelick, David A.
- Venue
- Annals of the New York Academy of Sciences
- Publisher
- Wiley
- Published
- 2014-07-28
- Volume
- 1327
- Issue
- 1
- Pages
- 79-93
- ISSN
- 0077-8923 (ISSN-L)
- 1749-6632
- PMC
- PMC4206564
- OpenAlex
- W2154268783
- Cited by
- 195
- References
- 105
- Citations by year
- 2026: 10 · 2025: 20 · 2024: 12 · 2023: 14 · 2022: 16 · 2021: 12 · 2020: 17 · 2019: 17 · 2018: 22 · 2017: 17 · 2016: 21 · 2015: 15 · 2014: 2
- FWCI
- 1.49
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of the New York Academy of Sciences (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (DA999999)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Keywords
- transcranial magnetic stimulation, repetitive transcranial magnetic stimulation, substance addiction, addiction treatment, drug craving, tobacco use, alcohol consumption, cocaine use, methamphetamine, dorsolateral prefrontal cortex, high-frequency stimulation, nicotine, cue-induced craving, dopamine, glutamate, response inhibition, selective attention
- MeSH terms
- Animals, Brain Chemistry, Humans, Inhibition, Psychological, Neurons, Prefrontal Cortex, Evidence-Based Medicine, Substance-Related Disorders, Transcranial Magnetic Stimulation
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