Transcranial Magnetic Stimulation for Substance Use Disorder

Transcranial Magnetic Stimulation for Substance Use Disorder

Alvin Sherman Library

This review evaluates transcranial magnetic stimulation (TMS) as a supplemental intervention for decreasing substance use disorder (SUD) relapse rates by synthesizing understandings of neurobiological mechanisms and clinical outcomes. TMS stimulates the activity of neural cells in the dorsolateral prefrontal cortex (DLPFC), a small portion of the prefrontal cortex that houses impulse control and decision-making skills. This leads to improved neuroplasticity and dopamine regulation, both of which are disrupted by unregulated substance use. Although TMS is not FDA-approved for substance use disorder, the neurobiological similarities between SUD and its comorbidities like major depressive disorder or anxiety highlight TMS's theoretical potential to treat SUD. Acknowledging the treatment benefits for SUD would expand treatment options in addiction medicine and make it more accessible to patients and providers. We propose that TMS effectively reduces relapse rates, specifically when targeting DLPFC. Current findings suggest that TMS is not a stand-alone cure and is most effective when used in conjunction with other therapeutic options like psychotherapy or psychotropic drugs. However, the study of its efficacy is limited by methodological biases like attrition, selection, confounding, and performance bias-- all of which could cause the results to seem more promising than they are and be less generalizable to the entire population of individuals with SUD. Overall, the repetitive use of TMS (rTMS) presents to be a promising supplemental intervention for relapse prevention in SUD, calling for further research.