TMS for Substance Use: What is TMS and How Can It Treat Addiction?

Transcranial magnetic stimulation (TMS) can help individuals recover from addiction. Here's what you should know about this exciting new treatment option.

TMS for addiction

Article Contents

What Is Addiction?

According to the American Society of Addiction Medicine (ASAM), addiction is defined as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.” Generally, people struggling with addiction use substances and engage in risky behaviors despite harmful consequences in various aspects of their lives.1

ASAM provides this helpful alphabetical tool that characterizes the traits of addiction.

  • Abstain – The individual is unable to abstain from substance use consistently.
  • Behavioral Control – The person experiences impairment to the point of losing control.
  • Craving – The individual needs substances to trigger the reward pleasure pathways.
  • Diminished Recognition – The individual is unable to identify problematic behaviors and relationships.
  • Emotional Response – The person’s situational emotional responses are dysfunctional or unhelpful.

This alphabetic tool is useful for those using substances and loved ones learning about addiction.2

Signs of Addiction

Signs and symptoms of addiction include changes in behaviors, emotions, relationships, interactions, and cognitions. Here are a few signs to look for when considering whether addiction treatment is needed: 3

  • Using more than initially planned or intended
  • Unsuccessful attempts to cut back substance use
  • Spending excessive amounts of time to find, use, and recover from drugs or alcohol
  • Interpersonal or relationship problems
  • Continued use despite consequences
  • Increased mental health symptoms

It is critical to understand that although patients may initially choose to use substances, addiction is a chronic disease that occurs even when a person no longer wishes to use or feels pleasure from substance use. Clinical intervention is vital for disrupting active substance use and preventing relapse.2

Types of Addiction

There are many different types of addictions or substance use disorders (SUDs), according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Here are the SUD classifications, as outlined by DSM-5:

  • Alcohol Use Disorder
  • Caffeine Use Disorder
  • Cannabis Use Disorder
  • Phencyclidine Use Disorder and Other Hallucinogen Use Disorder
  • Inhalant Use Disorder
  • Opioid Use Disorder
  • Sedative, Hypnotic, or Anxiolytic Use Disorder
  • Stimulant Use Disorder
  • Tobacco Use Disorder

These classifications lay out the various types of addiction according to the DSM-5.3

How Is Addiction Diagnosed?

Professionally licensed clinicians diagnose substance use disorders. Clinicians utilize psycho-social assessments and ASAM to evaluate whether a patient meets the criteria for one or more substance disorders. The six dimensions considered during a substance use disorder assessment are:4

  • Dimension 1  – Acute Intoxication and Withdrawal Potential
  • Dimension 2 – Biomedical Conditions and Complications
  • Dimension 3 – Emotional, Behavioral, or Cognitive Conditions and Complications
  • Dimension 4 – Readiness to Change
  • Dimension 5 – Relapse, Continued Use, or Continued Problem Potential
  • Dimension 6 – Recovery and Living Environment

If individuals want to determine whether they have a substance use disorder, the first step is to schedule a comprehensive assessment with a licensed substance use disorder professional. 

Dual Diagnosis

Addiction and mental illness often go hand in hand with patients receiving behavioral health care. The terms dual diagnosis or co-occurring disorder are appropriate when a patient is diagnosed with both mental health and substance use disorders. Mental illness and addiction treatment are most effective when provided in an integrated setting.5

How Can TMS Help In Addiction Treatment?

Transcranial magnetic stimulation (TMS) is a brain stimulation therapy that providers are starting to use to treat symptoms of addiction, such as depression and cravings. Although TMS treatment is not currently an FDA-approved method for addiction treatment, published research shows promising results. Seventeen published studies have documented a reduction in substance use cravings among included patients.6

What Is TMS?

Transcranial magnetic stimulation, abbreviated to TMS, is a neurostimulation therapy that treats various behavioral health diagnoses (OCD, depression, addiction, etc.).7 Read on to explore TMS therapy and how TMS is useful for addiction treatment.

EEG Evaluation

Electroencephalography, or an EEG evaluation, uses electrodes to detect neurological electrical activity. Recent studies have discovered exciting advantages to using transcranial magnetic stimulation and EEG diagnostic testing together. This concurrent TMS therapy approach gives providers vital information about the individual patient’s brain activity and patterns.8

Magnetic Pulses

When a patient receives TMS treatment, a trained technician will place an electromagnetic coil onto their forehead. TMS therapy sends quick magnetic pulses through the skull, targeting strategic sites within the brain. Magnetic pulses are incredibly tiny electrical currents that stimulate nerve cells in the patient’s brain. When receiving TMS treatment for addiction, patients report feeling similar sensations to an MRI or tapping feeling.9

rTMS

rTMS stands for repetitive transcranial magnetic stimulation. When discussing TMS therapy with a provider, patients will commonly hear the abbreviations rTMS and TMS. Both of these terms are interchangeable and describe TMS therapy. Researchers have studied TMS for addiction and mental health conditions, including depression or OCD.9

What To Expect In TMS Therapy

TMS for addiction is a non-invasive therapeutic approach to treating behavioral health conditions such as substance use disorder. We will cover the most commonly asked patient questions surrounding TMS for addiction and SUDs.

How Long Is The Therapy?

When a patient schedules TMS for addiction, they can usually expect treatment to last about six weeks. Often, this program will include daily twenty to forty-minute treatment sessions.

How To Prepare for TMS?

To prepare for TMS, patients will need to complete both a physical exam and a psychiatric evaluation. A patient’s TMS provider will provide detailed instructions for completing these crucial tasks.

Physical Exam

A physical exam is a necessity before a patient can receive TMS for addiction. A medical provider completes a comprehensive evaluation that may include lab testing. Patients must be transparent with their health care provider about pre-existing medical conditions, substance use, and medications.

Psychiatric Evaluation

The second step when determining eligibility to receive TMS for addiction is a psychiatric evaluation. A licensed mental health practitioner will evaluate the patient to ensure TMS for addiction is clinically appropriate and safe. 

Who Administers TMS?

Professionally trained technicians specializing in brain stimulation therapy administer TMS treatment to patients. During each appointment, the technician will be present the entire time to administer TMS, monitor the patient, and answer any questions that come up throughout treatment.

Who Cannot Get TMS Therapy?

Those suffering from psychosis or suicidal ideation should not receive TMS therapy. Additionally, patients with pacemakers or other metal medical implants may not be eligible to receive TMS for addiction. A trained physician makes the final determination on this during the physical exam.

Benefits of TMS Therapy

Recent studies conducted in both outpatient and inpatient settings have examined patients struggling with nicotine, alcohol, and cocaine addictions. The majority of evidence from these clinical trials supports TMS therapy for addiction. However, the research is still limited. Therefore, patients and providers should exercise caution when treatment planning.

Structural

Unlike electroconvulsive treatment, a commonly known brain stimulation therapy, rTMS does not use electricity to stimulate the entire brain. TMS therapy for addiction targets specific sites in the brain, which structurally minimizes the risk of adverse side effects.9

Physiological

TMS treatment uses advanced magnetic stimulation technology. This innovative therapeutic tool can improve physiological processing within the patient’s brain. Physiological improvements can minimize addiction cravings and other mental health symptoms associated with substance use, such as depression.

High-Success Rate

As previously mentioned, multiple clinical trials have published positive results after using TMS to treat addiction. For example, in three out of four outpatient treatment centers for nicotine use disorder, patient’s cravings and frequency of use decreased.

Additionally, two outpatient clinical trials were conducted around cocaine use. Patients in both clinical trials reported fewer cravings, and in one trial, patients demonstrated less substance use. Lastly, a controlled clinical trial was conducted in an inpatient setting for alcohol use disorder. The study reported lower cravings for individuals that had received TMS for addiction.

Non-Invasive

TMS therapy is an entirely non-invasive approach to treating behavioral health disorders. The patient can be alert, awake, and oriented during the entire outpatient visit. Patients do not have to undergo anesthesia and also have the opportunity to stop at any time during TMS treatment.

No-Side Effects

Most TMS patients do not experience any adverse side effects after completing their treatment appointments. However, in rare cases, patients have reported mild muscle contractions, tingly sensations, headaches, and light-headedness.

If the patient has a history of seizures or epilepsy, the technician should be made aware of this before administering TMS. As with any medical procedure or treatment, transparency with the health care provider is vital.

  1. https://www.asam.org/Quality-Science/definition-of-addiction
  2. https://www.asam.org/docs/default-source/public-policy-statements/1definition_of_addiction_long_4-11.pdf?sfvrsn=a8f64512_4
  3. https://www.ncbi.nlm.nih.gov/books/NBK519702/
  4. https://www.asam.org/asam-criteria/about
  5. https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Substance-Use-Disorders
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206564/
  7. https://www.nami.org/About-Mental-Illness/Treatments/ECT,-TMS-and-Other-Brain-Stimulation-Therapies
  8. https://pubmed.ncbi.nlm.nih.gov/30772238/
  9. https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies   

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