Transcranial magnetic stimulation (TMS) therapy is a groundbreaking non-invasive treatment that uses magnetic fields to stimulate nerve cells in the brain to initiate changes that can improve psychological conditions. Although it is best known as a treatment for depression, research has found that TMS may be able to address a variety of neurological and psychological conditions, including substance use disorders.
Below, we’ll dive into the basics of TMS therapy, discuss the potential benefits for individuals recovering from substance use disorders, and find out what the research says about this promising new therapy.
- Transcranial magnetic stimulation (TMS) is a non-invasive treatment using magnetic pulses to target brain regions linked to mood, cravings, and impulse control.
- It has been shown to reduce cravings, improve mood, and enhance recovery when used for substance use disorders.
- TMS therapy is best used as a complementary therapy alongside traditional addiction treatments.
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What is Transcranial Magnetic Stimulation (TMS)?
TMS therapy is considered a non-invasive treatment for mental health conditions often that fail to respond to other types of treatments like psychotherapy or antidepressants. This therapy is currently FDA-approved for the treatment of depression, anxiety, and obsessive-compulsive disorder. Originally created in 1985 for individuals who did not respond to traditional epilepsy treatments, researchers found TMS had unintended positive effects on other psychological conditions.[1]
The therapy involves placing electromagnetic coils against the scalp that deliver magnetic pulses. These pulses can target specific areas of the brain that may be impacted by a certain psychological condition. When the cells in the brain are stimulated it can alter the activity of cells, modulating neural activity, and potentially regulating mood, cravings, and other factors linked to addiction.
How TMS therapy works
Because the cells of the brain rely on tiny electrical impulses to send signals to each other, TMS treatment works by altering these signals to activate regions of the brain that may have less-than-optimal activity due to conditions like depression, OCD, or substance use disorders. By delivering targeted magnetic pulses, TMS stimulates neural activity in specific areas, such as the dorsolateral prefrontal cortex (DLPFC), which plays a critical role in decision-making, impulse control, and craving regulation. [1]
The exact area of the brain targeted during TMS therapy depends on the condition being treated. [1] For example, addiction-focused TMS may aim to rebalance disrupted reward pathways, while TMS for depression targets areas linked to mood regulation.
TMS therapy for substance use disorders
TMS for substance use disorders works by targeting areas of the brain associated with addiction and reward. One of the main brain regions targeted with TMS is the dorsolateral prefrontal cortex (DLPFC), which plays a key role in decision-making, impulse control, and craving regulation. By stimulating this region, TMS may enhance neural connectivity and improve the brain's ability to resist addictive behaviors.
Although the exact mechanisms behind how TMS therapy works for substance use disorder aren't completely understood, research has also demonstrated that TMS may work by increasing dopamine and glutamate function or by modulating the neural activity in brain circuits that mediate cognitive processes relevant to addiction, such as response inhibition, selective attention, and reactivity to drug-associated cues. [2]
According to research, one of the main benefits of TMS therapy is its ability to reduce cravings. In a 2009 study on TMS therapy’s influence on alcohol dependence, TMS was shown to significantly reduce cravings after one month (10 sessions) of rTMS directed as the right DLPFC. [3] Similarly, a 2020 case study on its effects on an individual with opioid and cocaine dependence, found that after 7 sessions there was a mean reduction in cravings for heroin and cocaine by about 60%, a pretty significant reduction for substance use disorder. [4] Maybe even more important, was TMS’ ability to reduce opioid cravings during periods of early abstinence, one of the most challenging times to maintain sobriety. [5] It has also been shown to reduce cravings in tobacco use disorder. [6]
TMS therapy has also been shown to improve mood, particularly in depression and anxiety, which often co-occur with substance use disorders. By improving mood, TMS may help individuals with substance use disorders remain sober and better cope with the challenges of life in recovery.
Because TMS is a non-invasive therapy (meaning no surgery, incisions, or drugs) individuals can expect minimal downtime and rest assured they will not be exposed to any substances that may impact substance use disorders. Additionally, TMS protocols can be tailored to meet individual needs meaning it's customizable to your unique needs in recovery.
Types of addictions treated with TMS
Research into the types of addictions that may benefit from TMS is rapidly growing. Currently, there is research on its benefits for the following substances or addictions:
As the field of TMS therapy expands, the types of addictions treated will likely continue to grow over the coming years.
TMS therapy procedure: What to expect
TMS therapy, although non-invasive, is an intensive treatment option that requires sessions typically five days a week for 4-6 weeks. Sessions usually last 30-40 minutes depending on the type of TMS therapy you are receiving.
During your initial consultation, your technician will start the stimulation process, which requires mapping the brain. During the mapping session, your TMS provider will identify the precise brain regions to target to best treat your symptoms. They will also determine the needed stimulation intensity by targeting the motor cortex in the brain. Targeting the motor cortex allows the technicians to determine where to place the stimulation coil and how strong the signal should be to create the necessary stimulation to promote the desired changes in the brain.
What a TMS procedure looks like
During your treatment sessions, you will sit comfortably in a chair while the electromagnetic coil is placed on your head in the precise location to deliver the magnetic pulses. The electromagnetic coil is either in a helmet that you wear or may be attached to an extension arm. Your provider will give you earplugs to avoid any hearing injuries due to the sound of the magnet. The procedure is not painful, although you may feel a tapping sensation on your scalp or twitching or movement in your hands.
Once your provider has the magnet set to the appropriate place and signal strength, they will have it deliver a specific timing or pattern of signals. You may hear clicking during the treatment as the magnet turns on and off.
Your provider will monitor your progress, assess improvements, and adjust the protocol if needed.
Is TMS therapy right for you?
TMS therapy is an excellent choice for many individuals dealing with substance use disorder.
Potential reasons to choose TMS therapy:
- Other treatments have failed: TMS therapy often is a last-resort treatment modality. If you are still struggling with substance use disorder after trying other treatments, this may be a great therapy to try.
- Works cooperatively: TMS can work in conjunction with other therapies such as medications, psychotherapy, and more.
- It is non-invasive: Â No surgery, anesthesia, or downtime after treatments.
- Safe and effective: Research has demonstrated TMS is safe and works very well for a range of psychological disorders. It has demonstrated a low side effect profile and high success rates for most of the physiological conditions it has been proven to treat.
Risks and side effects of TMS
TMS comes with minimal risks, side effects, and potential complications. The most common serious side effect is seizures, which occur in less than 1 in 10,000 people, making the potential for this side effect very rare. [11]
Side effects after the session are typically mild and can include:
- Headaches
- Pain in the neck or scalp
- Dizziness or lightheadedness
- Tingling in the scalp or face
- Ringing in the ears
- High sensitivity to sound
Other rare, but more serious side effects include hearing loss and emotional highs (mania) in individuals with bipolar disorder.
If you experience any side effects that last for a prolonged period of time after your sessions, be sure to notify your provider so they can adjust or stop your treatment if necessary.
TMS vs. Other treatment options
Traditional therapies for substance use disorders, such as psychotherapy, behavioral therapy, and medication-assisted treatment (MAT), primarily focus on addressing the psychological, behavioral, and physiological aspects of addiction. These treatments are highly effective in managing symptoms, building coping skills, and providing the support necessary for long-term recovery. However, they may not fully address the underlying neurological imbalances in brain activity that contribute to cravings, impulse control issues, and relapse risk.
In contrast, Transcranial Magnetic Stimulation (TMS) offers a more targeted, brain-based approach by using magnetic pulses to stimulate specific regions of the brain involved in decision-making, mood regulation, and addiction-related behaviors. While TMS does not replace traditional therapies, it complements them by addressing the neurobiological factors of addiction.
Combining neurofeedback with traditional treatments
While TMS therapy shows great promise as a standalone treatment for substance use disorders, it is most effective when integrated into a comprehensive treatment plan.
Combining TMS with traditional therapies such as psychotherapy, medication-assisted treatment (MAT), and support groups can enhance outcomes and provide individuals with a multifaceted approach to recovery.
One well-studied example is pairing TMS with cognitive-behavioral therapy (CBT) because it can address both the neurological and psychological aspects of addiction. TMS helps regulate brain activity to reduce cravings and impulsivity, while CBT provides strategies for managing triggers and building healthier habits. A 2020 study on the combined effects of cognitive behavioral therapy and neurofeedback in a group of alcoholics found the combination significantly reduced relapse rates. [12]Â
TMS can also be a useful adjunct to medications like naltrexone or buprenorphine, potentially improving medication adherence and reducing relapse rates.
How to find TMS programs
To find a reputable TMS program for substance, start by consulting your healthcare provider or a mental health professional, who can recommend trusted and experienced specialists. Look for clinics with certified providers, such as those accredited by the Clinical TMS Society or using FDA-approved devices. Research-affiliated clinics often offer the latest evidence-based treatments.
You can also use online directories from professional organizations to locate providers near you. Before starting treatment, check with your insurance to confirm coverage and clarify costs.
Lastly, you should schedule a consultation to discuss your goals with the provider and ensure the program is a good fit for your needs.
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