Modulating Neural Circuits with Transcranial Magnetic Stimulation: Implications for Addiction Treatment Development

Abstract

Although the last 50 years of clinical and preclinical research have demonstrated that addiction is a brain disease, we still have no neural circuit-based treatments for substance dependence or cue reactivity at large. Now, for the first time, it appears that a noninvasive brain stimulation technique known as transcranial magnetic stimulation (TMS), which is Food and Drug Administration approved to treat depression, may be the first tool available to fill this critical void in addiction treatment development. The goals of this review are to 1) introduce TMS as a tool to induce causal change in behavior, cortical excitability, and frontal-striatal activity; 2) describe repetitive TMS (rTMS) as an interventional tool; 3) provide an overview of the studies that have evaluated rTMS as a therapeutic tool for alcohol and drug use disorders; and 4) outline a conceptual framework for target selection when designing future rTMS clinical trials in substance use disorders. The manuscript concludes with some suggestions for methodological innovation, specifically with regard to combining rTMS with pharmacotherapy as well as cognitive behavioral training paradigms. We have attempted to create a comprehensive manuscript that provides the reader with a basic set of knowledge and an introduction to the primary experimental questions that will likely drive the field of TMS treatment development forward for the next several years.

Long-Term Outcome of Repetitive Transcranial Magnetic Stimulation in a Large Cohort of Patients With Cocaine-Use Disorder: An Observational Study

“…Studies published to date are limited by small sample sizes and short duration of follow-up. In almost half the published studies using rTMS or a similar intervention for CocUD, there was, strictly speaking, no follow-up: responses (e.g., cocaine craving) were assessed only within the laboratory on the day of stimulation (6)(7)(8)(9). In 6 studies that assessed real-world outcomes, follow-up durations ranged from 5 days to 6 months (median 39 days), and the number of cocaine users receiving stimulation ranged from 6 to 36 (median 14) (10-15).…”

Transcriptional alterations in opioid use disorder reveal an interplay between neuroinflammation and synaptic remodeling

“…Functional alterations at the circuit-level occur across multiple brain regions in opioid dependence(3) and during treatment response(164). One such change occurs at the transcriptional level, where different brain regions can increasingly synchronize their patterns of transcription.…”

The Influence of Recreational Substance Use in TMS Research

“…Studies assessing the influence of neuroplasticity-inducing protocols (e.g., repetitive transcranial magnetic stimulation, rTMS; paired associative stimulation, PAS; transcranial direct current stimulation, tDCS) on cravings or symptoms relating to chronic substance use were excluded as this was outside the scope of this review. For reviews on this topic, refer to Gorelick et al [ 5 ], Hanlon et al [ 6 ], Hauer et al [ 7 ], or Mostafavi et al [ 8 ]. Further, studies assessing the influence of substance use on the magnitude of corticospinal change following neuroplasticity-inducing protocols were excluded.…”