Human beings take substances all the time to alter how they feel. Caffeine is  a common, relatively low-impact example. Depending on the substance and its ability to bind with certain receptors in the brain, this use can set up a cycle of reward, craving, and repeat use. This is not the fault of the person affected; it’s basic biology. 

For some substances, the cycle of addiction emerges after just a few exposures to a potent substance that impacts the brain. One example is opiate addiction, which can begin during legitimate medical treatment. Withdrawal from opiate treatment can trigger the onset of depression, causing the patient to seek out further medication to stave off symptoms. Other individuals turn to substances to “self-medicate” or relieve the pain of already existing depression, anxiety, trauma, PTSD, or other illnesses. Sadly, while the substance may provide some temporary relief or distraction during intoxication, addictive behaviors will ultimately worsen rather than help the underlying condition. This can lead to an increased desire for relief, leading to more intoxication. This is the addictive cycle.

When a substance is used regularly, it provokes changes in areas of the brain that control thinking, judgement, learning, and mood. These changes are long-lasting and extend well beyond the period of intoxication. Over time, the substance use leads to growing impairment in four areas: 

1. Decreased self-control over the use of the substance, accompanied by frequent or constant thoughts about using again, often referred to as cravings.
2. Social problems caused by substance use, including inability to complete tasks at work or school, inability to be emotionally available in personal relationships, and cutting back on activities and relationships that are not part of substance use.
3. Denial, or disregard of the harm and risks associated with continued use.l
4. Increased use motivated by withdrawal avoidance and/or increased tolerance (needing more of the substance to achieve the same effect).

TMS is never the primary or only treatment used for these conditions. However, TMS can play a very important role in helping the individual establish and maintain sobriety.

TMS targets the cravings that make sobriety so challenging, and can also treat associated conditions, including depression, anxiety and PTSD, which either trigger the use of substances or have come about as a result of substance abuse. Experts agree that adequate treatment of these mood conditions is necessary for success in overcoming addiction.

TMS has been studied in the treatment of nicotine, alcohol, cocaine, and methamphetamine addiction. The evidence shows that between 15 and 20 treatments of TMS can reduce cravings for up to six months. Accelerated TMS (aTMS) shows an even greater impact on craving than standard TMS. During aTMS treatment, TMS is administered multiple times over the course of the day, instead of once per day. In the majority of studies, addiction patients treated with aTMS self-reported reduced craving intensity, reduced substance use, and increased life satisfaction and stability, compared with their usual substance abuse treatment.

TMS treatments vary by the frequency of the magnetic pulses, the region of the brain that is targeted, and a number of other factors. Research is ongoing to determine the best protocols for TMS addiction treatment. It may be that, over time, different protocols will emerge for treating different types of substances. One of the most recent surveys of TMS research examined 218 published studies and selected 50 of these as high-quality studies. The majority of these high-quality studies used the standard treatments and the standard targeting of the dorsolateral prefrontal cortex (DLPFC) that are used when treating depression. Another recent review looked at 618 published articles and found 18 to be of high quality. Both reviews found evidence that TMS can be helpful in treating addiction. 

The safety profile of TMS is equally excellent whether it is used in the treatment of addiction or depression. However, it is important to understand that people who receive treatment while intoxicated or suffering from withdrawals may have an increased risk of seizure. Active substance use during a course of TMS treatment may also lower its overall effectiveness. It is critical that there be clear and accurate communication between the TMS team and the patient regarding the extent of recent and current usage. 

Although the idea remains controversial outside of medical circles, from a neuropsychological perspective, addiction to certain non-drug-use behaviors appears to be the same as other addictions. Problematic gambling, sexual behavior, internet use, food consumption, and food restriction all can be looked at as types of addiction. Significant medical research supports this view. TMS has been studied as a treatment for each of the above addictions and has shown promise in some cases. Other studies showed no impact. It may be that TMS helps relieve these addictions in certain individuals by treating underlying conditions that contribute to them. Since depression, if present, often makes managing addiction more difficult, adequate treatment of depression is strongly recommended for any individual struggling with addiction. 

Health insurance coverage is typically available only for FDA approved indications. For TMS, this currently includes depression, OCD, and nicotine addiction. Not all plans of insurance recognize these FDA cleared indications, however, and some deny coverage. Federal appeals courts have determined that insurance companies are violating the law when they set up their own standards (separate from FDA approval or professional medical society standards) to limit approval for TMS. Despite these clear legal rulings, it sometimes takes considerable effort to obtain Prior Authorization for TMS treatment. We are willing to work with prospective patients to gain necessary authorization. 

If a patient’s history clearly establishes that depression was present before substance use began or became a problem, it is sometimes possible to obtain insurance company approval for treatment under the depression standards. Other companies try to use their own standards to deny TMS coverage if there is a history of substance use. 

We do offer both “on-label” and “off-label” TMS treatments, as well as both insurance-covered and non-insurance-covered treatments. If we can’t help you obtain insurance coverage, we’ll work with you to arrange for self-pay TMS treatment. We’re also constantly following the latest research and will keep you up to date on any new medical findings relevant to your substance use treatment options.