Transcranial magnetic stimulation, or "TMS," is an FDA-approved psychiatric treatment for major depressive disorder and obsessive-compulsive disorder (OCD), with intriguing clinical trials suggesting future application in a variety of difficult-to-treat conditions, including PTSD (post-traumatic stress disorder), anxiety disorders, eating disorder, addictions, ADHD (attention deficit/hyperactivity disorder), sleep issues, and a range of other applications—all currently "off-label" for clinical use, and under research investigation. In recent posts, we've looked at rapid protocols for treating depression, known as "accelerated TMS," as well as recent research directly comparing TMS with multiple medication trials and finding greater benefit from TMS than a series of medications1. Because TMS is generally safe and well-tolerated, aside from issues with access and insurance coverage, it is often worth considering earlier in in treatment due to the favorable risk-benefit profile.
Because TMS can activate brain circuits which improve executive control to slow down some of the habit and reward areas of the brain, there is a natural question as to whether it could help with addictions and compulsions. Alcohol cravings are particularly problematic for people with alcohol use disorder, and reducing cravings is correlated with lower rates of abuse and relapse from sobriety.
Medications like naltrexone can reduce cravings by blocking the brain's endogenous opioid system, and therapy can help people influence cravings to prevent undesired behaviors. TMS might be able to help control cravings, for example by activating executive brain centers to increase self-control,........