For someone experiencing addiction, craving can be one of the most difficult parts of recovery. A craving can be triggered by a substance related cue, it could be a particular environment, an emotion, a memory or even a seemingly ordinary situation that was associated with previous substance use. Although craving does not inevitably lead to relapse, it can make maintaining recovery much more challenging.
As our understanding of addiction has developed, researchers have become increasingly interested in brain networks that are involved in craving, reward, impulse control, and decision making. This has led to a growing interest in neuromodulation including Transcranial Magnetic Stimulation (TMS), as a possible treatment approach.
The research is encouraging so far. Studies suggest that particular TMS protocols may reduce craving in some substance use disorders, but the effects are not consistent across every substance, every protocol or every individual. TMS is viewed as an emerging potential adjunct to established addiction treatment, rather than a cure for addiction.
Craving is often described as an intense desire or urge to use a substance. However, it is more complex than simply wanting a drug or alcohol. Craving can involve interactions between reward processing, memories, attention, emotion, motivation and cognitive control. Environmental cues can become strongly associated with substance use, meaning that exposure to a familiar place, person, smell or situation may activate learned responses and increase the urge to use.
This helps explain why someone can genuinely want to recover while still experiencing powerful cravings. Importantly, experiencing a craving does not mean that a person has failed in their recovery. Cravings can occur during recovery even when someone is highly motivated to change. Consequently, finding interventions that can reduce craving or strengthen a person's ability to respond differently to it could be clinically valuable.
TMS uses magnetic pulses to stimulate specific areas of the brain. Repetitive TMS (rTMS) delivers these pulses repeatedly over a series of treatment sessions, producing changes in brain activity that may extend beyond the stimulation period itself.
Researchers became interested in TMS as a potential treatment for addiction because cravings appear to involve several brain networks responsible for reward, motivation, attention, decision making, and self-control. One of the most studied regions is the dorsolateral prefrontal cortex (DLPFC), as an area involved in planning, cognitive control, and regulating behavior.
Addictive substances can alter the brain's reward system, particularly pathways involving the neurotransmitter for dopamine. Over time, the brain may become increasingly responsive to substance-related cues while becoming less responsive to everyday sources of reward. At the same time, areas involved in impulse control and decision making may become less effective at regulating behaviour. This combination can make it difficult to resist cravings even when a person is highly motivated to stop using a substance.
Researchers believe that this may help explain why addiction is far more complex than a simple lack of willpower. Changes in brain function can contribute to the cycle of craving, substance use, and relapse. The idea behind TMS is not that it simply "switches off" cravings, instead researchers are investigating whether neuromodulation can help strengthen networks involved in cognitive control and alter how the brain responds to craving related cues.
This is an important distinction. Addiction is a complex biopsychosocial condition, and craving is only one part of the picture.
Early studies suggested that high frequency rTMS may reduce craving, particularly when stimulation is delivered to the DLPFC. A meta-analysis by Jansen and colleagues (2013) found an overall benefit of active stimulation compared with sham stimulation, although results differed depending on the substance being studied. Since then, the evidence base has expanded considerably, with researchers investigating TMS across a range of substance use disorders.
One of the most significant recent developments was a 2026 meta-analysis that examined data from 81 randomised controlled trials. Overall, TMS was associated with small to moderate improvements in both craving and substance use outcomes compared with sham stimulation. Importantly, the researchers also explored which brain regions appeared most closely associated with positive treatment outcomes. Rather than identifying a single target, the findings pointed towards several regions, including the pre-supplementary motor area (pre-SMA), inferior frontal gyrus (IFG), and frontopolar cortex.
This reflects a broader shift in addiction neuroscience. Researchers are increasingly moving away from the question of whether TMS works and towards more personalised questions: which brain networks should be targeted, which stimulation approaches are most effective, and which individuals are most likely to benefit.
Most addiction studies investigate TMS as a course of treatment delivered over several weeks rather than as a single intervention. During treatment, a magnetic coil is positioned against the scalp, delivering brief magnetic pulses to targeted brain regions. The exact approach varies between studies, with differences in treatment frequency, stimulation intensity, number of sessions, and brain targets. This variation is one reason why findings can sometimes appear inconsistent. Researchers are often investigating quite different treatment protocols under the broad umbrella of "TMS."
One of the areas in which the evidence has been particularly interesting is cocaine use disorder. A systematic review by Amerio et al (2023) examined eight randomized controlled trials investigating rTMS for cocaine use disorder. The strongest findings came from studies using multiple sessions of high frequency rTMS particularly targeting the left DLPFC. The studies reported reductions in self-reported cocaine craving, including cue-induced craving, compared with control conditions. Some research also suggested improvements in impulsivity. While results are promising, they have not yet established one universally effective TMS protocol for cocaine addiction.
This distinction is important when communicating research to patients. A reduction in craving observed in a clinical trial does not necessarily mean that every individual receiving TMS will experience the same effect.
Smoking and nicotine dependence have been among the most extensively investigated areas of addiction research in TMS.
A 2025 meta-analysis examined 17 randomized controlled trials involving 859 participants and found that rTMS produced a significant reduction in craving measured using the Tobacco Questionnaire for Smoking Urges. The analysis also reported improvements in abstinence outcomes.
These findings illustrate one of the recurring themes in TMS research; a treatment can appear promising one outcome while producing fewer convincing results for another. Reducing craving, reducing consumption, and achieving long term abstinences are related but they are not the same thing.
The evidence for alcohol use disorders is also growing. A 2024 meta-analysis for multiple session rTMS for alcohol craving included 12 studies involving 475 participants. The researchers found that rTMS reduced alcohol craving compared with sham stimulation immediately after treatment, although variability between studies was substantial.
More broadly, a 2025 systematic review on non-invasive brain stimulation in alcohol use disorder found a statistically significant reduction in alcohol craving compared with sham stimulation, although the overall effect size was relatively modest. Again, these findings are encouraging, but they do not demonstrate that TMS eliminates alcohol craving or prevents relapse in everyone who receives treatment.
Researchers have also begun investigating TMS for behavioural addictions, including gambling disorders and problematic eating behaviours. Although the evidence remains more limited than it is for substances such as nicotine, alcohol or cocaine, several reviews have reported reductions in craving related symptoms following active stimulation. However, the number of available studies remains relatively small, and further research is needed. These findings are nevertheless interesting because they suggest that TMS may influence craving related brain networks across different forms of addictive behaviour.
This may be one of the most important questions for future research. Craving is strongly associated with relapse, but reducing craving does not necessarily guarantee long term abstinence. A person may experience fewer cravings but still encounter social, psychological, or environmental factors that increase the likelihood of returning to substance use. Equally, someone may experience a craving but successfully manage it without using it.
Future studies need to look beyond immediate changes in craving scores and examine outcomes such as:
This is particularly relevant because addiction is a long-term condition, while many studies measure outcomes shortly after treatment.
Rather than viewing TMS as a replacement for established addiction treatments, researchers are increasingly interested in whether neuromodulation might complement them. A 2024 review examining neuromodulation alongside medication assisted treatment found that combining brain stimulation with pharmacotherapy was associated with significant reductions in craving related outcomes compared with sham stimulation. This raises an important clinical question, rather than asking whether TMS can replace medication, psychological therapy or psychosocial support, future research may increasingly ask: can neuromodulation enhance the effectiveness of a broader treatment program? That may ultimately prove to be its most realistic role.
TMS can influence brain networks involved in cognitive control and reward processing. Several studies have reported reductions in craving following active stimulation, and evidence is particularly encouraging nicotine dependence. Research in cocaine and alcohol use disorders continues to grow. TMS may have value as an adjunct to established addiction treatments, but more precise targeting of brain networks may improve future outcomes.
What remains uncertain is which protocol is most effective for each substance use disorder, which brain regions should be targeted, how many treatment sessions are required, and how long treatment effects will last. Does reducing craving consistently translate into sustained abstinence, which individuals are most likely to benefit, can TMS reduce relapse rates and how should TMS test best, be integrated with psychological and medical treatments.
These are not minor questions; they are central to understanding whether TMS will become an established component of addiction treatment in the future.
So as to whether TMS reduces craving, the most honest answer at present is, it may help some people under some circumstances. Research increasingly suggests that TMS can influence brain networks in craving, self-control, and reward processing. Across multiple substance use disorders, studies have reported reductions in cravings following active stimulation when compared with sham treatment.
The evidence is encouraging for nicotine dependence while growing research also supports further investigation into cocaine use disorder, alcohol use disorder, and other addictions. Reducing craving is not the same as curing addiction; recovery is influenced by biological, psychological, and social factors, and most people benefit from a combination of support approaches.
The most promising future for TMS may therefore be as part of a broader treatment plan alongside psychological therapy, medical support, and relapse prevention strategies.
The future of TMS and addiction may not be about switching craving off, but about helping the brain become better equipped to respond to it.
Written by Nikki, Smart TMS Birmingham Practitioner