Substance Use Disorder (SUD) is a complex and chronic disease affecting 2.2% of the global population, representing a significant public health burden (Castaldelli-Maia et al., 2022). The World Health Organization (2024) estimates 400 million people, equivalent to 7% of the worldwide population, live with alcohol use disorder (AUD), having detrimental long-term impacts on individuals’ lives. Nevertheless, this is only one type of SUD, representing only a portion of the total number of individuals affected by addiction. SUD is characterised by several symptoms, including experiencing cravings, compulsive drug-seeking, loss of control, and negative effects on both physical and mental health (Fattore & Diana, 2016). While SUDs have a detrimental physical impact, they have also been found to often co-occur with psychiatric disorders, most frequently mood disorders (Mehta et al., 2024).
Whilst modern treatments include a combination of evidence-based psychotherapeutic and pharmacological approaches, dropout and relapse rates remain high (Mehta et al., 2024). This highlights the need for innovative, evidence-based addiction treatments that better target the underlying neurobiology of addiction. One emerging option is Transcranial Magnetic Stimulation (TMS) — a non-invasive brain stimulation therapy increasingly used in mental health care.
TMS therapy for addiction works by targeting specific brain regions involved in craving, reward processing, and cognitive control. Growing evidence suggests that TMS for substance use disorders can significantly reduce cravings and substance use, positioning it as a promising non-invasive addiction treatment (Antonelli et al., 2021). The following sections explore how neuromodulation for substance abuse, particularly repetitive TMS (rTMS), is being applied across different addictions.
A systematic analysis investigating findings from the Global Burden of Disease (2019) reported over one billion tobacco smokers globally, equating to approximately seven trillion cigarettes consumed annually (Reitsma et al., 2021). Smoking accounted for over seven million deaths and 200 million disability-adjusted life years in 2019 alone (Reitsma et al., 2021), reinforcing the urgent need for more effective treatments.
Research into TMS therapy for addiction, particularly smoking cessation, has expanded significantly over recent decades (Eichhammer et al., 2003; Tseng et al., 2022). In a large study involving 710 participants, rTMS significantly reduced smoking frequency compared to sham treatment (Tseng et al., 2022). High-frequency stimulation (10Hz) targeting the left dorsolateral prefrontal cortex (DLPFC) was found to be most effective and well tolerated.
The effectiveness of TMS for addiction treatment is thought to stem from its ability to modulate dopamine release and improve reward system functioning during withdrawal and craving states. By promoting neuroplasticity, TMS strengthens cognitive control and reduces craving intensity, making it a valuable brain stimulation therapy for addiction.
Similarly, TMS for drug addiction has shown promising outcomes in cocaine use disorder. A systematic review found that rTMS significantly reduced cue-induced cravings, overall craving scores, and impulsivity in individuals with cocaine addiction (Amerio et al., 2023).
As with nicotine addiction, high-frequency stimulation of the left DLPFC appears most effective. This area of the brain is associated with executive function, emotional regulation, and decision-making. By targeting these pathways, TMS treatment for cravings enhances cognitive control and reduces compulsive drug-seeking behaviours.
In addition, rTMS influences both dopaminergic and glutamatergic systems, improving reward processing and executive functioning (Rasgado-Toledo et al., 2024). These mechanisms highlight how neuromodulation therapies like TMS address the core drivers of addiction rather than just the symptoms.
Alcohol use disorder (AUD) remains one of the most prevalent and burdensome forms of addiction globally. Consistent with other SUDs, TMS for alcohol addiction has demonstrated significant clinical benefits.
A recent systematic review and meta-analysis (Treiber et al., 2025), including 475 patients, found that rTMS significantly reduced cravings both immediately after treatment and at three-month follow-up. These findings reinforce the role of TMS therapy for substance use disorders as an effective and durable intervention.
Importantly, the first 12 weeks of AUD treatment represent the highest risk period for relapse (Kelly et al., 2026). The sustained effects of TMS during this critical window suggest it may play a key role in improving long-term recovery outcomes. As a non-invasive addiction treatment, TMS offers a well-tolerated alternative or adjunct to traditional approaches.
In conclusion, current research positions Transcranial Magnetic Stimulation (TMS) as a highly promising, evidence-based treatment across multiple forms of addiction. Its ability to target key neural mechanisms — including reward processing, executive functioning, cognitive control, and emotional regulation — makes it particularly effective in reducing cravings and relapse risk (Amerio et al., 2023; Rasgado-Toledo et al., 2024).
By modulating dopaminergic and glutamatergic systems, TMS for substance use disorders offers the potential for lasting neurobiological change and improved long-term outcomes (Tseng et al., 2022; Rasgado-Toledo et al., 2024). Furthermore, its sustained effects beyond the treatment period make it especially valuable during high-risk relapse phases (Treiber et al., 2025; Kelly et al., 2026).
As demand grows for effective, evidence-based addiction treatments, TMS therapy for addiction is becoming an increasingly important tool within modern mental health care. Its non-invasive nature, strong safety profile, and growing clinical evidence make it a compelling option for individuals seeking alternative or adjunctive treatments.
If you are exploring TMS for addiction, TMS for substance use disorders, or alternative approaches to managing cravings and relapse, Smart TMS can help. As a leading provider of private TMS therapy in the UK, Smart TMS offers personalised, evidence-based treatment designed to support recovery and long-term wellbeing.
If you’re interested in learning more about TMS therapy for addiction or would like to find out whether this treatment is right for you, please get in touch with Smart TMS today. Our team is here to provide expert guidance and support every step of the way.
Written by Lavina, Smart TMS Edinburgh Practitioner
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