Intermittent Theta Burst Stimulation (iTBS) for Alcohol Use Disorder: Effects on Relapse and Drinking Outcomes
This content is intended for healthcare professionals and is provided for educational purposes only. Transcranial magnetic stimulation (TMS) is not approved for the treatment of alcohol use disorder.
Alcohol use disorder (AUD) remains associated with high relapse rates, with many individuals returning to hazardous drinking levels within months of treatment. This highlights the need for approaches that address not only short-term symptom reduction but also longer-term patterns of alcohol use and relapse.
A randomized, double-blind, placebo-controlled clinical trial by Durazzo et al. (2025) evaluated whether intermittent theta burst stimulation (iTBS) targeting the left dorsolateral prefrontal cortex could influence drinking outcomes in individuals with alcohol use disorder. The study included Veterans with AUD who received 20 sessions of active or sham stimulation over a two-week period, allowing for comparison of neuromodulation effects on post-treatment behavior.
In this study, participants receiving active iTBS showed a greater reduction in heavy drinking days, comparing the three months prior to treatment with the six-month follow-up period. A trend toward higher rates of continuous abstinence was also observed in the active stimulation group.
Among participants who resumed alcohol use, those receiving active stimulation demonstrated longer periods of abstinence, lower overall alcohol consumption, and more favorable recovery trajectories compared to sham. These findings suggest that neuromodulation may influence patterns of alcohol use beyond immediate treatment effects.
The analysis further indicated that baseline alcohol consumption did not predict follow-up drinking behavior, suggesting that iTBS may be associated with changes in established patterns of use rather than simply reflecting prior severity.
The study also explored a higher stimulation dose of 24,000 pulses, approximately double that used in earlier pilot studies. This provides additional context for understanding how stimulation parameters may influence clinical outcomes and highlights the need for further investigation into dose optimization.
Taken together, these findings contribute to the growing body of research on transcranial magnetic stimulation (TMS) and neuromodulation in addiction, particularly in relation to relapse and sustained recovery in alcohol use disorder.
As a randomized controlled trial, the study provides controlled evidence within a defined population. However, interpretation should remain within the study context, and the findings do not establish clinical recommendations or regulatory approval for this indication. Further research is needed to confirm these observations and to better define the role of iTBS in AUD.
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