20 sessions of DLPFC iTBS is feasible and effective for Veterans with AUD - a pilot study

TMS is an emerging treatment tool for AUD, but has not yet been evaluated among a prospective sample of U.S. Veterans. Additionally, U.S. Veterans with AUD often have higher rates of co-morbidities such as depression, which may lead to differences in TMS response, relative to the civilian population. Here, we delivered 20 sessions of intermittent theta burst stimulation (iTBS) to the dorsolateral prefrontal cortex (DLPFC) to a sample of 17 Veterans with AUD. Individuals who received active iTBS were 12 times less likely to relapse within 3-months after treatment. Further, greater reductions in anhedonia (depression) were observed following active iTBS (Cohen’s d=-0.59), relative to sham (d=-0.25). Brain response to alcohol cues was reduced following active iTBS and increased following sham within brain regions involved in reward processing. This report demonstrates the high potential of this approach to reduce relapse rates and depression severity, while offering a valuable set of effect sizes to inform larger, clinical trials within this population.