Brain Stimulation (rTMS) Reduced Cannabis Use Frequency in Preliminary Trial

Active rTMS (10Hz, left DLPFC, 20 sessions) did not significantly reduce craving compared to sham. However, active rTMS participants reported fewer days of cannabis use in the final two weeks of follow-up (-0.72 days/week, p = 0.02). They also had numerically more weeks of abstinence (15.5% vs 9.3%) though not statistically significant.

Two-site, phase-2, double-blind RCT. 72 treatment-seeking participants with moderate or greater CUD randomized to active or sham rTMS (20 total sessions, 2 per visit, 2 visits per week) with cannabis cues, plus 3-session motivational enhancement therapy.

There are no FDA-approved medications for cannabis use disorder. rTMS is a non-invasive brain stimulation technique already approved for depression and OCD. This preliminary trial suggests it may have therapeutic potential for CUD, warranting larger studies.

Brain stimulation is an active area of addiction research. The finding that rTMS reduced use frequency without reducing craving suggests it may work through mechanisms other than craving reduction, possibly by enhancing prefrontal control over substance-seeking behavior.

Small sample (n=72). Short follow-up (4 weeks). Primary outcome (craving) was negative. Use frequency effect emerged only in the final two weeks. All participants also received motivational enhancement therapy.