Transcranial Magnetic Stimulation + Episodic Future Thinking for Methamphetamine Addiction

Overseen By Jessica Vincent

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: The University of Texas Health Science Center, Houston

Must not be taking: Antidepressants, Antipsychotics, Stimulants, others

Disqualifiers: Substance use, Psychiatric, Implants, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 1 week

20 Participants Needed

Trial Summary

What is the purpose of this trial?

The purpose of this study is to assess impact of repetitive transcranial magnetic stimulation (rTMS)+Episodic Future Thinking (EFT) vs. sham rTMS+EFT on delay discounting and methamphetamine (MA) demand, on vividness of future positive events during EFT training and on frequency of episodic thinking during the week following EFT training

Will I have to stop taking my current medications?

The trial requires participants to stop taking certain medications that increase the risk of seizures, such as clozapine, chlorpromazine, and bupropion, among others. If you are taking any of these medications, you will need to stop them before joining the study.

What data supports the effectiveness of this treatment for methamphetamine addiction?

Research shows that repetitive transcranial magnetic stimulation (rTMS) can reduce cravings and improve decision-making in people with methamphetamine addiction. High-frequency rTMS over a specific brain area called the left dorsolateral prefrontal cortex has been found to decrease drug cravings and enhance cognitive functions, suggesting it may be a promising treatment option. ^{1 2 3 4 5}

Is Transcranial Magnetic Stimulation (TMS) safe for humans?

Transcranial Magnetic Stimulation (TMS) is generally considered safe for humans and has been used in various studies involving 316 adults for different substance addictions, including methamphetamine. It is a non-invasive method that has shown promise in reducing drug cravings and improving decision-making abilities, although it is still considered experimental for addiction treatment. ^{1 2 3 5 6}

How does the treatment of Transcranial Magnetic Stimulation and Episodic Future Thinking for methamphetamine addiction differ from other treatments?

This treatment is unique because it combines Transcranial Magnetic Stimulation (TMS), a non-invasive brain stimulation technique, with Episodic Future Thinking, which involves imagining future events to reduce cravings. Unlike traditional treatments, this approach targets brain activity and cognitive processes directly, offering a novel way to address methamphetamine addiction where no effective medical treatments currently exist. ^{1 2 3 5 7}

Research Team

Heather Webber, PhD

Principal Investigator

The University of Texas Health Science Center, Houston

Eligibility Criteria

This trial is for English-speaking individuals with a primary diagnosis of methamphetamine use disorder, as per DSM-5. Participants must not have severe substance use disorders other than methamphetamine and marijuana, no major medical or psychiatric conditions that could affect the study, and cannot be pregnant or nursing.

Inclusion Criteria

Meet Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for primary methamphetamine use disorder

Be fluent in English and able to understand the consent form

Exclusion Criteria

I have a history of epilepsy or seizures.

Current DSM-5 diagnosis for any illicit substance use disorder other than methamphetamine and marijuana

Current DSM-5 diagnosis of moderate or greater severity for alcohol and marijuana use disorder

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

EFT Training

Participants undergo Episodic Future Thinking (EFT) training and receive either high-frequency rTMS or sham rTMS

1 day

1 visit (in-person)

Treatment

Participants receive repetitive transcranial magnetic stimulation (rTMS) combined with Episodic Future Thinking (EFT)

1 week

Multiple sessions (in-person)

Follow-up

Participants are monitored for changes in delay discounting, methamphetamine demand, and engagement in EFT

7 days

1 visit (in-person or virtual)

Treatment Details

Interventions

• Episodic Future Thinking
• Transcranial Magnetic Stimulation

Trial Overview The study is testing whether combining repetitive transcranial magnetic stimulation (rTMS) with Episodic Future Thinking (EFT) can influence decision-making, cravings for methamphetamine, and the ability to imagine future events compared to a sham rTMS plus EFT.

Participant Groups

Group I: highfrequency rTMS+EFT Experimental Treatment 2 Interventions

Group II: sham rTMS+EFT Placebo Group 2 Interventions

Who Is Running the Clinical Trial?

The University of Texas Health Science Center, Houston

Lead Sponsor

Trials

974

Recruited

361,000+

Findings from Research

In a study involving 97 patients with severe methamphetamine use disorder (MUD), those who had better cognitive and emotional functioning were more likely to respond positively to repetitive transcranial magnetic stimulation (rTMS) treatment, indicating that these factors can help predict treatment outcomes.

Patients with MUD exhibited significant cognitive impairments and emotional disturbances compared to healthy controls, suggesting that addressing these issues may enhance the effectiveness of rTMS in reducing drug cravings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive and emotional predictors of real versus sham repetitive transcranial magnetic stimulation treatment response in methamphetamine use disorder. Chen, T., Su, H., Jiang, H., et al.[2021]

Transcranial magnetic stimulation (TMS) has been explored in 19 studies involving 316 adults for its potential to reduce drug cravings and use, particularly targeting the dorsolateral prefrontal cortex with high-frequency pulses.

While some studies showed promising results, such as decreased smoking and cocaine use, the treatment is still experimental, and the exact mechanisms and optimal parameters for rTMS in addiction treatment remain unclear.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transcranial magnetic stimulation in the treatment of substance addiction. Gorelick, DA., Zangen, A., George, MS.[2022]

High-frequency repetitive transcranial magnetic stimulation (rTMS) significantly reduced drug craving in patients with methamphetamine use disorder, as evidenced by lower Visual Analog Scale (VAS) scores compared to the sham group.

The 10-Hz rTMS group also showed improved decision-making abilities on the Iowa Game Test (IGT), particularly in later blocks, indicating that rTMS may enhance cognitive function in addition to reducing cravings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex reduces drug craving and improves decision-making ability in methamphetamine use disorder. Wang, W., Zhu, Y., Wang, L., et al.[2023]

High-frequency repetitive transcranial magnetic stimulation (rTMS) at 10 Hz applied to the left dorsolateral prefrontal cortex (DLPFC) significantly improved behavioral adjustment in long-term methamphetamine (METH) addicts by reducing the post-error slowing effect in their response times.

After rTMS treatment, the response times of METH addicts during post-error trials became comparable to those of healthy individuals, indicating that this intervention may help restore normal cognitive functioning related to error processing.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intervention Effect of Repetitive TMS on Behavioral Adjustment After Error Commission in Long-Term Methamphetamine Addicts: Evidence From a Two-Choice Oddball Task. Liang, Q., Lin, J., Yang, J., et al.[2019]

A study involving 60 participants with severe methamphetamine use disorder found that 20 sessions of intermittent theta burst rTMS significantly reduced drug cravings and induced neuroplastic changes in brain connectivity.

The reduction in craving was linked to increased functional connectivity between the left dorsolateral prefrontal cortex and the inferior parietal lobule, suggesting that rTMS may help rewire brain networks involved in addiction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuroplastic changes in resting-state functional connectivity after rTMS intervention for methamphetamine craving. Su, H., Liu, Y., Yin, D., et al.[2021]

In a study involving 10 methamphetamine-dependent users and 8 healthy controls, low-frequency rTMS (1 Hz) of the left DLPFC significantly increased self-reported craving for methamphetamine in users compared to sham stimulation, indicating a potential mechanism for craving modulation.

The rTMS procedure was found to be safe and tolerable for all participants, suggesting that while it may enhance craving in certain individuals, it does not pose immediate safety concerns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Low frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex transiently increases cue-induced craving for methamphetamine: a preliminary study. Li, X., Malcolm, RJ., Huebner, K., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Cognitive and emotional predictors of real versus sham repetitive transcranial magnetic stimulation treatment response in methamphetamine use disorder. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Transcranial magnetic stimulation in the treatment of substance addiction. [2022]

3. Ireland pubmed.ncbi.nlm.nih.gov

High-frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex reduces drug craving and improves decision-making ability in methamphetamine use disorder. [2023]

4. Singapore pubmed.ncbi.nlm.nih.gov

Intervention Effect of Repetitive TMS on Behavioral Adjustment After Error Commission in Long-Term Methamphetamine Addicts: Evidence From a Two-Choice Oddball Task. [2019]

5. England pubmed.ncbi.nlm.nih.gov

Neuroplastic changes in resting-state functional connectivity after rTMS intervention for methamphetamine craving. [2021]

6. Ireland pubmed.ncbi.nlm.nih.gov

Low frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex transiently increases cue-induced craving for methamphetamine: a preliminary study. [2022]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Modulation of Methamphetamine-Related Attention Bias by Intermittent Theta-Burst Stimulation on Left Dorsolateral Prefrontal Cortex. [2022]