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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method to help individuals with methamphetamine addiction by combining transcranial magnetic stimulation (a technique using magnetic fields to affect brain activity) with episodic future thinking (a mental exercise focusing on imagining positive future events). The goal is to determine if this approach can reduce cravings and improve decision-making. Participants will be divided into two groups: one will receive real magnetic stimulation, and the other will receive a sham (placebo) version, both alongside episodic future thinking sessions. The trial seeks individuals with a primary methamphetamine use disorder who can read and speak English. As an unphased trial, this study offers a unique opportunity to contribute to groundbreaking research that could lead to innovative treatments for addiction.

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 prior data suggests that transcranial magnetic stimulation and episodic future thinking are safe for methamphetamine addiction treatment?

Research has shown that repetitive transcranial magnetic stimulation (rTMS) is under study for its safety and potential benefits in treating methamphetamine addiction. Studies have found that patients generally tolerate rTMS well. Some individuals might experience mild side effects, such as headaches or discomfort at the stimulation site, but these effects typically do not last long.

While specific safety information for using rTMS with Episodic Future Thinking (EFT) is not available, rTMS has been safely used in other conditions and is considered safe enough for ongoing research. This suggests that the treatment is reasonably safe for individuals. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Most treatments for methamphetamine addiction rely on behavioral therapies and support groups, but this trial is exploring something new. Researchers are excited about combining Transcranial Magnetic Stimulation (TMS) with Episodic Future Thinking (EFT) because it targets the brain in a novel way. TMS uses magnetic fields to stimulate specific brain areas involved in addiction, while EFT encourages individuals to imagine positive future scenarios, potentially altering their motivation and decision-making processes. This approach could offer a unique, non-invasive alternative that directly influences brain function and cognitive patterns, offering hope for more effective treatment outcomes.

What evidence suggests that this trial's treatments could be effective for methamphetamine addiction?

This trial will compare the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) combined with episodic future thinking (EFT) against a sham rTMS combined with EFT. Studies have shown that rTMS can aid individuals with methamphetamine use disorder by enhancing decision-making skills. rTMS uses magnetic fields to stimulate specific brain areas, helping to control cravings. Research suggests that combining rTMS with EFT—a method where individuals imagine positive future events—might enhance treatment effectiveness. Early findings indicate this combination could reduce the desire for methamphetamine by making future goals feel more real and achievable. Although more research is needed, these initial results offer promise for those seeking new ways to manage addiction. ^{1 2 4 6 7}

Who Is on the Research Team?

Heather Webber, PhD

Principal Investigator

The University of Texas Health Science Center, Houston

Are You a Good Fit for This Trial?

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 for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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 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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9197111/

Efficacy of Repetitive Transcranial Magnetic Stimulation in ... Repetitive transcranial magnetic stimulation (rTMS) has demonstrated therapeutic potential for treating patients with methamphetamine use disorder (MUD).

2. centerwatch.com centerwatch.com/clinical-trials/listings/NCT06712446/a-pilot-study-of-transcranial-magnetic-stimulation-plus-episodic-future-thinking-for-methamphetamine-use-disorder

A Pilot Study of Transcranial Magnetic Stimulation Plus ... 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 ...

3. nature.com nature.com/articles/s41398-024-03000-z

Modulation of dlPFC function and decision-making ... This study explores the impact of repetitive transcranial magnetic stimulation (rTMS) on decision-making capabilities in individuals with methamphetamine use ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12060337/

Repetitive transcranial magnetic stimulation for stimulant use ... Cocaine and methamphetamine use disorders (CcUD/MtUD) have serious public health, medical, and psychiatric consequences.

5. researchgate.net researchgate.net/publication/395877776_Repetitive_TMS-based_Identification_of_Methamphetamine-Dependent_Individuals_Using_EEG_Spectra

Repetitive TMS-Based Identification of Methamphetamine ... This study explores the feasibility of using neural signals to obtain more objective results. EEG signals recorded from 20 METH-addicted ...

6. sciencedirect.com sciencedirect.com/science/article/pii/S2352047723000217

Effects of repetitive transcranial magnetic stimulation and ... In this review, we collected data on the brain modulation of participants who received rTMS and analyzed them using brain connectivity network techniques based ...

7. clinicaltrials.gov clinicaltrials.gov/study/NCT06244329

Repetitive Transcranial Magnetic Stimulation in Drugs ... This study also aims to develop and apply a standard repetitive transcranial magnetic stimulation (rTMS) protocol on drug users. The investigators want to ...