Transcranial Magnetic Stimulation for the Treatment of Veterans With Alcohol Use Disorders

Inclusion Criteria

• The study will be open to male and females, regardless of race and ethnic origin, who are in active treatment for an alcohol use disorder (AUD).
• Meet Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for AUD, and alcohol is self-identified as primary substance of misuse.
• Actively in treatment at VA Palo Alto HCS Addiction Treatment Service, and able to read, verbalize understanding, and voluntarily sign the Informed Consent Form prior to participation in study procedures.
• Participants will be accepted if taking medications specifically for the treatment of MDD, cigarette smoking, or for other psychiatric conditions.
• as long as the medications are not documented to lower seizure threshold
• must be stable on any psychotropic medication for at least 1 month prior to enrollment
• it would be clinically contraindicated to require participants to discontinue such medications for research.
• Participants will be abstinent from alcohol and non-prescribed substances for at least 7 consecutive days prior to active or sham rTMS and no participant demonstrates active acute withdrawal symptoms.

Exclusion Criteria

Psychiatric:

• History of Schizophrenia Spectrum Disorders
• Bipolar Disorders
• A current substance use disorder that exceeds the severity of the AUD
• based on DSM-5 diagnostic criteria
• Current use of an FDA approved medication for treatment of AUD, i.e.:
• disulfiram
• acamprosate
• naltrexone
• Active current suicidal intent or plan
• patients with a previous clinical flag for risk for suicide will be required to have an established safety plan involving their primary psychiatrist and the treatment team before entering the clinical trial
• Any form of previous rTMS or electroconvulsive treatment

Biomedical:

• Including but not limited to uncontrolled thyroid disease
• Unstable congestive heart failure
• Angina
• Other severe cardiac illness as defined by treatment regimen changes in the prior 3 months
• Cerebrovascular accident
• Cancer if 30 minutes
• Any primary or traumatically induced seizure disorder

General:

• Lack of fluency in English
• Wechsler Adult Reading Test below the 7th percentile, i.e.:
• moderate or greater impairment in estimated general intelligence
• Females who are pregnant or actively attempting pregnancy
• conservative exclusion for magnetic resonance research
• Current use of any medication or substance that is documented to lower seizure threshold or has been identified as a contraindication for rTMS treatment