Transcranial Magnetic Stimulation as an Adjunctive Intervention in an Adolescent with Substance Use Disorder and Co-occurring Behavioral Disorders: A Case Report
Background:
Substance use disorder (SUD) remains a major challenge in the healthcare field, as it is associated with structural and functional alterations in the brain. Adolescents are particularly susceptible to substance use due to the ongoing maturation of neural systems, especially the prefrontal cortex, which governs decision-making and emotional regulation. This developmental vulnerability is often compounded by the co-occurrence of behavioral disturbances. Transcranial Magnetic Stimulation (TMS) has been widely utilized in the treatment of various psychiatric conditions in adolescents, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and depression. However, there is a paucity of case reports and empirical studies specifically addressing its application in the context of SUD accompanied with behavioral disorder.
Case Presentation:
A 15-year-old male was admitted to a BNN rehabilitation facility following a diagnosis of moderate methamphetamine use disorder that had persisted for two years. His clinical history was notable for several co-occurring issues, including online gambling, hiring prostitution services, theft, and dropping out of school. Findings from a quantitative electroencephalogram (qEEG) indicated impaired inter-regional brain communication, which correlated with observed impairments in concentration, decision-making, problem-solving, impulsive or compulsive behaviors, and emotional dysregulation.
Intervention/Management:
The initial treatment plan for the patient was a four-month rehabilitation program, including individual and group counseling, family sessions, motivational interviewing, psychoeducation, and Cognitive Behavioral Therapy. Psychopharmacological medications, such as Olanzapine, Depakote, and Escitalopram, were also prescribed to control his psychological problems. After 3-months observation, there were no significant improvements seen in his behavioral issues, particularly in desire of online gambling and prostitution. TMS was recommended as an adjunctive therapy to address these persistent issues. One therapy session daily was administered for a total of 10 days with the protocol consisting of Continuous Theta Burst Stimulation (cTBS) applied to the F4 area and Intermittent Theta Burst Stimulation (iTBS) to the F3 area.
Results:
After 10 days, the post-treatment qEEG showed significant improvements compared to the pre-treatment baseline, including enhanced cognitive function, better emotional regulation, and reduced impulsive and compulsive behaviors. Clinically, the patient reported improvement in sleep quality, experienced fewer racing thoughts, and enhanced in processing information.
Conclusion:
TMS can be a promising adjunctive intervention for managing both substance use and behavioral disorders.
