Evaluating the Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) on Craving Reduction and Relapse Prevention in Alcohol and Opioid Use Disorders: A Randomized Controlled Trial

High relapse rates in alcohol (AUD) and opioid (OUD) use disorders remain a major treatment challenge. This study investigated the efficacy of repetitive transcranial magnetic stimulation (rTMS) for sustained craving reduction and relapse prevention in a Nigerian cohort.

Methods:

In this randomized controlled trial, 300 participants with AUD or OUD were assigned to active or sham rTMS groups. All received standard cognitive-behavioral therapy. The active group underwent 20 sessions of 10 Hz rTMS over the left dorsolateral prefrontal cortex. Primary outcomes were changes in craving (measured by Visual Analog Scale and Obsessive Compulsive Drug Use Scale) and relapse rates at 3, 6, and 12-month follow-ups.

Results:

Active rTMS yielded significantly greater craving reduction versus sham at all assessments (p<0.001). The 12-month cumulative relapse rate was markedly lower in the active group (31.7%, 45/142) compared to sham (72.3%, 102/141; p<0.001). This protective effect was consistent at all time points and across both substance subgroups.

Conclusion:

High-frequency rTMS is an effective adjunct therapy, demonstrating robust and sustained reductions in craving and relapse over 12 months for patients with AUD and OUD. These findings support its integration into standard treatment protocols in Nigeria and similar settings.

Keywords:

Alcohol Use Disorder, Craving, Opioid Use Disorder, Relapse Prevention, Repetitive Transcranial Magnetic Stimulation, rTMS.