Transcranial Neurostimulation (TCNS)
Transcranial neurostimulation (TCNS) is a cutting-edge treatment for psychiatric disorders like substance use disorders (SUD).
There are many types of TCNS, some of them invasive and some of them noninvasive. Both types have their merits in treating different disorders.
Deep brain stimulation (DBS) is invasive, but it has clear benefits in treating drug addiction. Transcranial magnetic stimulation (TMS) is more common and less invasive. And transcranial current stimulation is mildly invasive, but very effective.
All types of TCNS have one factor in common: TCNS always targets specific regions of the brain, which makes it ideal for treating neurological disorders like addiction.
There’s evidence that targeting specific parts of the cerebral cortex can decrease addiction-related behavior. A transcranial-focused ultrasound can help target the right brain regions in invasive procedures like DBS.
If you’re a candidate for TCNS, your care team will help you choose the procedure that’s best for you. Like any medical procedure, there are risks and benefits involved in any form of TMS, whether it’s invasive or not.
Let’s take a closer look at transcranial stimulation and a deeper dive into the most common type of TCNS:
What are Types of Transcranial Neurostimulation?
There are several types of TCNS, each of which uses different techniques to stimulate regions of the brain related to psychiatric disorders. Some of them include:
- ECT: Electroconvulsive therapy is the use of electrical current to induce seizures, which stimulate the brain. The storm of brain activity that’s caused by a seizure stimulates the frontal and temporal lobes, which are involved in behavioral disorders like addiction.
- DBS: Deep brain stimulation is the use of surgically implanted probes to stimulate deep parts of the brain, like the subthalamic nucleus. This is the most invasive type of TCNS, but it’s considered safe and well-tolerated. During the implant procedure, your care team will use transcranial ultrasound imaging to place the probe.
- tDCS: Transcranial direct current stimulation is also known as transcranial electrical stimulation (tSC) or transcranial electrostimulation. Both terms refer to a type of invasive brain stimulation that involves direct current at a constant low frequency. tDCS brain stimulation is the second-most common type of TCNS.
ECT and DBS aren’t widely used for addiction treatment as of 2020. Instead, the most common type of addiction treatment is transcranial magnetic stimulation, or TMS.
What Is Transcranial Magnetic Stimulation (TMS)?
The most common type of TCNS is transcranial magnetic stimulation (TMS), which is a noninvasive type of brain stimulation. In fact, TMS is so common that the rest of this article will focus on it.
It uses magnetic fields to stimulate parts of the brain that are involved in addiction, depression, and other mental health disorders. Up to 60% of people who undergo TMS experience a meaningful improvement in their symptoms.
TMS is the most common type of brain stimulation treatment for a reason. Those reasons include:
- TMS is noninvasive
- TMS uses magnetic fields instead of electrodes
- TMS treats co-occurring disorders including anxiety disorders, post-traumatic stress disorder, and depression
How Transcranial Magnetic Stimulation (TMS) Works
TMS uses a wire coil to produce an electromagnetic field across the top of the skull, which causes electrical stimulation to take place. As current moves through the coil and generates a magnetic field, the nerve cells in your brain become excitable and fire more impulses.
This is helpful in treating addiction for two reasons:
- It can allow your neurology team to diagnose co-occurring psychiatric disorders based on what’s happening in your brain
- It can provide direct stimulation and treatment for psychiatric disorders including your substance use disorder
You may know this procedure as repetitive transcranial magnetic stimulation (rTMS). It gets its name from the repetitive magnetic impulses that it delivers. The term TMS by itself usually means the diagnostic version of the procedure, which delivers pulses constantly rather than repetitively.
Using Transcranial Magnetic Stimulation (TMS) to Treat Addiction
You may undergo TMS as an outpatient procedure or as part of your inpatient stay. If you receive TMS while you’re in treatment for addiction, you may receive one or 2 treatments for diagnostic purposes, or you may receive a series of therapeutic treatments.
At each treatment, your care provider will apply a transcranial stimulator to your head, which looks like a plastic coil that contains concealed metal wires.
The first rTMS treatment is the longest. In fact, your first treatment may last 2 hours or longer. That’s because at your first visit, your doctor will check your anatomy and response to make sure that the coil placement and dose is correct.
This check is called a motor threshold test. During this test, your doctor will administer a magnetic pulse to your motor cortex until it reaches the right level of stimulation. You’ll know that you’ve reached the right signal strength if your fingers start to move. Then, your doctor will move the coil forward to the frontal lobe.
After the first treatment, subsequent treatments take 30 to 40 minutes. The coil will deliver rapid magnetic pulses to your brain, and you’ll hear a loud clicking sound that may come with tapping sensations. The sound will happen in 4-second sequences up to 3 times per minute.
If you’ve ever had an MRI, getting a TMS or rTMS treatment sounds and feels similar. You’ll wear earplugs to help protect your hearing. As part of your addiction treatment, you may receive an rTMS treatment up to 5 times weekly for up to 6 weeks. The length and frequency will be adjusted based on what you need.
Side Effects of Transcranial Magnetic Stimulation (TMS)
Most people who get this treatment find that the TMS side effects are mild and easy to tolerate. If you received an outpatient treatment, you can drive home after treatment unless you received any sedation (which is not typically needed.)
The most common side effects of TMS include:
- Mild irritation or pain at the coil site
- Tingling facial muscles
Rarely, TMS can cause seizures. You should avoid getting TMS if you have a history of epilepsy or seizures. If you have bipolar disorder or another mood disorder with mania, you might experience mania after a session.
There’s no evidence that TMS affects your memory like other forms of brain stimulation sometimes do.
Is TMS Treatment for Alcoholism Effective?
Research suggests that rTMS can be an effective treatment for alcohol addiction. One case report reported that rTMS treatment for alcohol resulted in a lack of cravings and lack of withdrawal symptoms that lasted 3 months.
Another study showed that 10 sessions of rTMS resulted in reduced cravings that lasted 30 days after treatment.
It’s clear that there needs to be more research to show how and why rTMS works to treat alcohol addiction. It’s possible that rTMS could treat other forms of addiction as well, but the research doesn’t exist yet to support its use.
Can You Drink Alcohol During TMS Therapy?
TMS therapy and alcohol do not mix! You should not drink alcohol during rTMS therapy. In fact, you should avoid addictive substances of any kind while undergoing treatment.
There’s a 50% to 60% chance of eventual relapse on TCNS therapy. Without treatment, that becomes a 90% chance.
These types of therapy are not a cure-all for your addiction. If you drink alcohol (or use another substance of choice) while undergoing rTMS therapy, you could be increasing the odds that it won’t work.
rTMS works best when it’s part of a complete care plan that addresses your health and well-being. Drinking alcohol doesn’t fit in with that recovery plan.
If you’re worried that you might relapse on alcohol during your rTMS course, talk to your doctor. You may benefit from undergoing treatment in an rTMS treatment center setting, where the temptation of relapse is removed.
Who is a Candidate for Transcranial Magnetic Stimulation?
Transcranial magnetic stimulation isn’t a first-line treatment for addiction as of 2020. Instead, it’s reserved for people who have treatment-resistant psychiatric disorders, like addiction with a history of relapse.
You might be a candidate for rTMS if you have:
- Relapsed on substances many times
- Attended treatment many times
- A history of relapsing mental illness
For most people who meet those criteria, rTMS is safe and effective. Your doctor will talk to you about whether you’re a candidate for rTMS treatment. There are a few people who shouldn’t use TMS treatment, including people with epilepsy or people with a history of brain injuries.
Even though it’s the most common TCNS treatment for addiction, rTMS isn’t the perfect choice for every patient. Your care team will help you find the best fit, whether it’s tDCS therapy, deep brain stimulation with ultrasound, or another treatment entirely.
Start TMS Treatment for Alcohol
Bedrock Recovery Center can help you start your journey toward recovery from alcohol. If TMS treatment is part of your path, we’ll talk to you about the best way to benefit from it as part of an integrated care plan. Call us today to learn how our Massachusetts treatment center can be the place where it all starts for you.