Transcranial Magnetic Stimulation for Tobacco Use Disorder (TUD) is showing promise as a noninvasive treatment to help people quit smoking. This brain-based therapy uses magnetic pulses to target specific regions involved in craving, self-control, and reward processing. Unlike medications or nicotine replacement therapies, TMS works directly on the brain’s neural circuits, aiming to reduce the power of cravings and support long-term abstinence.
A new multisite study led by Dhvani Mehta and colleagues, published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging in 2025, examined whether inducing cravings before TMS could enhance treatment outcomes. This approach, called craving induction, involves showing cues such as images or reminders of smoking to activate addiction-related brain networks before stimulation begins. The idea is that by targeting the brain while it is in an “active craving state,” TMS might better disrupt the pathways that maintain addiction.
Craving Induction and Brain Response
In the trial, 262 participants with tobacco use disorder received either active or sham deep TMS (dTMS) over six weeks, with each participant setting a quit date early in the process. Before each session, researchers assessed craving levels using a visual analog scale, both before and after the craving induction task.
The results were interesting: craving induction consistently increased craving levels slightly across sessions, showing that participants did experience emotional and cognitive activation. However, the strength of these induced cravings did not predict who would successfully quit smoking by the end of the study. This finding challenges the assumption that stronger craving responses might lead to stronger treatment effects.
What These Results Mean for Addiction Treatment
While craving induction did activate brain networks related to addiction, it did not appear to make TMS more effective in helping participants quit. The study suggests that the relationship between brain-state activation and treatment outcomes may be more complex than previously thought.
One possibility is that TMS influences multiple systems involved in addiction—such as inhibitory control, decision-making, and motivation—rather than simply reducing cravings. Understanding how these systems interact could help tailor TMS protocols more precisely for individuals struggling with addiction.
This study also highlights the need for ongoing exploration into how neuromodulation therapies can be optimized for substance use disorders. Future research might focus on combining TMS with behavioral therapies or targeting different brain regions that regulate self-control and impulse suppression.
The Future of TMS in Addiction Medicine
Deep TMS and other forms of brain stimulation are emerging as valuable tools in the broader field of addiction neuroscience. The technology has already been FDA-cleared for smoking cessation, depression, and obsessive-compulsive disorder, and new studies continue to refine its use for other conditions like alcohol and opioid use disorders.
While craving induction may not directly enhance treatment success, it remains an important experimental tool for understanding how the brain responds during therapy. The ultimate goal is to personalize TMS based on each patient’s neural profile—aligning brain stimulation with the moments and mechanisms that most influence relapse and recovery.
References
- Mehta, D. D., Sloan, M. E., Sas, A., et al. (2025). Craving Induction and Treatment Response in Transcranial Magnetic Stimulation for Tobacco Use Disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. https://doi.org/10.1016/j.bpsc.2025.10.004
- Zangen, A., Roth, Y., et al. (2021). Deep Transcranial Magnetic Stimulation for Smoking Cessation: A Multicenter Randomized Controlled Trial. World Psychiatry, 20(2), 254–261. https://doi.org/10.1002/wps.20852