A Secondary Analysis Suggests That Repetitive Transcranial Magnetic Stimulation Applied to the Left Dorsolateral Prefrontal Cortex Reduces Cue-Induced-Craving in Treatment Seeking Participants with Cannabis Use Disorder
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Background
Studies across multiple addictions have suggested that repetitive transcranial magnetic stimulation (rTMS) applied to the left dorsolateral prefrontal cortex (L-DLPFC) reduces cue-induced-craving (CIC), however there are no studies in treatment seeking participants with cannabis use disorder (CUD). In this secondary analysis of a previously completed trial, we explore whether a multi-session course of rTMS reduces CIC in CUD.
Methods
Seventy-one participants with ≥moderate CUD (age=30.2±9.9;37.5% female) were randomized to twenty sessions of active or sham rTMS applied to the left DLPFC (20-sessions, Beam-F3; 10Hz) in a two-site, double-blind, sham-controlled, phase-2 trial where they also received motivational enhancement therapy. Participants rated their craving for cannabis via the short-form of the marijuana craving questionnaire (MCQ-SF) before and after a neutral and cannabis-cue presentation. Participants underwent assessment before (immediate-pre), after (immediate-post), and two-, and four-weeks following the course of rTMS.
Results
The MCQ-SF scores increased following the presentation of cannabis cues relative to neutral cues at the immediate-pre timepoint in both treatment groups ( p <0.0001). Following study treatment, the percent increase in MCQ-SF following cues diverged between the active and sham groups with significantly reduced CIC in the active group at the two-week post time-point (5.8±7.1% sham group, 0.91±4.1% active group; p =0.02). Between-group effect sizes (Cohen’s d) were 0.24, 0.89, and 0.67 at the immediate-post, 2-week, and 4-week follow-up periods respectively.
Conclusions
L-DLPFC applied rTMS may reduce CIC in treatment seeking participants with CUD.
Highlights
Craving may be separable into tonic and phasic constructs
DLPFC applied rTMS did not effect tonic craving in a recent treatment trial for CUD
Data from that same trial suggests that DLPFC applied rTMS may have reduced phasic craving
