Image-guided, Robot Navigated Transcranial Magnetic Stimulation (IR-TMS) for Alcohol Use Disorder (AUD)

Participants with AUD will undergo accelerated IR-TMS treatments and longitudinal fMRI scanning to determine treatment effects and durability. Participants will be recruited and randomized to 1 of 3 treatment target site regions: 1) Left dorsolateral prefrontal cortex; 2) Dorsomedial prefrontal cortex; or 3) Orbitofrontal Cortex. Each participant's target site region will be determined by personalized fMRI connectivity maps. Participants will receive up to 4 IR-TMS treatments per day for up to 10 days (total = 40 accelerated IR-TMS treatments) in an open-label clinical trial with an adaptive treatment design-if one target site region demonstrates superior treatment responses, the remaining participant sample will undergo IR-TMS treatments on that target site.

Inclusion criteria

• Two self-reported heavy drinking episodes (>4 drinks for men, >3 for women) or >13 drinks in the last 14 days (at screening)
• PEth >20 ng/mL (at baseline)
• Diagnosis of a current, moderate to severe AUD assessed by the The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use checklist
• Able to attend all study appointments
• Fluent in English

Exclusion criteria

• Current diagnosis of a moderate or severe substance use disorder (SUD; other than AUD, cannabis, or nicotine)
• Inability to provide informed consent
• Alcohol withdrawal-related seizure or hospitalization in the prior 12 months
• Currently enrolled in AUD treatment
• Psychiatrically or medically unsafe to participate due to a documented diagnostic history of bipolar disorder, schizophrenia or schizoaffective disorder
• Any history or signs of serious medical or neurological illness including seizure disorders
• History of traumatic brain injury (TBI) with loss of consciousness for 20 minutes or more
• Liver enzymes that are more than 5x the normal range
• Females will be excluded if they are pregnant
• Any history or signs of metal objects in the body deemed unsafe for Magnetic Resonance Imaging (MRI) or that may adversely affect image quality of the brain region (e.g. surgical clips, cardiac pacemakers, metal implants, etc.)