Many addiction treatment centers and group practices are adding Transcranial Magnetic Stimulation, or TMS, to their offerings. Independent TMS clinics are popping up across the country as more and more people learn about the benefits of this unique treatment.

But what is TMS? Who benefits from this treatment? What conditions does it treat? How does it work? 

Let’s dive into these questions and learn why so many people in the addiction treatment field are excited about this unusual medical device. 

What is TMS? 

TMS, or Transcranial Magnetic Stimulation, is a type of non-invasive treatment that uses strong magnetic fields to stimulate brain activity in the patient. 

Treatments are done in a chair resembling a dentist’s chair. An articulated arm containing the magnetic coils is placed around the patient’s head. While tapping and clicking may be heard and felt during treatment, TMS sessions are not typically painful. Patients do not require sedation or anesthesia for a TMS treatment session. Patients are usually able to drive themselves home after treatment. 

While protocols vary, a patient usually undergoes a series of treatments spread over the course of several weeks or months. This technology has been extensively studied since the 1980’s but has gained popularity in recent years, as the FDA approved TMS treatment for treatment resistant depression in 2008 and obsessive-compulsive disorder (OCD) in 2017. 

What are the benefits of TMS treatment? What conditions does it treat?

TMS has been FDA approved for treatment resistant depression and obsessive-compulsive disorder. However, it is used “off-label” for many other conditions, including substance use disorders. TMS is also sometimes used to treat anxiety, PTSD, Alzheimers, Parkinson’s schizophrenia, stroke rehabilitation, migraines, chronic pain, multiple sclerosis.

The non-invasive nature of TMS is a huge selling point for patients who don’t wish to undergo treatments that interrupt work or other responsibilities. 

How does TMS work? 

Researchers aren’t completely confident in the mechanism of action that generates the results we see with TMS, however it’s suggested that TMS increases the neuroplasticity of the brain, making it easier for patients to form new “pathways” in the brain and unlearn unhelpful old behaviors and cognition styles. 

Does TMS work for addiction treatment? 

TMS is a popular option for smoking cessation. The FDA has given “marketing clearance” for TMS as a short-term smoking cessation aid. In one study, four weeks of TMS resulted in sustained smoking cessation for over 1 in 4 participants, a much higher success rate than a placebo treatment. Interestingly, younger patients, patients with a higher income, and patients who identify as white had higher rates of smoking cessation success than patients who do not possess these traits. More research needs to be done to explain this phenomenon as the association here is not well understood. 

Emerging research is also beginning to demonstrate that TMS may be helpful for other Substance Use Disorders, like Alcohol Use Disorder and Cocaine Use Disorder. Some researchers believe that behavioral addictions, like those seen with problem gambling, may also ultimately be shown to improve with TMS treatment. 

How exactly does TMS work to improve symptoms of Substance Use Disorder?

As with other conditions, the mechanism of action behind TMS treatments for addiction is not completely clear. There are, however, various theories about why TMS may be helpful for people with SUD that are currently being studied. It’s possible that more than one of these theories may prove to be true. It’s also possible that none of these theories explain the benefits patients might see with TMS treatment for addiction. 

Mechanisms behind positive effects of TMS for addiction treatment may possibly include: 

• Stimulation of the cortico-striatial axons 

• Reduction in GABA signaling that causes GABA inhibition to be reduced in the intra-cortical region

• Influencing connectivity within the ventral tegmental area (VTA)

• Working on various brain regions to actually reduce some forms of neuroplasticity that may result in impulsive behavior

Is TMS covered by insurance? Does Medicare or Medicaid pay for TMS treatments?

Medicare will cover TMS under certain conditions. Patients may only receive Medicare coverage for TMS if they have been diagnosed by a Medicare-approved doctor with MDD (Major Depressive Disorder) and if they have already tried and failed to reduce their symptoms with psychiatric medication. Typically, Medicare patients who are eligible for TMS coverage are still responsible for their portion of the bill (typically 20%) as well as any premiums and deductibles that may apply.

Medicaid requirements for TMS coverage are generally similar to Medicare requirements but because these plans vary from state to state, it’s difficult to generalize about TMS coverage for Medicaid. 

Most major insurance plans also cover TMS therapy. As with other forms of insurance, private insurance companies will typically limit coverage to FDA-approved uses of TMS, particularly for those with treatment-resistant depression. 

At this time, no payer - public or private - is likely to cover TMS treatment for Substance Use Disorder, as this use has not been approved by the FDA and its usefulness in addiction treatment is still being researched. 

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