Evaluating the Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) on Craving Reduction and Relapse Prevention in Alcohol and Opioid Use Disorders: A Randomised Controlled Trial.

Background: High relapse rates in alcohol use disorder (AUD) and opioid use disorder (OUD) remain a significant treatment challenge globally and within Nigeria. This randomised controlled trial evaluated the efficacy of repetitive transcranial magnetic stimulation (rTMS) as an adjunct to cognitive-behavioural therapy (CBT) for sustained craving reduction and relapse prevention in patients with AUD and OUD. Methodology: In this double-blind, sham-controlled trial, 300 participants with AUD or OUD were assigned to active or sham rTMS groups. All received standard cognitive-behavioural therapy. The active group underwent 20 sessions of 10 Hz rTMS over the left dorsolateral prefrontal cortex. Primary outcomes were changes in craving (measured by the Visual Analog Scale and the Obsessive Compulsive Drug Use Scale) and relapse rates at 3, 6, and 12-month follow-ups. Results: Active rTMS yielded significantly greater craving reduction versus sham at all assessment points (p<0.001). The 12-month cumulative relapse rate was markedly lower in the active group (31.7%, 45/142) compared to the sham (72.3%, 102/141; p<0.001). The number needed to treat was 2.5 (95% CI: 2.1-3.1), and the hazard ratio for relapse was 0.34 (95% CI: 0.24-0.48, p<0.001). These therapeutic effects were consistent at all time points and across both AUD and OUD subgroups. Conclusion: Adjunctive high-frequency rTMS is an effective intervention, demonstrating robust and sustained reductions in craving and relapse over 12 months for patients with AUD and OUD. These findings support its integration into standard treatment protocols in Nigeria and similar settings.