Substance use disorder is a serious condition in which repeated use of psychoactive substances leads to lasting changes in the brain’s reward and control systems. This may involve the misuse of, for example, opioids, stimulants, cannabis, or other intoxicating substances. Over time, use can develop into compulsive behaviour, where craving for the substance dominates thoughts and actions—even when the consequences are severe.

From a neurobiological perspective, substance use disorder is associated with changes in the brain’s dopaminergic reward systems as well as in the prefrontal regions that are normally responsible for impulse control, decision-making, and behavioural regulation. Repeated substance use weakens the brain’s ability to inhibit craving and increases sensitivity to substance-related cues, which contributes to relapse.

In practice, this dysregulation means that many individuals experience intense cravings, reduced control, and repeated unsuccessful attempts to stop—also after detoxification or longer periods of abstinence. Substance use disorder is therefore not solely a matter of willpower, but of altered brain function.

rTMS has been studied as a treatment for substance use disorder with the aim of reducing craving and strengthening the brain’s regulatory control mechanisms. The treatment typically targets prefrontal brain regions, which play a central role in impulse control, decision-making, and inhibition of substance-related behaviour.

Repeated stimulation over several weeks can increase activity in these areas and thereby contribute to improved regulation of craving and impulsive actions. rTMS is used as a supplement to existing treatment and does not replace detoxification, medication, or psychosocial interventions where these are relevant.

Treatment takes place at the clinic. You remain awake throughout the session and can go home afterwards. A session typically lasts between 20 and 40 minutes depending on the protocol, and a course of treatment often extends over several weeks.

Studies show that rTMS can, for some patients with substance use disorder, reduce craving and lower the risk of relapse during the treatment period. The effect varies between individuals and substance types, and rTMS does not work for everyone. When an effect is achieved, it typically develops gradually over time.

For many, the benefit is not the complete elimination of craving, but increased control and a better ability to maintain abstinence in combination with other treatments. rTMS can therefore function as a supportive tool within a broader treatment approach.

For the vast majority, side effects are mild and short-lived. The most common are mild headache or slight discomfort during stimulation, especially at the beginning of the treatment course.

Treatment of substance use disorder typically consists of:

• Detoxification and medical support

• Psychosocial treatment and therapy

• Structured rehabilitation and support programmes

Although many benefit from these interventions, a significant number still experience relapse. rTMS differs in that it directly targets the brain regions involved in craving and impulse control, and for selected patients it may be a relevant supplement to the overall treatment.