Leveraging the neurocircuitry of addiction to test novel brain stimulation paradigms and rationally combine them with other existent treatments

      Introduction: Repetitive Transcranial Magnetic Stimulation (rTMS) has recently transcended the gap between the bench and bedside with its clearance by the Food and Drug Administration (FDA) for smoking cessation. Despite the successful translation of this technology, there remains room for optimization as quit rates currently fall short of the goal of 100%. In addition to the FDA-cleared paradigm for smoking cessation, there are encouraging trials using other rTMS treatment paradigms focused on other distinct circuitry, with still other targets currently unexplored. Beyond the promise of further optimized rTMS paradigms, there are established behavioral and pharmacotherapeutic interventions with proven efficacy in smoking cessation. To date, however, there are no published trials combining rTMS and any of these approaches in smoking cessation, and few combining rTMS with other interventions in other substance use disordered populations.
      Proposal: In this portion of the symposium, the presenter will review the neurocircuitry of addiction in the context of both the stages of addiction model and the likely circuit dysfunction underpinning the common symptoms of substance use disorders. Within this circuit framework a theoretical treatment target heuristic will be described with pertinent published literature in rTMS and pharmacotherapy presented to provide a series of proof of concepts. The presenter will emphasize smoking cessation; however, given the shared neurocircuitry across substance use disorders, data across addictions will be discussed. Finally, a rational approach to combining rTMS with other treatments will be explored.
      Keywords: addiction, substance use disorder, TMS, tobacco