Accelerated Intermittent Theta-Burst Stimulation for the Treatment of Alcohol Use Disorder: A Randomized Sham-Controlled Study With Six-Month Follow-Up.

BACKGROUND: Accelerated intermittent theta-burst stimulation (a-iTBS) is a novel rTMS protocol increasingly used for mental disorders, but its application in alcohol use disorder (AUD) remains early. This exploratory sham-controlled study evaluated a 50-session a-iTBS protocol for AUD. METHODS: Sixty-one male AUD inpatients were randomized to receive traditional iTBS (once daily, 600 pulse/session), a-iTBS (5 sessions/day, 3000 pulses/day), or sham iTBS. Treatments were administered on 10 weekdays (Monday to Friday over 2 weeks) and targeted the dorsolateral prefrontal cortex. The primary outcome was the change in craving. The alcohol relapse behavior, emotional symptoms, and sleep quality were evaluated pre-/post-intervention. RESULTS: Group showed no significant main effect on craving percentage change. The a-iTBS group showed a higher response rate and earlier response onset than the s-iTBS group, whereas no significant differences existed between a-iTBS and iTBS, or iTBS and s-iTBS. No intergroup differences were detected for mood and sleep indicators. At the 6-month follow-up, participants receiving a-iTBS achieved longer abstinence duration than those given s-iTBS. Exploratory logistic regression indicated that baseline GAD-7 scores and treatment group were associated with treatment response. CONCLUSIONS: Although the primary craving outcome did not differ significantly among groups, a-iTBS showed preliminary signals of earlier response and longer time to first relapse than sham stimulation. These exploratory findings require confirmation in larger trials.