Award Date


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Committee Member

Hyunhwa Lee

Second Committee Member

Rebecca Benfield

Third Committee Member

Jennifer Kawi

Fourth Committee Member

Brach Poston

Number of Pages



Opioid Use Disorder (OUD) is a multi-faceted, complex ailment affecting many individuals and their families across the globe. Currently, there are multiple interventions used in the treatment of OUD, many of which are designed to reduce cravings for opioids. Cravings for opioids are a strong predictor of relapse in the disorder. However, many of the interventions used in clinical practice have inherent risks including a potential for abuse and diversion. Repetitive Transcranial Magnetic Stimulation (rTMS) is an outpatient procedure that may be effective in reducing cravings for opioids, thereby reducing relapse. Methods: This study employed a randomized, single-blind, experimental design with a control group. Ten rTMS or sham treatments were delivered. The intervention group received active rTMS treatment delivered at 10 Hz, 100% resting motor threshold, 2000 pulses delivered in five seconds per train with a 10-second intra-train pause, delivered once daily, five days per week, Monday through Friday for 10 days (10 total treatments). The control group received a sham treatment where the coil was turned 90 degrees counter-clockwise, and the side of the coil rested on the scalp over the area of the skull corresponding to the motor cortex, so the participant felt the coil making contact. Cravings for opioids were measured at various time points throughout the study, including at baseline, after a single treatment, at various increments throughout the delivery of 10 rTMS treatments, and again 30 days after the final treatment. The Desires for Drug Questionnaire (DDQ) was used to measure cravings for opioids. The DDQ contains 13 items to evaluate cravings in three domains: desire and intention, negative reinforcement, and control. Results: Each of the intervention and control groups had 12 participants who were randomly assigned (n = 24). After a single rTMS treatment, the intervention group showed a significant decrease in the desire domain score (p < .001) and negative reinforcement domain score (p = .01), and a significant increase in the control domain score (p = .01). 30 days after the last rTMS treatment, the intervention group had significant reductions in the desire domain score (p = .042) and negative reinforcement domain score (p = .015), compared to immediately after 10 rTMS treatments. Mixed effect regression revealed reduced cravings for opioids for the intervention group evidenced by a decreased desire domain score (p < .001) and negative reinforcement domain score (p < .001), and increased control domain scores (p = 0.17) over time. However, only the desire domain score revealed a statistically significant reduction in opioid cravings compared to the control group (p < 0.001). Discussion: rTMS may be a useful intervention for clinicians to consider in the treatment of adults with OUD. These findings also contribute to the body of knowledge to help identify the most effective rTMS protocol to be used to reduce opioid cravings. There was a significant reduction in the desire domain of opioid cravings over time with rTMS treatment compared to the control group, but this reduction was not as prominent in the negative reinforcement and control domains of opioid cravings. This suggests that rTMS should be used with other treatment options to address the negative reinforcement and control domains of opioid cravings. This study also included female participants in the study design suggesting the effect of rTMS on opioid cravings in females may be similar to that demonstrated in males.


addiction; heroin; opioid use disorder; transcranial magnetic stimulation



File Format


File Size

1393 KB

Degree Grantor

University of Nevada, Las Vegas




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