Transcranial Magnetic Stimulation for the Treatment of Veterans With Alcohol Use Disorders

Inclusion Criteria:

* The study will be open to male and females, regardless of race and ethnic origin, who are in active treatment for an alcohol use disorder (AUD).
* Meet Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for AUD, and alcohol is self-identified as primary substance of misuse.
* Actively in treatment at VA Palo Alto HCS Addiction Treatment Service, and able to read, verbalize understanding, and voluntarily sign the Informed Consent Form prior to participation in study procedures.
* Participants will be accepted if taking medications specifically for the treatment of MDD, cigarette smoking, or for other psychiatric conditions.

* as long as the medications are not documented to lower seizure threshold
* must be stable on any psychotropic medication for at least 1 month prior to enrollment
* it would be clinically contraindicated to require participants to discontinue such medications for research.
* Participants will be abstinent from alcohol and non-prescribed substances for at least 7 consecutive days prior to active or sham rTMS and no participant demonstrates active acute withdrawal symptoms.

Exclusion Criteria:

Psychiatric:

* History of Schizophrenia Spectrum Disorders
* Bipolar Disorders
* A current substance use disorder that exceeds the severity of the AUD

* based on DSM-5 diagnostic criteria
* Current use of an FDA approved medication for treatment of AUD, i.e.:

* disulfiram
* acamprosate
* naltrexone
* Active current suicidal intent or plan

* patients with a previous clinical flag for risk for suicide will be required to have an established safety plan involving their primary psychiatrist and the treatment team before entering the clinical trial
* Any form of previous rTMS or electroconvulsive treatment

Biomedical:

* Including but not limited to uncontrolled thyroid disease
* Unstable congestive heart failure
* Angina
* Other severe cardiac illness as defined by treatment regimen changes in the prior 3 months
* Cerebrovascular accident
* Cancer if \< 1 year since end of treatment
* Unstable diabetes
* COPD requiring oxygen supplementation
* Alzheimer's disease
* Parkinson's disease
* Any biomedical implants with ferromagnetic content
* Neurostimulation devices
* Cardiac pacemakers or any magnetic resonance contraindications
* Traumatic brain injury with self-reported or observed loss of consciousness \> 30 minutes
* Any primary or traumatically induced seizure disorder

General:

* Lack of fluency in English
* Wechsler Adult Reading Test below the 7th percentile, i.e.:

* moderate or greater impairment in estimated general intelligence
* Females who are pregnant or actively attempting pregnancy

* conservative exclusion for magnetic resonance research
* Current use of any medication or substance that is documented to lower seizure threshold or has been identified as a contraindication for rTMS treatment