Tobacco use is the leading cause of preventable illness and death in the United States. While many people express their desire to quit smoking, long-term cessation remains a significant challenge, especially for those with underlying behavioral or mental health conditions. Emerging research suggests that transcranial magnetic stimulation, or TMS, may offer new hope in supporting individuals through the difficult process of nicotine addiction recovery.  Here’s everything you need to know about TMS for smoking cessation. 

What is Smoking Addiction? 

Nicotine is a highly addictive substance found in tobacco products, including cigarettes, cigars, chewing tobacco, and many e-cigarettes. When you first start using tobacco, your body gradually builds tolerance to nicotine. This means you need more and more of it to feel the same effects. As nicotine levels rise in your blood, your body becomes dependent on maintaining these levels to function normally.  As a result, stopping or reducing use causes withdrawal symptoms (e.g., irritability, restlessness, anxiety, and cravings). To avoid these uncomfortable symptoms, users continue smoking, thus reinforcing the addiction loop.  Around two-thirds of people who smoke say they want to quit, and half of all smokers attempt to quit each year. However, because nicotine affects mood, emotions, and behavior, success without support is rare. Many people use tobacco to self-medicate or mask heavy emotions. In addition, smoking is often associated with daily routines and social activities, which makes breaking the habit even more difficult. 

Prevalence of Smoking in the U.S.

Despite numerous public health campaigns, smoking is still a serious issue today. In 2022, an estimated 11.6% of American adults reported current cigarette use. To put this into perspective, that’s 28.8 million people. The rate was higher among men (13.1%) than women (10.1%), and most smokers fell within the 45-64 age group.  

Smoking and Brain Activity

Nicotine has a powerful effect on the brain, helping explain why quitting is so difficult. Within 10 seconds of inhaling smoke, nicotine reaches the brain and binds to special proteins on nerve cells called nicotinic acetylcholine receptors. This attachment triggers an onslaught of neurochemical changes.  For example, your brain releases multiple neurotransmitters, including dopamine, which is the “feel good” chemical tied to pleasure and reward. Outside of the brain, nicotine also stimulates adrenaline release, which raises blood pressure and heart rate.  The result? An initial buzz of pleasure and energy, followed by a calming effect and temporary improvements in attention and memory. Over time, your brain quickly learns to associate smoking with these positive feelings and becomes less responsive to natural rewards. This further deepens dependence and makes withdrawal more emotionally disruptive.    

Standard Smoking Cessation Options

Due to the complexity of addiction, quitting smoking may require some trial and error to find a treatment or combination of treatments that will be the most successful. Current standard treatments include counseling, nicotine replacement therapy, and/or prescription medications. 

Counseling

Behavioral health support is a foundational piece of smoking cessation treatment. Many individuals use tobacco as a way to manage symptoms of depression, anxiety, boredom, or loneliness. Types of therapies that have proven to be effective include: 

• Cognitive Behavioral Therapy (CBT)
• Motivational Interviewing (MI)
• Acceptance and Commitment Therapy (ACT)
• Contingency Management (CM)

In fact, cognitive therapies have been found to produce higher abstinence rates up to 12 months post-treatment than many other standalone interventions. However, therapeutic approaches require a significant time commitment and don’t address the neurochemical aspects of addiction. 

Nicotine Replacement Therapy (NRT)

Nicotine replacement therapy (NRT) helps reduce withdrawal symptoms by providing controlled doses of nicotine without the harmful chemicals found in tobacco smoke. Common NRT products include: 

• Nicotine gum is available in 2 mg and 4 mg dosages. Studies suggest the 4 mg option is more effective, especially in early withdrawal. Treatment typically lasts 6-12 weeks, with tapering afterward. 
• Nicotine lozenges are for those who need flexible dosing but can’t tolerate gum. 
• Nicotine patches steadily deliver nicotine over 16 or 24 hours and come in 5-21 mg doses. 
• Nicotine oral inhalers and nasal sprays are other options that may be used for quicker nicotine delivery. 

While NRT helps to manage withdrawal symptoms, it lacks the ability to treat the psychological and behavioral patterns that are tied to cravings. 

Prescription Medications

When NRT and counseling are unsuccessful or not enough, healthcare providers may recommend trying prescription medications. These include: 

• Varenicline (Chantix) reduces withdrawal symptoms and blocks nicotine’s rewarding effects. 
• Bupropion (Zyban) is an extended-release antidepressant that reduces cravings by modulating dopamine and norepinephrine. 
• Nortriptyline and clonidine are less commonly used but have shown effectiveness in some individuals, including those who can’t tolerate first-line options.  

Medications can be effective in smoking cessation, but they may also cause intolerable side effects and don’t work for everyone.

Can TMS Help You Quit Smoking? 

Due to the gaps left by the above treatments, researchers are exploring other methods for smoking cessation, one of which is transcranial magnetic stimulation. TMS is a non-invasive brain stimulation treatment that uses targeted magnetic pulses to stimulate specific regions of the brain. While originally FDA-approved for treatment-resistant depression, it has shown potential for other conditions, including nicotine addiction. 

How TMS Works for Nicotine Addiction

In smoking cessation treatment, TMS targets the prefrontal cortex and insula as these areas of the brain are specifically involved in cravings, impulse control, and decision-making.  Specifically, the prefrontal cortex plays a role in executive function and self-control. In people with addiction, this area often shows decreased activity, making it harder to resist urges and make healthy decisions. The insula, on the other hand, processes internal bodily sensations and emotional awareness, including the physical sensations associated with cravings.  By directly targeting these areas, repetitive TMS (rTMS) is thought to help reset abnormal brain activity patterns. This may reduce the intense urges that keep people trapped in the addiction cycle and make it easier to resist cigarettes and stay abstinent.   

TMS Success Rates for Smoking Cessation

Recent studies on TMS have shown promising results for smokers: 

• A study published in Frontiers in Human Neuroscience found that longer and more frequent rTMS sessions resulted in higher quit rates, fewer relapses, and improved impulse control. 
• Another clinic trial using 15 rTMS sessions over three weeks (targeting the left dorsolateral prefrontal cortex) led to significant reductions in cigarettes smoked, cravings, withdrawal symptoms, and nicotine dependence. Urinary cotinine levels were also lower, confirming reduced nicotine intake. 
• A 6-week rTMS protocol was associated with a doubling of quit rates among individuals with tobacco-use disorder. 

Not only do these studies prove the efficacy of TMS for smoking cessation, but they also suggest that TMS may be helpful for individuals with treatment-resistant smoking behaviors or co-occurring mental health conditions. 

Quit Smoking with TMS Therapy Today

At Cura Behavioral Health, we understand how challenging nicotine addiction can be, even without emotional or behavioral conditions. If you’ve struggled to quit smoking despite trying traditional methods, TMS may offer an evidence-based, non-medication alternative that supports your physical well-being and mental well-being. To learn more about how TMS therapy can support your journey toward a tobacco-free life, contact us today. 

Sources: 

Why Are Tobacco Products So Hard To Quit? - FDA  Why People Start Smoking and Why It’s Hard to Stop - American Cancer Society  Burden of Cigarette Use in the U.S. - CDC  The Brain and Nicotine - BrainFacts  Behavioral Health and Tobacco Cessation - American Family Physician  Interventions for Smoking Cessation and Treatments for Nicotine Dependence - Smoking Cessation: A Report of the Surgeon General  Nicotine replacement therapy - Journal of Family Medicine and Primary Care  Prescription Medicines to Help You Quit Tobacco - American Cancer Society  Repetitive transcranial magnetic stimulation for smoking cessation: Next steps for translation and implementation into clinical practice - Psychiatry Research  Transcranial Magnetic Stimulation for Long-Term Smoking Cessation: Preliminary Examination of Delay Discounting as a Therapeutic Target and the Effects of Intensity and Duration - Frontiers in Human Neuroscience  Efficacy and safety of repetitive transcranial magnetic stimulation in the treatment of male smokers with tobacco use disorder: a randomized controlled trial - Middle East Current Psychiatry  Efficacy of Repetitive Transcranial Magnetic Stimulation on Smoking Cessation - Psychiatry Advisor