Modulation of automatic alcohol approach tendencies using single-session 10Hz rTMS over the right dLPFC in males

Automatic alcohol approach tendencies are characterized by behavioral automaticity to move toward alcohol cues, which often override conscious self-control. Cognitive and behavioral modification techniques have shown limited efficacy in reducing these tendencies. The current study examined the feasibility of a single session of 10Hz repetitive transcranial magnetic stimulation (rTMS) to the right dorsolateral prefrontal cortex (dLPFC) for modulating automatic alcohol approach tendencies.

Forty-five healthy alcohol-using male participants completed an alcohol approach-avoidance task (A-AAT) with concurrent electroencephalographic recording before and after active (10Hz rTMS; 3.9s trains, 26.1s inter-train intervals, 1560 pulses, 110% resting motor threshold) or sham (coil tilted at 90°) stimulation of the right dLPFC. Primary analyses focused on participants with baseline alcohol approach tendencies (n = 35).

At baseline, individuals with approach tendencies exhibited attenuated N2 (r = 0.745) and P3b (r = 0.642) amplitudes to alcohol relative to non-alcohol cues, consistent with reduced regulatory engagement during alcohol cue processing, irrespective of group. Following stimulation, active rTMS selectively facilitated alcohol avoidance responses (r = 0.545) and enhanced prefrontal N2 amplitudes (r = 0.522), consistent with greater prefrontal engagement supporting avoidance execution. In contrast, the sham group showed progressive strengthening of approach responses (r = 0.832).

These findings suggest that high-frequency rTMS over the right dLPFC can modulate alcohol approach tendencies by strengthening neural control mechanisms, supporting its further evaluation as a neuromodulatory adjunct for individuals with or at risk of problematic alcohol use. Baseline motivational profiles may additionally influence rTMS response and warrant consideration when tailoring such approaches.