A Pilot Study of Transcranial Magnetic Stimulation Plus Episodic Future Thinking for Methamphetamine Use Disorder

Inclusion Criteria:

• Meet Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)criteria for primary methamphetamine use disorder

• Be fluent in English and able to understand the consent form

Exclusion Criteria:

• Current DSM-5 diagnosis for any illicit substance use disorder other thanmethamphetamine and marijuana

• Current DSM-5 diagnosis of moderate or greater severity for alcohol and marijuanause disorder

• In the opinion of the PI, the presence of any medical, neurological, psychiatric (e.g., psychotic or bipolar disorder), or physical condition, disease, or illnessthat, may: (a) compromise, interfere, limit, effect or reduce the subject's abilityto complete the study; or (b) adversely impact the safety of the subject or theintegrity of the data

• Has current or recent (within 3 months of potential enrollment) suicidal ideation,suicidal behavior, homicidal ideation or a homicidal plan sufficient to raisesubject safety concerns based on the following assessments according to the PI:

1. Structured Clinical Interview for DSM-5 (SCID-5)

2. Columbia-Suicide Severity Rating Scale (C-SSRS) Screening - Answers YES toQuestions 3, 4, 5, or 6

3. Assault & homicidal danger assessment tool - Key to danger >1

• Medical implants contraindicating TMS (i.e., aneurysm clips or coils, stents,implanted stimulators, implanted vagus nerve or deep brain stimulators, implantedelectrical devices such as pacemakers or medication pumps, electrodes for monitoringbrain activity, cochlear implants for hearing, any magnetic implants, bulletfragments, any other metal device or object implanted in your body closer than 30 cmfrom the coil)

• History of brain surgery

• History of an intracranial lesion or any medical or neurological diagnosis/conditionassociated with increased intracranial pressure (i.e., Idiopathic IntracranialHypertension/Pseudotumor Cerebri) OR any of the following symptoms within 30 days ofenrollment: headaches > 15 days/month, loss of vision or decreased vision

• Moderate-to-severe heart disease

• History of stroke

• Is taking any antidepressant or antipsychotic medication at a dose above the maximumrecommended dose or at a dose deemed to be potentially unsafe according to the PI;has taken any of the following medications, which are known to increase the risk ofseizures, within 1 week of study enrollment; or does not agree to abstain fromtaking the following medications during study participation:

1. clozapine

2. chlorpromazine

3. bupropion

4. clomipramine hydrochloride

5. amoxapine

6. maprotiline hydrochloride

7. diphenhydramine

8. stimulants other than methamphetamine including the following:Dextroamphetamine and amphetamine, Dextroamphetamine, Lisdexamfetaminedimesylate, Cocaine, Methylphenidate,

9. tramadol

10. isoniazid

• Personal history of epilepsy or seizure disorder and/or family history including afirst-degree relative

• Serious head injury with loss of consciousness

• Impending incarceration

• Pregnant or nursing females

• Inability to read, write, or speak English

• For adolescent aged participants (18-21 only): any risk factor for neurocardiogenicsyncope (history of syncope/presyncope related to noxious stimuli, anxiety,micturition, or posture)