Effects of self-care intervention using a mobile instant messenger on hemodialysis patient's knowledge, self-efficacy, self-care behavior and physiological index.

Alcohol use disorder (AUD) is a leading cause of preventable morbidity and mortality worldwide and is frequently complicated by psychiatric comorbidity, particularly major depressive disorder (MDD). Nearly 40% of individuals with AUD meet criteria for lifetime MDD, and co-occurring AUD and MDD is associated with greater disability, elevated relapse risk, and poorer outcomes than either disorder alone (, ). Despite this burden, interventions that simultaneously address alcohol use and depressive symptoms show limited and inconsistent effectiveness (, , ). A key contributor is the heterogeneity of AUD and its frequent co-occurrence with affective dysregulation, which complicates treatment matching and may obscure subgroup-specific mechanisms. These challenges have motivated calls for integrated, neurobiologically informed approaches that target shared and state-dependent mechanisms across disorders (). Neuromodulation, particularly transcranial magnetic stimulation (TMS), has been increasingly investigated as a potential intervention for substance use and mood disorders. In this review, “TMS” refers broadly to repetitive TMS (rTMS), including patterned protocols such as intermittent and continuous theta burst stimulation (iTBS, cTBS), as well as deep TMS and accelerated stimulation protocols. In AUD, rTMS studies have most commonly targeted the dorsolateral prefrontal cortex (DLPFC), given its role in executive control, decision-making, and craving regulation (). While some trials report reductions in craving and drinking outcomes, findings remain heterogeneous, with modest and variable effects (, ). Most studies rely on region-centric targeting and do not incorporate neuroimaging to verify circuit engagement or mechanism (see ). As summarized in , TMS studies in AUD are characterized by predominant DLPFC targeting, methodological heterogeneity, and mixed clinical outcomes despite evidence of neural engagement. Given the extensive and comparatively more standardized TMS literature in MDD [e.g., (, )], we focus on AUD to highlight greater variability in targets and study design. These limitations raise questions about whether current paradigms adequately capture distributed circuit dysfunction in AUD, particularly in the context of comorbid depression. Recent consensus efforts emphasize the feasibility and clinical relevance of TMS in individuals with co-occurring substance use, but primarily address implementation and safety rather than mechanism (, ). Together, these findings underscore the need for mechanistically informed approaches to optimize target selection and engagement. Summary of transcranial magnetic stimulation (TMS) studies in alcohol use disorder (AUD), including stimulation targets, study design, imaging approaches, and behavioral outcomes.