The prevalence of amphetamine/methamphetamine use disorder (AUD/MUD) has been increasing with accompanying high risks of drug overdose-associated mortality. Noninvasive brain stimulation (NIBS) methods are a promising treatment for AUD/MUD; however, the comparative efficacy of NIBS protocols remains to be elucidated. We aimed to compare the efficacy and acceptability of various NIBS protocols and pharmacologic interventions for AUD/MUD management. We performed randomized controlled trials to investigate the efficacy of NIBS and guideline-recommended pharmacologic treatments to reduce craving severity in patients with either AUD or MUD and conducted frequentist model-based network meta-analysis. We included 22 randomized controlled trials with 1,888 participants. All randomized controlled trials covered patients with MUD, but not AUD. A combination of intermittent theta burst stimulation over the left dorsolateral prefrontal cortex and continuous theta burst stimulation over the left ventromedial prefrontal cortex was associated with the largest decrease in craving severity. Furthermore, high frequency repetitive transcranial magnetic stimulation over the left dorsolateral prefrontal cortex was associated with the largest improvement in depression and quality of sleep. The drop-out rate was not significantly different between the groups. In conclusion, the combined theta burst stimulation protocol over the prefrontal cortex was associated with the greatest improvement in craving severity. Since the sample size was relatively small, further large-scale randomized controlled trials are warranted.
 Authors' abstract