RTMS Targets Neural Circuits for Smoking Cessation

Inclusion Criteria

* Be between the ages of 22 and 70 years old.
* Smoke 10 or more cigarettes per day and have a carbon monoxide (CO) level \> 10 ppm indicative of recent smoking.
* Have not received substance abuse treatment within the previous 30 days.
* Meet the criteria for tobacco use disorder as determined by DSM-5.
* Be in stable mental and physical health.
* If female, test non-pregnant and use adequate birth control.
* Show no evidence of focal or diffuse brain lesions on MRI.
* Be willing to provide informed consent.
* Be able to comply with protocol requirements and likely to complete all study procedures.
* Be motivated to quit smoking (based on responses of "very likely," or "somewhat likely" in the motivation questionnaire).

Exclusion Criteria

* Current moderate to severe substance use of any psychoactive substances other than nicotine or caffeine, as defined by DSM-V criteria.
* Contraindications to MRI (e.g., presence of metal in the skull, orbital or intracranial cavity, or having claustrophobia).
* Contraindication to rTMS.
* History of autoimmune, endocrine, viral, or vascular disorders affecting the brain.
* History or MRI evidence of neurological disorder that would lead to local or diffuse brain lesions or significant physical impairment.
* Unstable cardiac disease, uncontrolled hypertension, severe renal or liver insufficiency, or sleep apnea.
* Lifetime history of major Axis I disorders such as: bipolar affective disorder (BPAD), schizophrenia, post-traumatic stress disorder (PTSD), dementia, suicidal ideation or major depression.
* Self-report of \>21 standard alcohol drinks per week in any week in the 30 days prior to screening.
* Use of other forms of nicotine delivery, such as nicotine patches, electronic cigarettes, gum, nasal spray, inhalers, and nicotine lozenges.
* Use of other tobacco products, including cigars, cigarillos, chew, snuff, and pouches/snus.
* Previous treatment with TMS.