OBJECTIVES: This study aimed to evaluate the effects of transcranial magnetic stimulation (TMS) on alcohol craving, abstinence days, alcohol intake, anxiety, depression, and cognitive function in patients with alcohol use disorder (AUD), providing evidence to support precision treatment strategies.

METHODS: As of March 6, 2026, we have systematically searched eight databases (PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Science Journal Database, Wanfang Database, and China Biomedical Literature Service System). The Cochrane Risk of Bias Tool for Randomized Trials (RoB 2) was used to assess the quality of the included randomized controlled trial (RCT) studies. Stata15 was employed for the meta-analysis.

RESULTS: We included 19 RCT studies involving 942 patients with AUD. Compared with the sham stimulation group, TMS significantly reduced alcohol craving in patients with AUD. Subgroup analysis showed significant effect sizes in cases where the TMS type was continuous theta burst stimulation (cTBS), the number of sessions was 10 or 15, the frequency was 10 Hz, and the follow-up duration was ≤ 1 month or ≥ 3 months. Meta-regression indicated that disease type might be the main reason for the high heterogeneity in alcohol craving. Compared with the sham stimulation group, TMS showed significant differences in maintaining abstinence days, reducing alcohol intake, alleviating depressive symptoms, and improving cognitive function.

CONCLUSIONS: Current evidence indicates that TMS can effectively alleviate craving in patients with AUD and demonstrate significant advantages in maintaining abstinence days, reducing alcohol intake, alleviating depressive symptoms, and improving cognitive function. Given the high degree of heterogeneity, the results were interpreted with caution. In the future, more large-sample, multi-center, double-blind RCT will be needed to supplement and validate the results of this study.