Noninvasive brain stimulation technologies such as transcranial electrical and magnetic stimulation (tES and TMS) are emerging neuromodulation therapies that are being used to target the neural substrates of substance use disorders. By the end of 2022, 205 trials of tES or TMS in the treatment of substance use disorders had been published, with heterogeneous results, and there is still no consensus on the optimal target brain region. Recent work may help clarify where and how to apply stimulation, owing to expanding databases of neuroimaging studies, new systematic reviews, and improved methods for causal brain mapping. Whereas most previous clinical trials targeted the dorsolateral prefrontal cortex, accumulating data highlight the frontopolar cortex as a promising therapeutic target for transcranial brain stimulation in substance use disorders. This approach is supported by converging multimodal evidence, including lesion-based maps, functional MRI-based maps, tES studies, TMS studies, and dose-response relationships. This review highlights the importance of targeting the frontopolar area and tailoring the treatment according to interindividual variations in brain state and trait and electric field distribution patterns. This converging evidence supports the potential for treatment optimization through context, target, dose, and timing dimensions to improve clinical outcomes of transcranial brain stimulation in people with substance use disorders in future clinical trials.

经颅电刺激和磁刺激（tES 和 TMS）等非侵入性脑刺激技术是新兴的神经调节疗法，用于针对物质使用障碍的神经基质。截至 2022 年底，已有 205 项 tES 或 TMS 治疗物质使用障碍的试验发表，结果参差不齐，并且对于最佳靶脑区域仍没有达成共识。由于神经影像研究数据库的扩大、新的系统评价以及因果脑图谱方法的改进，最近的工作可能有助于阐明在何处以及如何应用刺激。尽管之前大多数临床试验都针对背外侧前额叶皮层，但不断积累的数据强调，额极皮层是药物滥用障碍中经颅脑刺激的有希望的治疗靶点。这种方法得到了融合多模态证据的支持，包括基于病变的图、基于功能 MRI 的图、tES 研究、TMS 研究和剂量反应关系。这篇综述强调了针对额极区域并根据大脑状态和特征以及电场分布模式的个体差异调整治疗的重要性。这些汇聚的证据支持通过背景、目标、剂量和时间维度优化治疗的潜力，以改善未来临床试验中物质使用障碍患者经颅脑刺激的临床结果。