rTMS and Cognitive-behavioral Therapy for Cocaine Use Disorder

Inclusion Criteria: Age 18-65; Able to give informed consent and comply with study procedures; Meets DSM-5 criteria for current moderate/severe CUD and are treatment-seeking; Used cocaine at least 9 days in the past 28 days, with at least weekly cocaine use; Agree to no more than moderate alcohol consumption (<15 drinks/week for men and <8 drinks/week for women) and to avoid using amphetamine/methamphetamine and non-prescribed benzodiazepines or barbiturates; and Women of childbearing potential must agree to use a method of contraception with proven efficacy and agree to not become pregnant during the study. Exclusion Criteria: Meets DSM-5 criteria for current moderate/severe major depressive episode, OCD, bipolar disorder, schizophrenia or any psychotic disorder other than transient psychosis due to substance use; Hamilton Depression Rating Scale score > 17; Young Mania Rating Scale score >10; Meets DSM-5 criteria for current moderate/severe other substance use disorder (aside from tobacco use disorder; physiologic dependence on any other substance other than nicotine, including alcohol, is exclusionary); Heavy weekly alcohol drinking as defined by an average of >14 drinks/week for men or >7 drinks/week for women on average during the past 28 days; Prior alcohol, benzodiazepine, or barbiturate withdrawal that resulted in hospitalization, medical detoxification, or resulted in seizures or delirium tremens; More than twice weekly use of non-prescribed medications/drugs that may change the seizure threshold, including benzodiazepines, barbiturates, GHB/GBL, amphetamines/methamphetamine; Any other current DSM-5 psychiatric disorder(s) that in the investigator's judgment are unstable, would be disrupted by study procedures, or are likely to require pharmacotherapy or psychotherapy during the study period; Significant current suicide risk, indicated by either: (1) "yes" response on #3, 4, or #5 on the C-SSRS and a psychiatric risk assessment indicating a moderate or high risk of suicide or (2) suicidal behavior in the past 3 months (note: non-suicidal self-injurious behavior is not exclusionary); Females with a positive urine pregnancy test; Clinically significant abnormal cardiac functioning per electrocardiogram (ECG) (required for any participant age 60 years and older); Seizure history including: seizure disorder/epilepsy, alcohol/drug withdrawal seizure, or seizure deemed by the study physician to be related to cocaine intoxication/withdrawal (note: febrile seizures are not exclusionary) Other medical conditions that are relatively contraindicated with TMS (seizure disorders, glaucoma, increased intracranial pressure, severe migraines, stroke, brain lesions, pregnancy or breast-feeding, neurodegenerative disease, meningoencephalitis, intracerebral abscess, parenchymal or leptomeningeal cancers); Medications that lower seizure threshold and in the opinion of the investigator impose significant seizure risk for the individual; Cognitive disorder (MMSE <25); Disqualifying response on the TMS Adult Safety Screen (TASS); Implanted devices or stimulators (cardiac pacemakers, vagus nerve stimulators, spinal cord stimulators, cochlear implant); Currently taking ototoxic medications (aminoglycosides, cisplatin); Metal implants or paramagnetic objects in the body that prohibits MR scanning; Claustrophobia that prohibits MR scanning; or Legally mandated (e.g., to avoid incarceration or other penalties) to participate in SUD treatment program.