Effect of transcranial alternating current stimulation (NET Device™) on psychostimulant withdrawal severity and time course: a real-world data analysis

Background Psychostimulant use disorder is a life-threatening condition with no FDA-approved treatment. Stimulant withdrawal symptoms impede treatment engagement and are unaddressed by standard of care. The NET Device, a non-invasive transcranial alternating current stimulator, is FDA-cleared for opioid withdrawal suppression. No studies have evaluated whether NET Device use attenuates psychostimulant withdrawal. Methods Electronic health record and device utilization data were collected from 109 stimulant-only users and 112 stimulant/opioid co-users ( N = 221 adults total; M age =39.2, SD age =10.7; 119M) entering residential addiction treatment ( n = 168) or detention centers ( n = 53). The Amphetamine Cessation Symptom Assessment (ACSA) was administered at baseline and 1 hour (day 1), and twice daily on days 1–7. A linear mixed model (LMM) with random intercepts and slopes was used to analyze the trajectory of ACSA scores. Results ACSA severity and time course were similar across settings (residential vs. detention). A two-phase LMM separated acute (baseline to 1 hour) and post-acute withdrawal symptom reductions. Relative to baseline ACSA scores, stimulant-only and co-user groups each reported significant reductions at 1 hour (46% and 33%), day 2 morning (59% and 42%), and decelerating log-time trajectory through day 4 (79 hours), the primary analysis window. Estimates beyond day 4 rest on 6.9% of observations and are reported as exploratory only. Conclusion NET Device monotherapy was associated with rapid reduction in psychostimulant withdrawal severity regardless of setting and opioid co-use. No device-related adverse events were reported. These real-world data support initiation of a sham-controlled randomized trial to evaluate NET Device efficacy for stimulant use disorder.