Neuromodulation interventions for addictive disorders: challenges, promise, and roadmap for future research

Abstract

Addictive disorders are a major public health concern, associated with high relapse rates, significant disability and substantial mortality. Unfortunately, current interventions are only modestly effective. Preclinical studies as well as human neuroimaging studies have provided strong evidence that the observable behaviours that characterize the addiction phenotype, such as compulsive drug consumption, impaired self-control, and behavioural inflexibility, reflect underlying dysregulation and malfunction in specific neural circuits. These developments have been accompanied by advances in neuromodulation interventions, both invasive as deep brain stimulation, and non-invasive such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation. These interventions appear particularly promising as they may not only allow us to probe affected brain circuits in addictive disorders, but also seem to have unique therapeutic applications to directly target and remodel impaired circuits. However, the available literature is still relatively small and sparse, and the long-term safety and efficacy of these interventions need to be confirmed. Here we review the literature on the use of neuromodulation in addictive disorders to highlight progress limitations with the aim to suggest future directions for this field.

Memory and Cognition-Related Neuroplasticity Enhancement by Transcranial Direct Current Stimulation in Rodents: A Systematic Review

“…In a later phase of TBI, it was possible to observe motor recovery as well as spatial memory improvement following repeated anodal tDCS [48]. A growing number of studies has been reporting promising effects of neurostimulation in models of addictive disorders, by reducing craving and maladaptive pervasive learning [49]. In fact, repeated anodal stimulation in mouse frontal cortex decreased nicotine-induced conditioned place preference and further improved working memory [50].…”

Mindfulness‐Based Relapse Prevention and Transcranial Direct Current Stimulation to Reduce Heavy Drinking: A Double‐Blind Sham‐Controlled Randomized Trial

“…Active tDCS versus sham has been shown to enhance the effects of cognitive training in a number of domains, including inhibitory control, memory, attention, and other forms of cognition (Coffman et al., ). There have been over 250 clinical trials using tDCS for a variety of disorders and diseases, and there are also preliminary data suggesting tDCS has an effect on addictive disorders (Boggio et al., ; Coles et al., ; Feil and Zangen, ; Lapenta et al., ; Spagnolo and Goldman, ; Trojak et al., ). Specifically, tDCS has been shown to impact inhibitory control (Levasseur‐Moreau and Fecteau, ; Stramaccia et al., ), and cue reactivity and craving (Jansen et al., ; Nardone et al., ).…”

Neural correlates of cue‐ and stress‐induced craving in gambling disorders: implications for transcranial magnetic stimulation interventions

“…Interestingly, desire to gamble was measured before and after subjects performed a 15‐min slot machine game session, which preceded the stimulation. Several rTMS studies in SUDs have shown that using tasks and cue‐reactivity procedures to engage targeted circuits may improve stimulation outcomes (Hanlon et al ., ; Spagnolo & Goldman, ). Additionally, in this study, TMS effects on delay discounting and cognitive processes were also evaluated using the delay discounting and the Stroop interference task, with negative results (Zack et al ., ).…”