Transcranial direct current stimulation combined with alcohol cue inhibitory control training reduces the risk of early alcohol relapse: A randomized placebo-controlled clinical trial

Abstract

Background: Approximately half of all people with alcohol use disorder (AUD) relapse into alcohol reuse in the next few weeks after a withdrawal treatment. Brain stimulation and cognitive training represent recent forms of complementary interventions in the context of AUD. Objective: To evaluate the clinical efficacy of five sessions of 2 mA bilateral transcranial direct current stimulation (tDCS) for 20 min over the dorsolateral prefrontal cortex (DLPFC) (left cathodal/right anodal) combined with alcohol cue inhibitory control training (ICT) as part of rehabilitation. The secondary outcomes were executive functioning (e.g. response inhibition) and craving intensity, two mechanisms strongly related to abstinence. Methods: A randomized clinical trial with patients (n ¼ 125) with severe AUD at a withdrawal treatment unit. Each patient was randomly assigned to one of four conditions, in a 2 [verum vs. sham tDCS] x 2 [alcohol cue vs. neutral ICT] factorial design. The main outcome of treatment was the abstinence rate after two weeks or more (up to one year). Results: Verum tDCS improved the abstinence rate at the 2-week follow-up compared to the sham condition, independently of the training condition (79.7% [95% CI ¼ 69.8e89.6] vs. 60.7% [95% CI ¼ 48.3 e73.1]; p ¼ .02). A priori contrasts analyses revealed higher abstinence rates for the verum tDCS associated with alcohol cue ICT (86.1% [31/36; 95% CI ¼ 74.6e97.6]) than for the other three conditions (64% [57/89; 95% CI ¼ 54e74]). These positive clinical effects on abstinence did not persist beyond two weeks after the intervention. Neither the reduction of craving nor the improvement in executive control resulted specifically from prefrontal-tDCS and ICT. Conclusions: AUD patients who received tDCS applied to DLPFC showed a significantly higher abstinence rate during the weeks following rehabilitation. When combined with alcohol specific ICT, brain stimulation may provide better clinical outcomes. Trial Registration: ClinicalTrials.gov number NCT03447054 https://clinicaltrials.gov/ct2/show/ NCT03447054.

Association of impulsivity with quality of life and well‐being after alcohol withdrawal treatment

“…been shown to promote brain activity related to attentional processes in binge drinking individuals (Dormal et al, 2020), and prevent relapse in alcohol use disorders (Dubuson et al, 2021).…”

Impulsivity trait mediates the relationship between white matter integrity of prefrontal–striatal circuits and the severity of dependence in alcoholism

“…As TBSS analysis fails to cover specific tracks between striatum and related ROIs, therefore, we selected ROIs associated with impulsive trait, including frontal cortex and the limbic basal ganglia. Specifically, the prefrontal cortex (dlPFC and vlPFC) has been linked to “top-down” cognitive control of inhibiting impulse that promotes risky behaviors and SMA has been related to the inhibition of motor impulse ( 53 , 54 ). Striatum acts in concert with portions of the PFC to modulate impulsive behavior ( 55 , 56 ).…”

Substance Use and Addiction in Athletes: The Case for Neuromodulation and Beyond

“…In the transcranial direct current studies, the results have been tepid at best with the most recent metanalysis revealed small positive effects on alcohol craving and consumption which contradicted a previous metanalysis [ 64 , 65 ]. One RCT performed recently demonstrated higher rates of abstinence in those treated with tDCS compared to other conditions but only for two weeks post rehabilitation [ 66 ].…”