Non-invasive Brain Stimulation for Alcohol Use Disorders: State of the Art and Future Directions

Abstract

Alcohol use disorders remain one of the leading causes of mortality and morbidity across the world, yet despite this impact, there are few treatment options for patients suffering from these disorders. To this end, non-invasive brain stimulation, most commonly utilizing technologies including transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), has recently emerged as promising potential treatments for alcohol use disorders. Enthusiasm for these interventions is fueled by their non-invasive nature, generally favorable safety profile, and ability to target and modulate brain regions implicated in substance use disorders. In this paper, we describe the underlying principles behind these commonly used stimulation technologies, summarize existing experiments and randomized controlled trials, and provide an integrative summary with suggestions for future areas of research. Currently available data generally supports the use of non-invasive brain stimulation as a near-term treatment for alcohol use disorder, with important caveats regarding the use of stimulation in this patient population.

Preventing relapse in alcohol disorder with EEG-neurofeedback as a neuromodulation technique: A review and new insights regarding its application

“…In this view, researchers have considered neural networks as a treatment variable of interest to reduce specific symptoms and/or to optimize performance (Enriquez-Geppert, Huster, & Herrmann, 2013). Transcranial electrical stimulation (Philip, Sorensen, McCalley, & Hanlon, 2019), transcranial magnetic stimulation (Philip et al, 2019), and cognitive training procedure (Azevedo & Mammis, 2017) are currently used for this purpose, promoting a "multimodal" approach suggesting that the typical psychological/pharmacological approach needs to be complemented with other treatments such as neuromodulation (e.g., Luigjes, Segrave, de Joode, Figee, & Denys, 2019) and cognitive revalidation (Bates, Buckman, & Nguyen, 2013). The main objective of the present paper is to focus on the merits of neurofeedback (NF), which is a tool that has experienced renewed interest in both clinical and research areas (Marzbani, Marateb, & Mansourian, 2016).…”

Regionally specific gray matter volume is lower in alcohol use disorder: Implications for noninvasive brain stimulation treatment

“…Recent technological advances have led to an increased appreciation for the role of cortical–subcortical circuits as novel treatment targets of AUD. Specially, there has been strong momentum for developing noninvasive neural circuit‐based therapeutic tools to decrease drinking in AUD patients (Ekhtiari et al, 2019; Philip et al, 2020).…”

“…It is not clear that the dosing parameters used for other indications will be efficacious in AUD. While there are now over 20 publications evaluating TMS as a tool to decrease drinking among individuals with AUD, many published trials have modest effect sizes and show high interindividual variability (Philip et al, 2020). In order to move TMS further down the treatment development pipeline, it is critical to consider unique aspects of the neurobiology of AUD that might influence TMS treatment efficacy.…”

Compulsive drinking is associated with neural activity patterns reflecting diminished behavioral control and enhanced seeking representations in dorsal medial prefrontal cortex

“…With these methods, we tested the hypothesis that representations of behavioral control signals are weakened in dmPFC during compulsive drinking. Finally, emerging data in humans suggests that targeting the mPFC 30-32 could reduce craving and intake in patients diagnosed with a substance use disorder 33, 34 . Thus, we used a chemogenetic approach to stimulate neurons in dmPFC to test the hypothesis that increasing dmPFC activity would reduce compulsive drinking, which would support the view that circuit manipulations that restore dmPFC function are potentially novel treatments for AUD.…”