rTMS Reduces Craving and Alcohol Use in Patients with Alcohol Use Disorder: Results of a Randomized, Sham-Controlled Clinical Trial

Abstract

(1) Background: Current evidence-based treatments for alcohol use disorder (AUD) are moderately effective. Studies testing repetitive transcranial magnetic stimulation (rTMS) in AUD commonly apply a limited number of rTMS sessions with different rTMS settings, showing inconsistent effects on craving for alcohol. This study tested the efficacy of a robust rTMS protocol on craving and alcohol use. (2) Methods: In a single-blind randomized controlled trial in recently detoxified patients with AUD, ten days of high-frequency rTMS over the right dorsolateral prefrontal cortex on top of treatment as usual (n = 14) was compared with sham rTMS (n = 16). Outcome measures were alcohol craving and use over a follow-up period of one year. Analysis was performed by means of repeated measures multivariate analysis of variance. (3) Results: The results showed a main group-by-time interaction effect on craving (Wilks’ Λ = 0.348, F (12, 17) = 2.654, p = 0.032) and an effect of group on alcohol use (Wilk’s Λ = 0.44, F (6, 23) = 4.9, p = 0.002), with lower alcohol craving and use in the group with active rTMS compared to the control group. Differences in craving between groups were most prominent three months after treatment. At 12 months follow-up, there was no effect of rTMS on craving or abstinence. (4) Conclusions: This small-scale randomized controlled trial showed the efficacy of high-frequency rTMS over the right dlPFC diminished alcohol craving and use in recently detoxified patients with AUD during the first months after detoxification. These findings suggest that rTMS might be an effective add-on in treating patients with AUD and warrant replication in future large-scale studies.

Effects of 10 add‐on HF‐rTMS treatment sessions on alcohol use and craving among detoxified inpatients with alcohol use disorder: a randomized sham‐controlled clinical trial

“…Together, our findings are in line with the negative findings reported in the relatively larger studies in AUD [ 63 ] and studies conducted in nicotine use disorder [ 65 ] and cocaine use disorder [ 69 ]. However, our findings are contrary to other smaller studies that were either pilot studies [ 60 , 62 ] or did not report on follow‐up measures of alcohol use [ 59 ]. Furthermore, results of the current study are hard to compare to other studies as they did not include follow‐up periods [ 66 , 68 ].…”

“…Belgers and colleagues showed a group × time interaction, showing decreased craving in the active group up to 3 months' follow-up [44,59]. Differences in study samples could have had an influence on the outcomes, as Belgers et al [59] collected data from outpatients whereas the current study only included inpatients.…”

“…A small study ( n = 17) using HF‐rTMS on the left DLPFC showed no changes in post‐treatment or 1 month follow‐up number of drinks between treatment groups [ 58 ]. Another relatively small RCT ( n = 30) using HF‐rTMS on the right DLPFC showed a group effect on post‐treatment alcohol use with lower alcohol use in the active group, but no group × time interaction analyses, were reported using follow‐up measures of alcohol use [ 59 ]. Other methods of applying rTMS might be more effective in improving alcohol use, such as deep rTMS using an H‐coil [ 60 ], used deep rTMS over the medial PFC in a small sample ( n = 18) in a pilot study and found a decrease in the number of drinks in the active stimulation group ( n = 9) from baseline to post‐treatment and up to 3 months (however, note that five patients dropped‐out at 3‐month follow‐up and only data of four patients were analyzed), and a significant reduction in number of drinks in the sham group ( n = 9) from baseline to 1‐month follow‐up.…”

Trans-cranial Magnetic Stimulation in Treatment of Alcohol Use Disorder: A Meta-analysis

“…There are very few studies which follow patients beyond the 6-month period. 38, 49 The outcomes measured include craving, impulsivity, 33 His study was based on randomized single blind sham-controlled design with one month follow-up. This was followed in 2015 by Girardi et al who performed an open label study to prove significant effect of add on TMS therapy compared to standard treatment.…”

Transcranial Stimulation for the Treatment of Stimulant Use Disorder

“…Animal and human studies have provided promising evidence that rTMS targeting the dorsolateral prefrontal cortex (DLPFC) may have the potential to alleviate craving in individuals with general substance dependence [ 38 , 39 ]. To bolster these findings, a randomized sham-control clinical trial using high-frequency rTMS to treat alcohol use disorders showed that stimulation of right DLPFC diminished both alcohol use and craving [ 40 ]. While these are promising findings, this evaluation requires further consideration as craving scales reflect a psychological construct which commonly leads to over-interpretation of results.…”