A randomized sham-controlled trial to study the effect of transcranial direct current stimulation on craving, abstinence, and time to relapse in severe alcohol use disorder.

Background: Neural circuitry-based treatments, such as transcranial direct current stimulation (tDCS), have demonstrated efficacy in reducing craving in individuals with alcohol use and other addictive substances. Aim: The study aimed to investigate the effectiveness of tDCS on craving, time taken to first drink, and relapse to drinking over 3 months among individuals with severe alcohol use disorder. Methods: A randomized sham-controlled trial included adults aged 18-55 years with severe alcohol dependence. Participants (n = 149) were abstinent from alcohol for at least 3 days, underwent a benzodiazepine washout, and exhibited active craving. tDCS was administered twice daily for 5 consecutive days, with bilateral stimulation being given by placing the anode over F3 and the cathode over F4 to the 'active' (A) and 'sham' (S) intervention groups. Clinical parameters were assessed at baseline, 1 month (1 m), and 3 months (3 m). Results: At completion, out of the 149 randomized subjects (n (A) =75, n (S) =74), 107 participants (n (A) =51, n (S) =56) received the intended tDCS sessions. Baseline characteristics were comparable between the two groups. Intention-to-treat analysis showed significantly lower craving scores in group A than in group S at 1 month and 3 month follow-up time points in comparison to the baseline (baseline: A = 48.33 ± 1.94, S = 48.27 ± 2.45; 1 m: A = 30.37 ± 11.66, S = 33.55 ± 13.73; 3 m: A = 28.50 ± 13.23, S = 34.75 ± 14.07; F (2,294) = 5.52, Conclusion: Adjunctive tDCS demonstrated efficacy in reducing craving and preventing relapse in individuals with severe alcohol dependence. These findings suggest the potential of tDCS as a therapeutic intervention for severe alcohol dependence which is less intense in terms of resources and time and can further be tailored to monitor neurobiological correlates in recovery.