Transcranical direct current stimulation in alcohol and substance use disorders: short and long term outcomes

Miuli 1, C. Montemitro 1, C. Di Natale 1, M. Lorusso 1, M.C. Spano 1, M. Lupi 1, M. Pettorruso 2, G. Sepede 1, L. Piro 1, M. Di Miscia 1, M. Coladonato 1, V. Cantelmi 3, B. Tittozzi 3, E. Chillemi4, M. di Giannantonio1, G. Martinotti1.

1“G. d’Annunzio” University, Department of Neuroscience- Imaging and Clinical Sciences, Chieti, Italy.

2Fondazione Policlinico Universitario “A.Gemelli”- Università Cattolica del Sacro Cuore, Institute of Psychiatry and Psychology, Roma, Italy.

3Sisifo, Comunità Terapeutica, Tuscania, Italy.

4“Villa Maria Pia”, Struttura Residenziale Psichiatrica, Roma, Italy.

 

Introduction: the tDCS (Transcranical Direct Current Stimulation) has nowadays a considerable role, as treatment option for many psychiatric disturbance, because it is a non-invasive, well tolerated, easy to use (as it is a portable and compact device) and almost adverse effect free technique. During the last few years, tDCS has been increasingly used in neuroscientific and psychiatric clinical research, showing significative results in the treatment of Major Depression Disorder.[1] The Addiction area is now slightly explored but recently it has been observed that the application of tDCS on the Dorsolateral Prefrontal Cortex (DLPFC) may be a useful technique in order to reduce craving both in the Substance Use Disorder (SUDs) and in behavioral addictions.[2] The aim of our study was to evaluate the efficacy of tDCS in association with psychopharmacological therapy, in the treatment of SUDs. Considering the elevated rate of association between mood disorders and SUDs, our secondary outcome was to estimate the change in impulsivity and depressive symptoms through psychometric scales.[3]

 

Material and Methods: In this randomize double-blind controlled study a population with age ≥ 18 years and with a diagnosis of a Substance Use Disorder and Addiction (following the DSM-5 criteria) has been enrolled. The psychiatric diagnosis of the included patients were: Cocaine, Alcohol, Heroin, Cannabis Use Disorder and/or Gambling Disorder. All the subjects underwent through an intensive treatment period of five consecutive days (patients were randomized in active or sham). Some psychometric scales (HAM-D, HAM-A, Y-MRS, BSI, SOGS, VAS 1-10 for craving) were used at the baseline and at the endpoint of these five days. Our protocol considers three months follow-up consisting in one stimulation per week while psychometric scales were administered one per month.

 

Results: Nowadays our sample is composed by 21 subjects, 3 women and 18 men (mean age: 37.17; SD: 10.42). Patients have been randomized in two groups: sham (n= 8) and active stimulation (n= 13). The analysis of the variance (ANOVA) of VAS, BIS, HAM-A and MRS scales was performed. A statistically significant reduction of values at the end of the first 5 days of intensive stimulation was found in the active group in the VAS scale [F(1,13) = 4.9; p = 0.044], HAM-D scale [F(1,13) = 4.8; p = 0.046] and BIS scale [F(1,13) = 7.9; p = 0.014].

 

Conclusion: Our findings reveal a statistically significant reduction of craving in the active tDCS group on the right DLPFC, confirming the scientific literature trend.[4] Furthermore, in our study, the reduction of HAM-D values shows an improvement of the depression-anxiety symptomatology, highlighting the connection and the influence of this treatment on SUDs and Addiction. [5] Considering international literature matching our findings, we believe that the Brain Stimulation Technique, combined with psychopharmacological therapy, could play an important role in treatment of SUDs.

References

(In the body text, a publication should be referred to by a consecutive number between brackets as well as entering them below, i.e. [1], [2], [3])

 

Nitsche M.A., Paulus W. Transcranial direct current stimulation–update 2011. Restor Neurol eurosci 2011; 29: 463-492.

Lupi M, Martinotti G, Santacroce R, Cinosi E, Carlucci M, Marini S, Acciavatti T, di Giannantonio M. Transcranial Direct Current Stimulation in Substance Use Disorders: A Systematic Review of Scientific Literature. J ECT. 2017 Sep;33(3):203-209

Martinotti G, Lupi M, Acciavatti T, Cinosi E, Santacroce R, Signorelli MS, Bandini L, Lisi G, Quattrone D, Ciambrone P, Aguglia A, Pinna F, Calò S, Janiri L, di Giannantonio M. Novel psychoactive substances in young adults with and without psychiatric comorbidities. Biomed Res Int. 2014;2014:815424

Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, Cotelli M, De Ridder D, Ferrucci R, Langguth B, Marangolo P, Mylius V, Nitsche MA, Padberg F, Palm U, Poulet E, Priori A, Rossi S, Schecklmann M, Vanneste S, Ziemann U, Garcia-Larrea L, Paulus W. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol. 2017 Jan;128(1):56-92.

Bakken, K., Landheim, S., e Vaglum, P. (2003). Primary and secondary substance misusers: do they differ in substance-induced and substance-independent mental disorders?. Alcohol and Alcoholism, 38, 54–59.

Topics: Addiction – Disorder / Neuromodulation – Intervention / Mood and bipolar disorder

 

Abstract for the 31st ECNP Congress, 6-9 October 2018, Barcelona, Spain.

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