Effects of neuromodulation on cognitive performance in individuals exhibiting addictive behaviors: A systematic review

Abstract

Background: There is growing interest in non-invasive brain stimulation techniques as treatments for addictive disorders. While multiple reviews have examined the effects of neuromodulation on craving and consumption, there has been no review of how neuromodulation affects cognitive functioning in addiction. This systematic review examined studies of the cognitive effects of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) in individuals exhibiting addictive behavior.

Methods: Articles were identified through searches in PubMed and PsycINFO conducted in October 2017. Eligible studies investigated the effects of tDCS or TMS on cognitive task performance in participants reporting substance use (e.g., alcohol, tobacco, or drugs) or addictive behaviors (e.g., gambling). Tasks were organized into five domains: (1) Inhibitory control, (2) Risk-taking, (3) Impulsive choice (delay discounting), (4) Executive function, and (5) Implicit biases.

Results: Twenty-four articles met the inclusion criteria. Fifty-seven percent of studies used tDCS and 43% used TMS, with nearly all studies (96%) targeting the dorsolateral prefrontal cortex. Ten studies reported significant within-subject modulation of cognitive functioning associated with active TMS or tDCS, with the same number reporting no change in cognitive performance. Of four studies that included both an experimental and control participant group, three showed between-group differences in the effects of neuromodulation.

Conclusions: While positive effects in several studies suggest that tDCS and TMS improve cognitive functioning in addiction, there is substantial heterogeneity across studies. We discuss person-related and methodological factors that could explain inconsistencies, and propose individualized stimulation protocols may sharpen the cognitive effects of neuromodulation in addiction.

Keywords: Addiction; Brain stimulation; Cognition; Substance use; Transcranial direct current stimulation; Transcranial magnetic stimulation.

Figure 1

PRISMA flow diagram showing the number of records identified and excluded, and reasons for exclusion. In the box showing reasons for exclusion, ‘Duplicate record’ refers to articles that were identical or a translated version of another article identified by our searches (which were not removed automatically by Covidence), ‘Not original research report’ refers to reviews and commentary articles, and ‘Data reported in another record’ was used to classify articles that described datasets reported in another record.