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Meta-Analysis
. 2024 Mar;49(4):649-680.
doi: 10.1038/s41386-023-01776-0. Epub 2023 Dec 12.

A systematic review and meta-analysis of neuromodulation therapies for substance use disorders

Dhvani D Mehta  1   2 , Angela Praecht  3   4 , Heather B Ward  5 , Marcos Sanches  3 , Maryam Sorkhou  3   4 , Victor M Tang  3   4 , Vaughn R Steele  6 , Colleen A Hanlon  7 , Tony P George  8   9
Affiliations
Meta-Analysis

A systematic review and meta-analysis of neuromodulation therapies for substance use disorders

Dhvani D Mehta et al. Neuropsychopharmacology. 2024 Mar.

Abstract

While pharmacological, behavioral and psychosocial treatments are available for substance use disorders (SUDs), they are not always effective or well-tolerated. Neuromodulation (NM) methods, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) may address SUDs by targeting addiction neurocircuitry. We evaluated the efficacy of NM to improve behavioral outcomes in SUDs. A systematic literature search was performed on MEDLINE, PsychINFO, and PubMed databases and a list of search terms for four key concepts (SUD, rTMS, tDCS, DBS) was applied. Ninety-four studies were identified that examined the effects of rTMS, tDCS, and DBS on substance use outcomes (e.g., craving, consumption, and relapse) amongst individuals with SUDs including alcohol, tobacco, cannabis, stimulants, and opioids. Meta-analyses were performed for alcohol and tobacco studies using rTMS and tDCS. We found that rTMS reduced substance use and craving, as indicated by medium to large effect sizes (Hedge's g > 0.5). Results were most encouraging when multiple stimulation sessions were applied, and the left dorsolateral prefrontal cortex (DLPFC) was targeted. tDCS also produced medium effect sizes for drug use and craving, though they were highly variable and less robust than rTMS; right anodal DLPFC stimulation appeared to be most efficacious. DBS studies were typically small, uncontrolled studies, but showed promise in reducing misuse of multiple substances. NM may be promising for the treatment of SUDs. Future studies should determine underlying neural mechanisms of NM, and further evaluate extended treatment durations, accelerated administration protocols and long-term outcomes with biochemical verification of substance use.

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Conflict of interest statement

TPG is a co-principal editor at Neuropsychopharmacology. CAH is employed by BrainsWay and has a financial interest in the company. The remaining authors have nothing to disclose.

Figures

Fig. 1
Fig. 1. Neuromodulation techniques.
Diagrams to illustrate the three neuromodulation techniques investigated: (a) rTMS (Deep TMS image acquired from Brainsway, Inc.), (b) tDCS, (c) DBS.
Fig. 2
Fig. 2. Meta-analyses of AUD studies using rTMS.
Forest plots of studies evaluating (A) alcohol craving following a single-session of rTMS (B) alcohol craving following multi-session rTMS (C) alcohol consumption following multi-session rTMS.
Fig. 3
Fig. 3. Meta-analyses of TUD studies using rTMS.
Forest plots of studies evaluating (A) tobacco cue-induced craving following a single-session of rTMS (B) tobacco craving following multi-session rTMS (C) tobacco consumption following multi-session rTMS.
Fig. 4
Fig. 4. Meta-analyses of AUD studies using tDCS.
Forest plots of studies evaluating (A) alcohol craving following a single-session of tDCS (B) alcohol craving following multi-session tDCS (C) alcohol consumption following multi-session tDCS.
Fig. 5
Fig. 5. Meta-analyses of TUD studies using tDCS.
Forest plots of studies evaluating (A) tobacco craving following a single-session of tDCS (B) tobacco consumption following a single-session of tDCS (C) tobacco craving following multi-session tDCS (D) tobacco consumption following multi-session tDCS.
See this image and copyright information in PMC

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