Transcranial direct current stimulation combined with alcohol cue inhibitory control training reduces the risk of early alcohol relapse: a randomized placebo-controlled clinical trial

Background Approximately half the people with alcohol use disorder (AUD) relapse into alcohol reuse in the few weeks following withdrawal treatment. Brain stimulation and cognitive training represent recent forms of complementary interventions in the context of AUD. Objective To evaluate the clinical efficacy of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) combined with alcohol cue inhibitory control training (ICT) as part of rehabilitation. Methods A randomized clinical trial was conducted on patients (n=125) withsevere AUD at a withdrawal treatment unit. Each patient was randomly assigned to one of four conditions, in a 2 [verum vs. sham tDCS] x 2 [alcohol cue vs. neutral ICT] factorial design. The primary outcome of the treatment was the measured abstinence rate after two weeks or more (up to one year). Results Verum tDCS improved the abstinence rate at the 2-week follow-up compared to the sham condition, independently of the training condition (79.7% [95% CI = 69.8-89.6] vs. 60.7% [95% CI = 48.3-73.1]; p = 0.02). A priori contrasts analyses revealed higher abstinence rates for the verum tDCS associated with alcohol cue ICT (86.1% [31/36; 95% CI= 74.6-97.6]) than for the other three conditions (64% [57/89; 95% CI = 54-74]). These positive clinical effects on abstinence did not persist beyond two weeks after the intervention. Conclusions AUD patients who received tDCS applied to DLPFC showed a significantly higher abstinence rate during the weeks following rehabilitation. When combined with alcohol-specific ICT, brain stimulation may provide better clinical outcomes. Trial Registration ClinicalTrials.gov number NCT03447054