Effects of 10 add-on HF-rTMS treatment sessions on alcohol use and craving among detoxified inpatients with alcohol use disorder: a randomized sham-controlled clinical trial

Monja Hoven; Renée S Schluter; Arnt F Schellekens; Ruth J van Holst; Anna E Goudriaan

doi:10.1111/add.16025

Effects of 10 add-on HF-rTMS treatment sessions on alcohol use and craving among detoxified inpatients with alcohol use disorder: a randomized sham-controlled clinical trial

Addiction. 2023 Jan;118(1):71-85. doi: 10.1111/add.16025. Epub 2022 Sep 7.

Authors

Monja Hoven^{1

2}, Renée S Schluter^{1

2}, Arnt F Schellekens^{3

4}, Ruth J van Holst^{1

2

5}, Anna E Goudriaan^{1

2

5

6

7}

Affiliations

¹ Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands.
² Amsterdam Institute for Addiction Research, Amsterdam, the Netherlands.
³ Donders Institute for Brain, Cognition, and Behavior, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands.
⁴ Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands.
⁵ Center for Urban Mental Health, University of Amsterdam, the Netherlands.
⁶ Arkin and Jellinek, Mental Health Care, Amsterdam, the Netherlands.
⁷ Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.

Abstract

Background and aims: Alcohol use disorder (AUD) is a chronic disorder with high relapse rates. There are currently few clinical trials of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) to reduce alcohol use among AUD patients, and results are mixed. The current study tested the effect of 10 add-on sessions of HF-rTMS over the right dorsolateral pre-frontal cortex (DLPFC) on alcohol use and craving.

Design: Single-center, single blind sham-controlled parallel-group RCT (n = 80), with 3 and 6 months follow-up.

Setting: Clinical treatment center in Amsterdam, the Netherlands.

Participants: Eighty detoxified and abstinent AUD inpatients in clinical treatment (20 females, average age = 44.35 years).

Intervention: Ten sessions of active or sham HF-rTMS (60 10 Hz trains of 5 sec at 110% motor threshold) over the right DLPFC on 10 consecutive work-days.

Measurements: The primary outcome measure is the number of abstinent days over 6-month follow-up (FU). Secondary outcome measures are craving over 6-month FU (alcohol urge questionnaire and obsessive-compulsive drinking scale), time to first relapse over 6-month FU and grams of alcohol consumed over 6-month FU. Additional outcome measures: full abstinence over 6-month FU and treatment success over 12-month FU.

Findings: HF-rTMS did not affect the number of abstinent days over 6 months FU [sham = 124 ± 65.9 days, active = 115 ± 69.8 days, difference: 9 days, 95% confidence interval (CI) = Poisson model: 0.578-3.547]. Moreover, HF-rTMS did not affect craving (AUQ/OCDS) (sham = 15.38/5.28, active = 17.48/4.75, differences = 2.1/-0.53, 95% CI mixed-effects model = -9.14 to 2.07/-1.44 to 2.40).

Conclusions: There was no clear evidence that high-frequency repetitive transcranial magnetic stimulation over the right dorsolateral pre-frontal cortex treatment has a long-term positive effect on alcohol use or craving as add-on treatment for alcohol use disorder. High treatment response at 6-month follow-up could have limited the possibility to find an effect.

Keywords: Abstinence; alcohol use; alcohol use disorder; craving; neuromodulation; relapse; transcranial magnetic stimulation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Alcoholism* / therapy
Craving / physiology
Female
Humans
Inpatients
Prefrontal Cortex / physiology
Recurrence
Single-Blind Method
Transcranial Magnetic Stimulation* / methods
Treatment Outcome