Efficacy of Invasive and Non-Invasive Brain Modulation Interventions for Addiction

Judy Luigjes, Rebecca Segrave, Niels de Joode, Martijn Figee, Damiaan Denys

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

It is important to find new treatments for addiction due to high relapse rates despite current interventions and due to expansion of the field with non-substance related addictive behaviors. Neuromodulation may provide a new type of treatment for addiction since it can directly target abnormalities in neurocircuits. We review literature on five neuromodulation techniques investigated for efficacy in substance related and behavioral addictions: transcranial direct current stimulation (tDCS), (repetitive) transcranial magnetic stimulation (rTMS), EEG, fMRI neurofeedback and deep brain stimulation (DBS) and additionally report on effects of these interventions on addiction-related cognitive processes. While rTMS and tDCS, mostly applied at the dorsolateral prefrontal cortex, show reductions in immediate craving for various addictive substances, placebo-responses are high and long-term outcomes are understudied. The lack in well-designed EEG-neurofeedback studies despite decades of investigation impedes conclusions about its efficacy. Studies investigating fMRI neurofeedback are new and show initial promising effects on craving, but future trials are needed to investigate long-term and behavioral effects. Case studies report prolonged abstinence of opioids or alcohol with ventral striatal DBS but difficulties with patient inclusion may hinder larger, controlled trials. DBS in neuropsychiatric patients modulates brain circuits involved in reward processing, extinction and negative-reinforcement that are also relevant for addiction. To establish the potential of neuromodulation for addiction, more randomized controlled trials are needed that also investigate treatment duration required for long-term abstinence and potential synergy with other addiction interventions. Finally, future advancement may be expected from tailoring neuromodulation techniques to specific patient (neurocognitive) profiles.

Original languageEnglish
Pages (from-to)116-138
Number of pages23
JournalNeuropsychology Review
Volume29
Issue number1
DOIs
Publication statusPublished - Mar 2019

Keywords

  • Addiction
  • Cognitive outcome measures
  • Deep brain stimulation
  • EEG neurofeedback
  • Neuromodulation
  • Transcranial direct current stimulation
  • Transcranial magnetic stimulation

Cite this

Luigjes, Judy ; Segrave, Rebecca ; de Joode, Niels ; Figee, Martijn ; Denys, Damiaan. / Efficacy of Invasive and Non-Invasive Brain Modulation Interventions for Addiction. In: Neuropsychology Review. 2019 ; Vol. 29, No. 1. pp. 116-138.
@article{4a259940633a464a82482ee785955d66,
title = "Efficacy of Invasive and Non-Invasive Brain Modulation Interventions for Addiction",
abstract = "It is important to find new treatments for addiction due to high relapse rates despite current interventions and due to expansion of the field with non-substance related addictive behaviors. Neuromodulation may provide a new type of treatment for addiction since it can directly target abnormalities in neurocircuits. We review literature on five neuromodulation techniques investigated for efficacy in substance related and behavioral addictions: transcranial direct current stimulation (tDCS), (repetitive) transcranial magnetic stimulation (rTMS), EEG, fMRI neurofeedback and deep brain stimulation (DBS) and additionally report on effects of these interventions on addiction-related cognitive processes. While rTMS and tDCS, mostly applied at the dorsolateral prefrontal cortex, show reductions in immediate craving for various addictive substances, placebo-responses are high and long-term outcomes are understudied. The lack in well-designed EEG-neurofeedback studies despite decades of investigation impedes conclusions about its efficacy. Studies investigating fMRI neurofeedback are new and show initial promising effects on craving, but future trials are needed to investigate long-term and behavioral effects. Case studies report prolonged abstinence of opioids or alcohol with ventral striatal DBS but difficulties with patient inclusion may hinder larger, controlled trials. DBS in neuropsychiatric patients modulates brain circuits involved in reward processing, extinction and negative-reinforcement that are also relevant for addiction. To establish the potential of neuromodulation for addiction, more randomized controlled trials are needed that also investigate treatment duration required for long-term abstinence and potential synergy with other addiction interventions. Finally, future advancement may be expected from tailoring neuromodulation techniques to specific patient (neurocognitive) profiles.",
keywords = "Addiction, Cognitive outcome measures, Deep brain stimulation, EEG neurofeedback, Neuromodulation, Transcranial direct current stimulation, Transcranial magnetic stimulation",
author = "Judy Luigjes and Rebecca Segrave and {de Joode}, Niels and Martijn Figee and Damiaan Denys",
year = "2019",
month = "3",
doi = "10.1007/s11065-018-9393-5",
language = "English",
volume = "29",
pages = "116--138",
journal = "Neuropsychology Review",
issn = "1040-7308",
publisher = "Springer-Verlag London Ltd.",
number = "1",

}

Efficacy of Invasive and Non-Invasive Brain Modulation Interventions for Addiction. / Luigjes, Judy; Segrave, Rebecca; de Joode, Niels; Figee, Martijn; Denys, Damiaan.

In: Neuropsychology Review, Vol. 29, No. 1, 03.2019, p. 116-138.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Efficacy of Invasive and Non-Invasive Brain Modulation Interventions for Addiction

AU - Luigjes, Judy

AU - Segrave, Rebecca

AU - de Joode, Niels

AU - Figee, Martijn

AU - Denys, Damiaan

PY - 2019/3

Y1 - 2019/3

N2 - It is important to find new treatments for addiction due to high relapse rates despite current interventions and due to expansion of the field with non-substance related addictive behaviors. Neuromodulation may provide a new type of treatment for addiction since it can directly target abnormalities in neurocircuits. We review literature on five neuromodulation techniques investigated for efficacy in substance related and behavioral addictions: transcranial direct current stimulation (tDCS), (repetitive) transcranial magnetic stimulation (rTMS), EEG, fMRI neurofeedback and deep brain stimulation (DBS) and additionally report on effects of these interventions on addiction-related cognitive processes. While rTMS and tDCS, mostly applied at the dorsolateral prefrontal cortex, show reductions in immediate craving for various addictive substances, placebo-responses are high and long-term outcomes are understudied. The lack in well-designed EEG-neurofeedback studies despite decades of investigation impedes conclusions about its efficacy. Studies investigating fMRI neurofeedback are new and show initial promising effects on craving, but future trials are needed to investigate long-term and behavioral effects. Case studies report prolonged abstinence of opioids or alcohol with ventral striatal DBS but difficulties with patient inclusion may hinder larger, controlled trials. DBS in neuropsychiatric patients modulates brain circuits involved in reward processing, extinction and negative-reinforcement that are also relevant for addiction. To establish the potential of neuromodulation for addiction, more randomized controlled trials are needed that also investigate treatment duration required for long-term abstinence and potential synergy with other addiction interventions. Finally, future advancement may be expected from tailoring neuromodulation techniques to specific patient (neurocognitive) profiles.

AB - It is important to find new treatments for addiction due to high relapse rates despite current interventions and due to expansion of the field with non-substance related addictive behaviors. Neuromodulation may provide a new type of treatment for addiction since it can directly target abnormalities in neurocircuits. We review literature on five neuromodulation techniques investigated for efficacy in substance related and behavioral addictions: transcranial direct current stimulation (tDCS), (repetitive) transcranial magnetic stimulation (rTMS), EEG, fMRI neurofeedback and deep brain stimulation (DBS) and additionally report on effects of these interventions on addiction-related cognitive processes. While rTMS and tDCS, mostly applied at the dorsolateral prefrontal cortex, show reductions in immediate craving for various addictive substances, placebo-responses are high and long-term outcomes are understudied. The lack in well-designed EEG-neurofeedback studies despite decades of investigation impedes conclusions about its efficacy. Studies investigating fMRI neurofeedback are new and show initial promising effects on craving, but future trials are needed to investigate long-term and behavioral effects. Case studies report prolonged abstinence of opioids or alcohol with ventral striatal DBS but difficulties with patient inclusion may hinder larger, controlled trials. DBS in neuropsychiatric patients modulates brain circuits involved in reward processing, extinction and negative-reinforcement that are also relevant for addiction. To establish the potential of neuromodulation for addiction, more randomized controlled trials are needed that also investigate treatment duration required for long-term abstinence and potential synergy with other addiction interventions. Finally, future advancement may be expected from tailoring neuromodulation techniques to specific patient (neurocognitive) profiles.

KW - Addiction

KW - Cognitive outcome measures

KW - Deep brain stimulation

KW - EEG neurofeedback

KW - Neuromodulation

KW - Transcranial direct current stimulation

KW - Transcranial magnetic stimulation

UR - http://www.scopus.com/inward/record.url?scp=85058123783&partnerID=8YFLogxK

U2 - 10.1007/s11065-018-9393-5

DO - 10.1007/s11065-018-9393-5

M3 - Review Article

VL - 29

SP - 116

EP - 138

JO - Neuropsychology Review

JF - Neuropsychology Review

SN - 1040-7308

IS - 1

ER -