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Addict Biol. 2017 Nov;22(6):1632-1640. doi: 10.1111/adb.12463. Epub 2016 Oct 27.

A clinical trial with combined transcranial direct current stimulation and alcohol approach bias retraining.

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Addiction, Development and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, The Netherlands.
Amsterdam Brain and Cognition (ABC), University of Amsterdam, The Netherlands.
Research Centre-Military Mental Health, Ministry of Defense, The Netherlands.
Behavioural Science Institute, Radboud University Nijmegen, The Netherlands.
Salus Klinik, Germany.


Two studies showed an improvement in clinical outcomes after alcohol approach bias retraining, a form of Cognitive Bias Modification (CBM). We investigated whether transcranial direct current stimulation (tDCS) could enhance effects of CBM. TDCS is a neuromodulation technique that can increase neuroplasticity and has previously been found to reduce craving. One hundred alcohol-dependent inpatients (91 used for analysis) were randomized into three experimental groups in a double-blind parallel design. The experimental group received four sessions of CBM while receiving 2 mA of anodal tDCS over the dorsolateral prefrontal cortex (DLPFC). There were two control groups: One received sham stimulation during training and one received active stimulation at a different moment. Treatment outcomes were abstinence duration (primary) and relapse after 3 and 12 months, craving and approach bias (secondary). Craving and approach bias scores decreased over time; there were no significant interactions with experimental condition. There was no effect on abstinence duration after three months (χ2(2) = 3.53, p = 0.77). However, a logistic regression on relapse rates after one year (standard outcome in the clinic, but not-preregistered) showed a trend when relevant predictors were included; relapse was lower in the condition receiving active stimulation during CBM only when comparing to sham stimulation (B = 1.52, S.E. = .836, p = .07, without predictors: p = .19). No strong evidence for a specific enhancement effect of tDCS on CBM was found. However, in a post-hoc analysis, tDCS combined with CBM showed a promising trend on treatment outcome. Important limitations are discussed, and replication is necessary to find more reliable effects.


CBM; alcoholism; tDCS

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