Non-invasive Brain Stimulation for Alcohol Use Disorders: State of the Art and Future Directions
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Non-invasive Brain Stimulation for Alcohol Use Disorders: State of the Art and Future Directions Noah S. Philip 1,2
&
David O. Sorensen 1 & Daniel M. McCalley 3 & Colleen A. Hanlon 3
# This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2019
Abstract Alcohol use disorders remain one of the leading causes of mortality and morbidity across the world, yet despite this impact, there are few treatment options for patients suffering from these disorders. To this end, non-invasive brain stimulation, most commonly utilizing technologies including transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), has recently emerged as promising potential treatments for alcohol use disorders. Enthusiasm for these interventions is fueled by their non-invasive nature, generally favorable safety profile, and ability to target and modulate brain regions implicated in substance use disorders. In this paper, we describe the underlying principles behind these commonly used stimulation technologies, summarize existing experiments and randomized controlled trials, and provide an integrative summary with suggestions for future areas of research. Currently available data generally supports the use of non-invasive brain stimulation as a near-term treatment for alcohol use disorder, with important caveats regarding the use of stimulation in this patient population. Key Words Transcranial magneticstimulation . transcranialdirectcurrent stimulation . non-invasive brain stimulation . alcohol use disorders . neural architecture
Introduction Alcohol use disorders (AUD) are prevalent, devastating, and often difficult to treat. Alcohol is the third leading preventable cause of mortality and morbidity in the USA, contributing to over 80,000 deaths annually and 241 deaths every day [1]. Furthermore, the combined costs of alcohol to society were nearly 249 billion USD in 2010; to place this number in perspective, this is nearly ten times the 2016 budget of the National Institute of Health [2]. Through advances in technology, we have an unprecedented understanding of the neural circuitry involved in the alcohol use and relapse process. Yet, * Noah S. Philip [email protected] 1
Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, 830 Chalkstone Avenue, Providence, Rhode Island 02908, USA
2
Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA
3
Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina 29412, USA
despite recent advances, treatment options remain limited for AUD, and are largely constrained to pharmacological and behavioral modification paradigms. To date, there are no available treatments that directly and specifically engage the neural targets underlying AUD.
Using Basic Science Knowledge to Develop an Effective, Neural Circuit–Based Treatment for AUD Several brain regions and circuit
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