Efficacy of single-session transcranial direct current stimulation on addiction-related inhibitory control and craving: a randomized trial in males with Internet gaming disorder

Lu-Lu Wu, Marc N Potenza, Nan Zhou, Hedy Kober, Xin-Hui Shi, Sarah W Yip, Jia-Hua Xu, Lei Zhu, Rui Wang, Guan-Qun Liu, Jin-Tao Zhang, Lu-Lu Wu, Marc N Potenza, Nan Zhou, Hedy Kober, Xin-Hui Shi, Sarah W Yip, Jia-Hua Xu, Lei Zhu, Rui Wang, Guan-Qun Liu, Jin-Tao Zhang

Abstract

Background: Transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (dlPFC) may reduce substance use and other addictive behaviours. However, the cognitive mechanisms that underpin such effects remain unclear. Impaired inhibitory control linked to hypoactivation of the prefrontal cortex may allow craving-related motivations to lead to compulsive addictive behaviours. However, very few studies have examined whether increasing the activation of the dlPFC via anodal tDCS could enhance inhibitory control over addiction-related distractors. The current study aimed to enrich empirical evidence related to this issue.

Methods: Thirty-three males with Internet gaming disorder underwent active (1.5 mA for 20 minutes) and sham tDCS 1 week apart, in randomized order. We assessed inhibitory control over gaming-related distractors and craving pre- and post-stimulation.

Results: Relative to sham treatment, active tDCS reduced interference from gaming-related (versus non-gaming) distractors and attenuated background craving, but did not affect cue-induced craving.

Limitations: This study was limited by its relatively small sample size and the fact that it lacked assessments of tDCS effects on addictive behaviour. Future tDCS studies with multiple sessions in larger samples are warranted to examine the effects on addictive behaviours of alterations in addiction-related inhibitory control.

Conclusion: These findings demonstrate that stimulation of the dlPFC influences inhibitory control over addiction-related cues and addiction-related motivation. This is the first empirical study to suggest that enhanced inhibitory control may be a cognitive mechanism underlying the effects of tDCS on addictions like Internet gaming disorder. Our finding of attenuated background craving replicated previous tDCS studies. Intriguingly, our finding of distinct tDCS effects on 2 forms of craving suggests that they may have disparate underlying mechanisms or differential sensitivity to tDCS.

Clinical trials #: NCT03352973.

Conflict of interest statement

M. Potenza has consulted for and advised INSYS, Shire, RiverMend Health, Lakelight Therapeutics/Opiant and Jazz Pharmaceuticals; has received research support from the Mohegan Sun Casino and the National Center for Responsible Gaming; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse control disorders or other health topics; and has consulted for law offices and gambling entities on issues related to impulse control or addictive disorders.

© 2021 Joule Inc. or its licensors

Figures

Fig. 1
Fig. 1
Flow chart depicting the screening and randomization of participants. Advertisements led to the eligibility screening of 364 young adults from universities in Beijing. Thirty-eight eligible participants with Internet gaming disorder were randomly assigned to 1 of 2 groups using a 1:1 ratio. One group received 2 tDCS sessions in active–sham order, and the other group received 2 tDCS sessions in sham–active order. Thirty-three participants completed the whole study; 5 participants discontinued because of scheduling conflicts with the second visit. tDCS = transcranial direct current stimulation.
Fig. 2
Fig. 2
Example of the trial sequence for the task assessing inhibitory control. Participants were instructed to ignore the central picture and judge whether the target letter was K or N.
Fig. 3
Fig. 3
Effects of transcranial direct current stimulation (tDCS) on inhibitory control and craving. (A) For the sham tDCS condition, the interference effect from gaming pictures was larger than that from non-gaming pictures; for the active tDCS condition, the 2 picture types revealed no significant difference in interference effect. (B1) For the sham tDCS condition, we found no significant difference in background craving between the pre- versus poststimulation conditions; for the active tDCS condition, craving was lower post-stimulation versus pre-stimulation. (B2) Analyses of ratings of cue-induced craving did not reveal significant results. *p < 0.05; **p < 0.01. NS = not significant.

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