Neuroscience and Biobehavioral Reviews 104 (2019) 118–140 Contents lists available at ScienceDirect Neuroscience and Biobehavioral Reviews journal homepage: www.elsevier.com/locate/neubiorev Review article Transcranial electrical and magnetic stimulation (tES and TMS) for T addiction medicine: A consensus paper on the present state of the science and the road ahead ⁎ Hamed Ekhtiaria, , Hosna Tavakolib,c, Giovanni Addoloratod,e, Chris Baekenf, Antonello Boncig,h,i, Salvatore Campanellaj, Luis Castelo-Brancok, Gaëlle Challet-Boujul, Vincent P. Clarkm,n, Eric Clausn, Pinhas N. Dannono, Alessandra Del Felicep,q, Tess den Uylr, Marco Dianas, Massimo di Giannantoniot, John R. Fedotau, Paul Fitzgeraldv, Luigi Gallimbertiw, Marie Grall-Bronnecl, Sarah C. Herremansf, Martin J. Herrmannx, Asif Jamily, Eman Khedrz, Christos KouimtsidisA, Karolina KozakB,C, Evgeny KrupitskyD,E, Claus LammF, William V. LechnerG, Graziella Madeog, Nastaran Malmirc, Giovanni Martinottit, William M. McDonaldH, Chiara Montemitrog,t, Ester M. Nakamura-PalaciosI, Mohammad NasehiJ, Xavier Noëlj, Masoud NosratabadiK, Martin Paulusa, Mauro Pettorrusot, Basant PradhanL, Samir K. PraharajM, Haley Raffertyk, Gregory SahlemN, Betty jo Salmerong, Anne SauvagetO,P, Renée S. Schlutera,b, Carmen SergiouQ, Alireza Shahbabaiey, Christine ShefferR, Primavera A. SpagnoloS, Vaughn R. Steeleu, Ti-fei YuanT, Josanne D.M. van DongenQ, Vincent Van WaesU, Ganesan VenkatasubramanianV, Antonio Verdejo-GarcíaW, Ilse VerveerQ, Justine W. WelshH, Michael J. WesleyX, Katie Witkiewitzn, Fateme Yavariy, Mohammad-Reza ZarrindastY, Laurie ZawertailoB,C, Xiaochu ZhangZ, Yoon-Hee Chaa, Tony P. GeorgeB,C, Flavio Frohlichaa, Anna E. Goudriaanab,ac, Shirley Fecteauad, Stacey B. Daughtersaa, Elliot A. Steinu, Felipe Fregnik, Michael A. Nitschey,ae, Abraham Zangenaf, Marom Biksonag, Colleen A. HanlonN a Laureate Institute for Brain Research, USA b Institute for Cognitive Science Studies (ICSS), Iran c Iranian National Center for Addiction Studies (INCAS), Iran d Alcohol Use Disorder Unit, Division of Internal Medicine, Gastroenterology and Hepatology Unit, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy e Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy f Department of Psychiatry and Medical Psychology, University Hospital Ghent, Ghent, Belgium g Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA h Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA i Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA j Université Libre de Bruxelles (ULB), Belgium k Spaulding Rehabilitation Hospital, Harvard Medical School, USA l University of Nantes, France m University of New Mexico, USA n The Mind Research Network, USA o University of Tel Aviv, Israel p University of Padova, Department of Neuroscience, Padova, Italy q Padova Neuroscience Center (PNC), University of Padova, Padova, Italy r University of Amsterdam, The Netherlands s ‘G. Minardi’ Laboratory of Cognitive Neuroscience, Department of Chemistry and Pharmacy, University of Sassari, Italy t University G.d’Annunzio of Chieti-Pescara, Italy u Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA v Monash University, Australia w Novella Fronda Foundation, Human Science and Brain Research, Padua, Italy ⁎ Corresponding Author at: Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK 74136-3326, USA. E-mail address: [email protected] (H. Ekhtiari). https://doi.org/10.1016/j.neubiorev.2019.06.007 Available online 02 July 2019 0149-7634/ © 2019 Elsevier Ltd. All rights reserved. H. Ekhtiari, et al. Neuroscience and Biobehavioral Reviews 104 (2019) 118–140 x Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany y Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany z Assiut University Hospital, Egypt A Imperial College London, UK B University of Toronto, Canada C Centre for Addiction and Mental Health (CAMH), Canada D V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St.-Petersburg, Russia E St.-Petersburg First Pavlov State Medical University, Russia F Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Austria G Kent State University, USA H Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA I Federal University of Espírito Santo, Brazil J Cognitive and Neuroscience Research Center (CNRC), Tehran Medical Sciences, Islamic Azad University, Tehran, Iran K University of Social Welfare and Rehabilitation Sciences, Iran L Cooper University Hospital, USA M Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India N Medical University of South Carolina (MUSC), USA O Laboratory «Movement, Interactions, Performance» (E.A. 4334), University of Nantes, 25 Bis Boulevard Guy Mollet, BP 72206, 44322, Nantes Cedex 3, France P CHU de Nantes Addictology and Liaison Psychiatry Department, University Hospital Nantes, Nantes Cedex 3, France Q Erasmus University Rotterdam, The Netherlands R Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA S National Institutes of Health, USA T Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China U Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université Bourgogne Franche-Comté, Besançon, France V National Institute of Mental Health and Neurosciences, India W Turner Institute for Brain and Mental Health, Monash University, Australia X University of Kentucky College of Medicine, USA Y Department of Pharmacology School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Z University of Science and Technology of China, China aa University of North Carolina at Chapel Hill, USA ab Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands ac Arkin, Department of Research and Quality of Care, Amsterdam, The Netherlands ad Laval University, Canada ae University Medical Hospital Bergmannsheil, Dept. Neurology, Bochum, Germany af Ben Gurion University of the Negev, Israel ag The City College of New York, USA ARTICLE INFO ABSTRACT Keywords: There is growing interest in non-invasive brain stimulation (NIBS) as a novel treatment option for substance-use Substance use disorder disorders (SUDs). Recent momentum stems from a foundation of preclinical neuroscience demonstrating links Addiction between neural circuits and drug consuming behavior, as well as recent FDA-approval of NIBS treatments for Non-invasive brain stimulation mental health disorders that share overlapping pathology with SUDs. As with any emerging field, enthusiasm Transcranial electrical stimulation must be tempered by reason; lessons learned from the past should be prudently applied to future therapies. Here, Transcranial magnetic stimulation an international ensemble of experts provides an overview of the state of transcranial-electrical (tES) and rTMS tDCS transcranial-magnetic (TMS) stimulation applied in SUDs. This consensus paper provides a systematic literature tES review on published data – emphasizing the heterogeneity of methods and outcome measures while suggesting NIBS strategies to help bridge knowledge gaps. The goal of this effort is to provide the community with guidelines for Psychiatry best practices in tES/TMS SUD research. We hope this will accelerate the speed at which the community translates basic neuroscience into advanced neuromodulation tools for clinical practice in addiction medicine. 1. Introduction have not been studied for SUDs at present, and therefore are not in- cluded in this review. Human neuroimaging and preclinical investigations have advanced The purpose of this consensus paper is to review the current body of our knowledge of the neural circuitry that perpetuates the cycle of re- knowledge of the utility of NIBS for SUDs and our current under- lapse and recovery in substance use disorders (SUD). The challenge now standing of the biological basis through which these techniques mod- is to translate this knowledge into evidence-based interventions for ulate the brain. An important challenge has been the tremendous patients with SUDs (Ekhtiari and Paulus, 2016). Two tools that de- variability in the methods and outcome measures across tES/TMS trials monstrate promise in bridging this gap are transcranial electrical sti- in SUDs. Additionally, as with most innovative approaches, many (al- mulation (tES) and transcranial magnetic stimulation (TMS) (Fig. 1) though not all) of the NIBS studies published in the SUD field have (Coles et al., 2018; Hone-Blanchet et al., 2015; Yavari et al., 2016). small sample sizes, do not contain rigorous control conditions, and are While these non-invasive brain stimulation (NIBS) techniques are still not sufficiently blinded. This makes reproducibility and interpretation in an early stage of development for SUDs, there is a growing inter- difficult. national community of investigators who are attempting to optimize, To address these limitations and to propose a new framework for evaluate, and validate their use as novel treatments for individuals