Commentary on the Role of Transcranial Direct Current Stimulation in Substance Use Disorders.

We read with interest the 2 related articles in this issue of The Journal of ECT: “The effect of transcranial direct current stimulation on opium craving, depression and anxiety: a preliminary study” by Taremian et al and “Transcranial direct current stimulation reduces craving in substance use disorders: a doubleblind placebo-controlled study” by Martinotti et al. Both these studies use transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex treatment (right anodal/left cathodal) for treatment of a fundamental feature of addiction—craving, which was added to theDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition, substance use disorder criteria. Both also investigate the effects of this treatment on co-occurring psychiatric symptoms. Both studies correctly recognize that the above issues, especially craving, are significant factors in continued use/relapse and that current interventions, whether behavioral or pharmacologic, are only moderately successful in addressing craving and are also relatively slow in reducing craving level. Interventions that can increase the power and speed with which craving and co-occurring psychiatric symptoms can be reduced could have significant benefits, including increased retention in treatment, reduction in against medical/clinical advice discharges, and earlier and more substantial engagement in treatment. Transcranial direct current stimulation as used in both studies showed significant rapid reductions in craving and co-occurring psychiatric symptoms (depression and anxiety in the study by Taremian et al as well as impulsiveness in the study byMartinotti et al), confirming the trends from the previous scientific