Bilateral Transcranial Direct-Current Stimulation Over the Dorsolateral Prefrontal Cortex Significantly Reduces Relief Craving During Alcohol Withdrawal: A Randomized Sham-Controlled Trial Among Inpatients With Alcohol Dependence Syndrome in Northern India

AI Summary

Bilateral dlPFC tDCS during withdrawal produced a significant reduction in relief craving versus sham (mean 14.17 vs 7.08; P < .001).
Treatment effect remained significant after controlling for dependence severity; SADQ did not modify outcome.
Protocol: 10 sessions over five days, 2 mA for 20 minutes, left cathodal F3 right anodal F4; affordable, well tolerated adjunct warranting larger trials.

TL;DR (AI Generated)

The objective of this study was to examine whether bilateral transcranial direct-current stimulation (tDCS) targeting the dorsolateral prefrontal cortex (dlPFC) could attenuate relief craving in ADS in patients undergoing withdrawal and whether treatment gains varied with the severity of dependence.

Craving and dependence severity were rated with the Penn Alcohol Craving Scale (PACS) and Severity of Alcohol Dependence Questionnaire (SADQ) at baseline (day 1) and 24 hours postcompletion (day 6).

Conclusion: Bilateral dlPFC tDCS applied during the active withdrawal period produced a clinically meaningful and statistically robust reduction in relief craving that exceeded sham and was not modified by dependence severity.

Basic summary

Prim Care Companion CNS Disord. 2026 Sep 17;28(5):26m04219. doi: 10.4088/PCC.26m04219.

ABSTRACT

Objective: Alcohol dependence syndrome (ADS) carries a heavy global disease burden. Relief craving, the compulsion to drink to escape withdrawal distress, is among its most treatment-resistant features and a frequent trigger for relapse. Given the limited effectiveness of conventional therapies, there is growing interest in targeted neuromodulation of prefrontal circuits as an adjunct approach. The objective of this study was to examine whether bilateral transcranial direct-current stimulation (tDCS) targeting the dorsolateral prefrontal cortex (dlPFC) could attenuate relief craving in ADS in patients undergoing withdrawal and whether treatment gains varied with the severity of dependence.

Methods: A single-blind (participant-blinded) study was conducted between March 2024 and March 2025 at a tertiary psychiatry center in Dehradun, Northern India. Fifty male inpatients meeting ICD-10 criteria for ADS were targeted; 48 completed the study and were included in the analysis. The participants had a mean age of 38.5 years and were allocated to either active tDCS (group A, n = 24; 2 mA for 20 min/session, left cathodal F3/right anodal F4) or sham tDCS (group B, n = 24) across 10 sessions over 5 days, initiated during the active withdrawal phase. Craving and dependence severity were rated with the Penn Alcohol Craving Scale (PACS) and Severity of Alcohol Dependence Questionnaire (SADQ) at baseline (day 1) and 24 hours postcompletion (day 6).

Results: PACS scores fell in both arms, but the active group’s reduction was nearly twice that of sham (14.17 vs. 7.08; P < .001). Repeated-measures analysis of covariance confirmed a group-by-time interaction independent of baseline dependence severity (F_1,45= 11.89, P = .001, ηp² = 0.209; SADQ covariate: F_1,45= 1.20, P = .279). The anticraving effect held across both mild-to-moderate and severe dependence subgroups.

Conclusion: Bilateral dlPFC tDCS applied during the active withdrawal period produced a clinically meaningful and statistically robust reduction in relief craving that exceeded sham and was not modified by dependence severity. These findings position tDCS as an affordable, well-tolerated adjunct worthy of investigation in larger definitive trials.

Trial Registration: ISRCTN identifier: ISRCTN88255964.

Prim Care Companion CNS Disord 2026;28(5):26m04219.

Author affiliations are listed at the end of this article.

PMID:42758631 | DOI:10.4088/PCC.26m04219

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