Modulating cue-induced craving in alcohol dependence syndrome: A functional magnetic resonance imaging blood oxygen level–dependent activation study of adjunctive cathodal high-definition transcranial direct current stimulation over the insula

Background: Cue-elicited craving is a major precipitant of relapse in alcohol dependence syndrome (ADS). High-definition transcranial direct current stimulation (HD-Tdcs) modulates craving circuits, while blood oxygen level–dependent (BOLD) functional magnetic resonance imaging (fMRI) maps brain activity to reveal addiction mechanisms. Aim: To compare the impact of cathodal HD-tDCS over the insula on cue-induced craving in ADS individuals, using changes in fMRI BOLD signal to measure individual differences in neural activation. Methodology: This study employed a randomized, double-arm, sham-controlled pre-post experimental design. Forty male ADS in-patients (18–50 years), diagnosed with ICD-10 DCR F10.24 and clinical institute withdrawal assessment for alcohol-revised (CIWA-Ar) <10, were assigned to active or sham HD-tDCS ( n = 20 each). Participants received cathodal HD-tDCS over the insula for 10 consecutive days, with assessments conducted immediately post-intervention and at 4 weeks post-baseline to evaluate sustained effects on craving and neural activation. Brain activation was measured with Philips Ingenia CX 3T fMRI through the visual image induced craving for ethanol (VICE) task. Severity of craving and dependence was rated with the alcohol craving questionnaire (ACQ), obsessive compulsive drinking scale (OCDS), and Severity of Alcohol Dependence Questionnaire (SADQ). Result: Baseline characteristics did not show any significant differences between groups. After intervention, active HD-tDCS was associated with significant decreases in ACQ-NOW (217.1 ± 18.38 to 122.2 ± 46.7, P < 0.001) and OCDS (42.3 ± 7.55 to 17.25 ± 10.81, P < 0.001). fMRI demonstrated left insula deactivation in the active group, reflecting modulation of craving-related neural circuits. Conclusion: Cathodal HD-tDCS over the insula could be an exciting adjunctive treatment for decreasing cue-induced craving in ADS.