title: Neuromodulation Therapies for Alcohol Addiction: A Literature Review.
abstract: OBJECTIVE
  The goal of this review is to explore alternative neurological therapies in the treatment of alcohol use disorder; including transcranial direct current stimulation (tDCS), transcranial magnetic stimulation, deep brain stimulation (DBS), electroconvulsive therapy (ECT), and the off-label use of the GABABreceptor agonist baclofen.
  
  
  METHODS
  A comprehensive literature search was conducted through EBSCOhost regarding the neurological therapies in the treatment of alcoholism discussed in this paper.
  
  
  RESULTS
  To date, few studies have been conducted on the subject, sample sizes are consistently small, and long-term abstinence appears a common problem. tDCS has shown to temporarily reduce alcohol cravings but with a high number of long-term relapses, 50-70%. DBS and TMS, similarly, fail to overcome high relapse rates. In one DBS study, for example, only two of five patients achieved prolonged abstinence. ECT seems to avoid such problems, but only a single case study exists to date. As such, no solid conclusions can be made regarding its success in alcohol addiction treatment. Baclofen, however, implicated in studies with comparatively larger patient samples and higher efficacy rates, presents with great promise, particularly in patients with more severe forms of AUD. In one of the largest observational studies to date (100 subjects) 92% of patients reported craving suppression and long-term relapse rates were low. The side-effects of oral baclofen (i.e., somnolence, insomnia, dizziness, paresthesia, etc.) though, pose a principle limitation to its administration in alcohol addiction.
  
  
  CONCLUSIONS
  Based on current information in the literature, the authors advocate that, following more extensive research on oral baclofen and its indications in the treatment of alcohol addiction, intrathecal administration be the next logical therapeutic option to be explored. In particular, those patients with severe AUD, requiring high doses of the medication, may benefit, as it eliminates the systemic side effects associated with oral baclofen.
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Celeste A
authors.initials: CA
authors.lastname: Azevedo
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Antonios
authors.initials: A
authors.lastname: Mammis
mesh_terms: D000437:Alcoholism / Q000628:therapy*; D000818:Animals; D001418:Baclofen / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D018377:Neurotransmitter Agents / Q000627:therapeutic use*; D065908:Transcranial Direct Current Stimulation; D050781:Transcranial Magnetic Stimulation
chemical_list: D018377:Neurotransmitter Agents; D001418:Baclofen
keywords: Alcohol addiction, baclofen, deep brain stimulation, electroconvulsive therapy, transcranial direct current stimulation, transcranial magnetic stimulation