The Effects of Transcranial Direct Current Stimulation of Dorsolateral Prefrontal Cortex on Reduction of Craving in Daily and Social Smokers
Objective: Tobacco smoking is an addictive behavior with many psychological side effects, and many smokers are unable to quit it. Despite various treatments for smoking cessation, there is an urgent need to develop and utilize a noninvasive technique with high efficacy. This study aimed to determine the effects of transcranial direct current stimulation (tDCS) of dorsolateral prefrontal cortex (DLPFC) on reduction of craving in daily and social smokers.
Method: This pretest-posttest quasi-experimental study, in which the participants were randomly assigned into sham and active groups, was performed on 40 daily and social smokers. Stimulation was delivered over the left DLPFC at a 2 m/A during 10 twenty-minute sessions for 5 weeks. The participants filled out the Desire for Drug questionnaire (DDQ) before and after intervention. Analysis of covariance was used for data analysis.
Results: A significant decrease was found in the number of cigarette smoking in both daily and social smokers compared to the sham group. Moreover, the results indicated that anodal tDCS on F3 and Cathodal tDCS on F4 has significant effects on nicotine craving (P < 0/000).
Conclusion: The results of the present study showed that the current tDCS of DLPFC decreases the craving of smoking. This noninvasive brain stimulation technique targeted at DLPFC area may be a promising method for reducing and treating smoking craving.
2. Lariscy JT. Smoking-attributable mortality by cause of death in the United States: An indirect approach.SSM Popul Health. 2019; 7: 100349.
3. World Health Organization report on the global tobacco epidemic. The MPOWER package. Available at:http://whqlibdoc. 2008;who.int/publications/2008/9789241596282_eng.pdf. Accessed November 2009.
4. Meng Z, Liu CH, Yu CH, Ma Y. Transcranial direct current stimulation of the frontal-parietal temporal area attenuates smoking behavior. J Psychiat Res. 2014; 54: 19-25.
5. Wing VC, Barr MS, Wass CE, Lipsman N, Lozano AM. Daskalakis ZJ, George TP. Brain Stimulation Methods to Treat Tobacco Addiction. Brain Stimul. 2013;6(3):221-30.
6. Volkow ND, Li TK. Drug addiction: the neurobiology of behavior gone awry. Nature Rev Neurosci. 2004; 5(12): 963-70.
7. Di Chiara G. Role of dopamine in the behavioral actions of nicotine related to addiction. Eur J Pharmacol. 2000; 393(1-3): 295-314.
8. Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Healton CG, Henderson PN. Treating tobacco use and dependence: 2008 update. Rockville, MD: US Department of Health and Human Services. 2008 May 27.
9. Due DL, Huettel SA, Hall WG, Rubin DC. Activation in mesolimbic and visuospatial neural circuits elicited by smoking cues: evidence from functional magnetic resonance imaging. Am J psychiat. 2002; 159: 954-60.
10. Garavan H, Pankiewicz J, Bloom A, Cho JK, Sperry L, Ross TJ, et al. Cue-induced cocaine craving: neuroanatomical specificity for drug users and drug stimuli. Am J Psychiatry. 2000;157(11):1789-98.
11. Goldstein RZ, Volkow ND. Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. Am J Psychiatry. 2002;159(10):1642-52.
12. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane database of systematic reviews. 2013(5).
13. Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2016(3).
14. Mondino M, Luck D, Grot S, Januel D, Suaud-Chagny MF, Poulet E, et al. Effects of repeated transcranial direct current stimulation on smoking, craving and brain reactivity to smoking cues. Sci Rep. 2018;8(1):8724.
15. Garavan H, Hester R. The role of cognitive control in cocaine dependence. Neuropsychol Rev. 2007;17(3):337-45.
16. Barr MS, Fitzgerald PB, Farzan F, George TP, Daskalakis ZJ. Transcranial magnetic stimulation to understand the pathophysiology and treatment of substance use disorders. Curr Drug Abuse Rev. 2008; 1(3): 328–39.
17. George MS, Aston-Jones G. Noninvasive techniques for probing neurocircuitry and treating illness: vagus nerve stimulation (VNS), transcranialmagnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Neuropsychopharmacology. 2010;35(1):301-16.
18. Nitsche MA, Cohen LG, Wassermann EM, Priori A, Lang N, Antal A, et al. Transcranial direct current stimulation: state of the art 2008. Brain Stimul. 2008; 1(3): 206-23.
19. Nitsche MA, Paulus W. Transcranial direct current stimulation-update 2011. Restor Neurol Neurosci. 2011;29(6):463-92.
20. Nitsche MA, Fricke K, Henschke U, Schlitterlau A, Liebetanz D, Lang N, et al. Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans. J Physiol. 2003; 553(1):293-301.
21. Been G, Ngo TT, Miller SM, Fitzgerald PB. The use of tDCS and CVS as methods of non-invasive brain stimulation. Brain Res Rev. 2007; 56(2): 346-61.
22. Huhn AS, Sweeney MM, Brooner RK, Kidorf MS, Tompkins DA, Ayaz H, et al. Prefrontal cortex response to drug cues, craving, and current depressive symptoms are associated with treatment outcomes in methadone-maintained patients. Neuropsychopharmacology. 2019; 44(4):826-33.
23. Nitsche MA, Lampe C, Antal A, Liebetanz D, Lang N, Tergau F, et al. Dopaminergic modulation of long-lasting direct current-induced cortical excitability changes in the human motor cortex. Eur J Neurosci. 2006; 23(6): 1651-7.
24. Fregni F, Liguori P, Fecteau S, Nitsche MA, Pascual-Leone A, Boggio PS. Cortical stimulation of the prefrontal cortex with transcranial direct current stimulation reduces cue-provoked smoking craving: a randomized, shamcontrolled study. J Clin Psychiat. 2008; 69(1): 32-40.
25. Boggio PS, Liguori P, Sultani N, Rezende L, Fecteau S, Fregni F. Cumulative priming effects of cortical stimulation on smoking cue-induced craving. Neurosci Lett. 2009; 463(1): 82-6.
26. Fecteau, S. et al. Modulation of smoking and decision-making behaviors with transcranial direct current stimulation in tobacco smokers: a preliminary study. Drug Alcohol Depend. 2014;140, 78–84.
27. Xu J, Fregni F, Brody AL, Rahman AS. Transcranial direct current stimulation reduces negative affect but not cigarette craving in overnight abstinent smokers. Front Psychiatry. 2013;4:112.
28. Falcone M, Bernardo L, Ashare RL, Hamilton R, Fasyilton O, McKee SA, et al. Transcranial Direct Current Brain Stimulation Increases Ability to Resist Smoking. Brain Stimul. 2016;9(2):191-6.
29. Mondino M. Bennabi D, Poulet E, Galvao F, Brunelin J, Haffen E. Can transcranial direct current stimulation (tDCS) alleviate symptoms and improve cognition in psychiatric disorders? World J Biol Psychiatry. 2014;15(4):261-75.
30. Franken IHA, Hendriks VM, & Van den Brink W. Initial validation of two opiate craving questionnaires: the obsessive compulsive drug use scale (OCDUS) and the desires for drug questionnaire (DDQ). Addict Behav. 2002; 27: 675- 85.
31. Hasani Abhariyan P, Mokri A, Ganjgahi H, Oghabian MA, Ekhtiari H. Validation for Persian versions of desire for drug questionnaire and obsessive compulsive drug use scale in heroin dependents. [In Persian]. Arch Iran Med. 2016; 19(9): 659-65.
32. Mostafavi SA, Khaleghi A, Mohammadi MR, Akhondzadeh SH. Is transcranial direct current stimulation an effective modality in reducing food craving? Nutr Neurosci. 2018:1-13.
33. Colder CR, Lloyd-Richardson EE, Flaherty BP, Hedeker D, Segawa E, Flay BR. The natural history of college smoking: Trajectories of daily smoking during the freshman year. Addict Behav. 2006;31(12):2212-22.