A new study published in Translational Psychiatry explores deep brain stimulation (DBS) in treating alcohol use disorder. The results of the study indicate that DBS may be a beneficial treatment for those with treatment-resistant alcohol use disorder. While the study didn’t show significant results in terms of continuous abstinence, it did indicate that DBS might help reduce symptoms associated with alcohol use disorder, such as abstaining from alcohol more often, reducing cravings, and lessening anhedonia.
Alcohol use disorder is a chronic and relapsing disorder that affects millions of people worldwide. Despite the availability of various treatments, many individuals with alcohol use disorder do not respond to traditional therapies.
DBS is a relatively new treatment option that has shown promise in treating other psychiatric disorders, such as epilepsy and obsessive-compulsive disorder. It involves implanting a device, often referred to as a “brain pacemaker,” into the brain to deliver electrical impulses to specific regions.
Using DBS to treat addiction in humans has been studied for more than 15 years. It started with a patient who had severe anxiety disorder and alcohol use disorder and noticed a decrease in alcohol consumption while receiving DBS treatment in a specific brain area called the nucleus accumbens.
However, previous studies had limitations because they were open-label (not blinded) and not randomized, meaning the effects observed could be influenced by factors other than DBS. To address these limitations, a new study called “Deep Brain Stimulation in Treatment-Resistant Alcoholism” (DeBraSTRA) was conducted involving multiple research sites.
The study was a double-blind, randomized controlled trial that included 12 participants with treatment-resistant alcohol use disorder. Participants were randomly assigned to receive either active DBS or placebo stimulation during a blind phase of 24 weeks. This was followed by a phase where all participants received DBS for 52 weeks.
The primary outcome measure was the proportion of participants who achieved and maintained abstinence from alcohol during the blind phase of the trial. Secondary outcome measures included changes in alcohol consumption, cravings, depression, anxiety, and general apathy.
The results of the study showed that DBS was safe and well-tolerated by participants. There were no serious adverse events related to the DBS treatment. However, the study did not find a statistically significant difference between the active DBS and placebo stimulation groups in terms of the primary outcome measure. This was most likely because the sample size of participants was small and the primary outcome measure was categorical (the participants either maintained continuous abstinence or they did not).
But the study did find a medium effect of DBS in treating alcohol use disorder, as indicated by the number needed to treat (NNT) calculation. The NNT for the active DBS group was 9.6. This suggests that for every 9.6 individuals treated with DBS, one additional person would achieve and maintain abstinence from alcohol.
Additionally, the results indicate that DBS treatment had a positive impact on some of the secondary outcomes, including a significantly higher proportion of abstinent days, lower alcohol craving, and lower anhedonia scores in the first experimental group as compared to those receiving placebo.
The results suggest that DBS may have a positive effect in treating alcohol use disorder, but further research is needed to confirm these findings. The research team acknowledges several limitations to the study, including the small sample size, the categorical nature of the primary outcome measure, and the limited statistical power of the study. The authors note that future research should include larger sample sizes, longer follow-up periods, and more sensitive outcome measures.
This study may represent a significant step forward in developing new treatments for alcohol use disorder. DBS has shown promise in treating other psychiatric disorders, and this study provides preliminary evidence that it may also be an helpful treatment for severe alcohol use disorder.
The study, “Deep brain stimulation of the nucleus accumbens in treatment-resistant alcohol use disorder: a double-blind, randomized controlled multi-center trial,” was authored by Patrick Bach, Mathias Luderer, Ulf Joachim Müller, Martin Jakobs, Juan Carlos Baldermann, Jürgen Voges, Karl Kiening, Anke Lux, Veerle Visser-Vandewalle, the DeBraSTRA study group, Bernhard Bogerts, Jens Kuhn, and Karl Mann.
