BACKGROUND Craving plays a central role in reinforcing alcohol use disorder (AUD), and non-invasive brain stimulation (NIBS) has shown potential as a therapeutic intervention in AUD. We aim to evaluate the efficacy and safety following the application of NIBS in patients with AUD.

METHODS A search of the PubMed, EMBASE, Cochrane Library and PsycINFO databases for articles published up to June 30, 2024 using predefined search terms identified a total of 20 randomized controlled trials (RCTs) and 22 units. The primary outcome of this study was the change in craving severity. The secondary outcome was the rate of adverse events.

RESULTS Comparing the effect of alcohol craving severity reduction between the NIBS group and the sham group, the NIBS group showed a significant reduction in alcohol craving severity compared to the sham group (SMD = -0.211; 95% CI = -0.379 to -0.042). The I value was 22.2%, indicating a low level of heterogeneity (p = 0.17). Regarding safety, the NIBS group had an increased rate of adverse events compared to the sham group, but this was not significant (OR = 1.494; 95% CI = 0.834 to 2.675). In a subgroup analysis based on the types of NIBS, only transcranial direct current stimulation showed a significant effect (SMD = -0.214; 95% CI = -0.427 to -0.002). Subgroup analyses of stimulation parameters in NIBS showed that a significant reduction in craving severity was observed when NIBS was applied to the dorsolateral prefrontal cortex (SMD = -0.200; 95% CI = -0.381 to -0.019) and when multiple sessions were administered (SMD = -0.388; 95% CI = -0.620 to -0.156). In addition, a significant reduction in craving severity due to delayed effects was observed even 4 weeks after the last stimulation (SMD = -0.553; 95% CI = -0.979 to -0.126), but this finding should be interpreted with caution.

CONCLUSIONS NIBS is effective in reducing the severity of craving in patients with AUD. This study provides the latest evidence on the effect of NIBS in reducing craving severity in AUD patients.