Vagus Nerve Stimulation as a Potential Therapeutic Strategy for Alcohol Use Disorder

Alcohol use disorder (AUD) contributes to approximately 3 million deaths worldwide each year and leads to substantial emotional, financial, and social implications for individuals and their families. AUD leads to multi-system damage, including the immune system, gut microbiome, neuroendocrine pathways, and the brain. Current treatments for AUD, focused primarily on behavioral and pharmaceutical interventions, insufficiently address alcohol's extensive impact on multiple body systems. Vagus nerve stimulation (VNS) has shown therapeutic benefits across a spectrum of neurological conditions, including epilepsy, depression, and addictive disorders. More recently, VNS is being investigated as a potential promising adjunctive treatment for AUD, which may complement currently used treatments by targeting many of the body systems dysregulated in AUD. Preclinical and clinical models have evaluated different VNS paradigms, including invasive, noninvasive, and minimally invasive approaches targeting motor and cognitive rehabilitation, withdrawal symptoms, and relapse during abstinence. However, while VNS has many promising potential benefits for improving AUD outcomes, direct evidence that VNS reduces alcohol consumption, alcohol seeking, or craving in AUD remains limited, and there are several logistical and ethical considerations that researchers, clinicians, and policymakers should evaluate before VNS is considered standard of care. Additionally, optimization of VNS parameters, modality (implanted versus noninvasive or minimally invasive), and development of responder biomarkers could better inform patient selection for VNS. Although significant work remains before transitioning VNS into clinical practice, VNS offers an exciting opportunity for adjunctive treatment in AUD that could potentially target multi-system AUD dysfunction.