A Novel Approach with Transcranial Direct Current Stimulation to Tackle Gambling Disorder: A Case Series of Four Patients in an Industrial Setting

Abstract

Gambling Disorder (GD), currently classified as a behavioural addiction in ICD-11, is associated with impairment in reward processing and impulsivity. The role of transcranial Direct Current Stimulation (tDCS) in reducing craving and impulsive behaviours by modulating dorsolateral prefrontal cortex (DLPFC) activity has been explored. We present a case series of four male patients with Gambling Disorder who exhibited severe financial losses, socio-occupational impairment, suicidal ideation or behaviour, and persistent gambling urges despite treatment with Naltrexone and Cognitive Behavioural Therapy (CBT). All patients received adjunctive bilateral tDCS consisting of six sessions of left cathodal/right anodal stimulation over the DLPFC (2 mA for 20 minutes on alternate days for two weeks). Clinical assessment using Gambling Symptom Assessment Scale (GSAS), Barratt Impulsiveness Scale-11 (BIS-11), and Montreal Cognitive Assessment (MoCA) demonstrated reduction in gambling urges and impulsivity following intervention, with sustained improvement at one-month follow-up. No significant cognitive adverse effects were observed. Mild transient side effects included tingling sensation and headache. These findings suggest that bilateral DLPFC tDCS may serve as a safe and promising augmentation strategy for Gambling Disorder.