The Progression of Neurofeedback: An Evolving Paradigm in Addiction Treatment and Relapse Prevention

Abstract

Abbreviations: TOVA, test of variables of attention; MMPI, minnesota multiphasic personality inventory; cAMP, cyclic adenosine monophosphate; CREB, camp response element binding protein; MCI, mild cognitive impairment Introduction Recognizing addiction as a public health crisisA recent report published by the Center for Behavioral Health Statistics and Quality found that approximately one in seven Americans is expected to develop a substance use disorder at some point in their lives.1 In 2015, 20.8 million people aged 12 or older in the United States had a substance abuse disorder, indicating that the number of Americans suffering from addiction is similar to the number of Americans suffering from diabetes.2 Moreover, the prevalence of substance use disorders is nearly 1.5 times that of all cancers combined. 3In 2014, over 47,000 people died from a drug overdose. This figure includes nearly 30,000 people who died from an overdose involving prescription drugs, which is more than in any previous year on record. Heroin overdoses have more than tripled between 2010 and 2014. 4 Alcohol misuse, which contributes to 88,000 deaths per year in the United States, was found to be the nation's fourth leading preventable cause of death. 5,6 Approximately one in ten deaths among working adults in the United States is caused by alcohol abuse. 5 The health care expenses, lost productivity, and criminal justice costs related to substance abuse are estimated to cost the federal government $442 billion dollars each year. 7,8 In response to this public health crisis, the U.S. Surgeon General published a report declaring that addiction must be approached as a chronic illness, alongside conditions such as heart disease, diabetes, and cancer. Current issues in addiction treatment and relapse preventionAddiction is characterized by improper engagement of the systems involved in adaptive decision-making.10 Deficiencies in executive functions such as working memory allow substance use behavior to be guided more strongly by automatic, impulsive processes.11 Genetic polymorphisms or stress may induce a hypodopaminergic trait/state, predisposing individuals to instinctively seek out substances or behaviors that stimulate dopaminergic activity.12,13 Substance use may thus engage a vicious cycle, as addictive drugs have been implicated to damage brain regions involved in higher-order functioning, further reducing self-regulatory capabilities.14 Although traditional methodologies such as counseling, group therapy, and medication have produced some success in treating addiction, relapse rates remain high. Bailey et al. reported that 90% of inpatient opioid detoxification patients relapsed within a year of treatment.15 A key factor accounting for the likelihood of relapse among addiction patients may be the persistence of aberrant neurobiological changes affecting reward prediction and motivation. It is plausible that traditional therapies may only address maladaptive patterns of synaptic connectivity to a limited extent, preserving some aberra...

A preregistered, systematic review considering mindfulness-based interventions and neurofeedback for targeting affective and cognitive processes in behavioral addictions.

“…Thus, the identification of core processes and their interactions in nonsubstance addictive behaviors is necessary not only for understanding their addictive potential but also for potentially using them as targets for clinical interventions (e.g., Dong & Potenza, 2014). Promising evidence for the usefulness of mindfulness and neurofeedback techniques in tackling the neurocognitive mechanisms of behavioral addictions stems from research in the context of SUDs (for reviews, see Garland & Howard, 2018; Martz et al, 2020; Sunder & Bohnen, 2017) where both techniques are considered successful in treating addictions.…”

Infralow neurofeedback in the treatment of substance use disorders: a randomized controlled trial

“…This contradicted early optimistic findings related to neurofeedback in the field of substance use disorder treatment. Neurofeedback has been generally accepted for its clinical utility as an adjunct treatment to other interventions for substance use disorders, [4][5][6]8 but comparing studies and drawing conclusions about its effectiveness is difficult because of its diverse applications in terms of equipment used, populations trained, treatment protocols used and outcome measures employed.…”

“…[4][5][6] However, reports have been somewhat mixed. Although previous work has demonstrated that neurofeedback can prolong treatment retention, 2 improve clinical outcomes by inducing long-lasting changes in neurophysiological brain activity and improve regulatory capabilities and executive function, 7,8 other studies have shown no significant effect of neurofeedback on addictive behaviours. 2,9 In recent years, neurofeedback has been applied successfully in diverse populations of patients with substance use disorders, such as those with disorders related to various substance classes, [10][11][12] common comorbidities (including craving, abstinence rates and attention deficits) and psychopathologies (such as trauma and depression).…”