Substance Abuse and Alcohol Use Disorders
Burkett, V. S., Cummins, J. M., Dickson, R. M., & Skolnick, M. (2005). An open clinical trial utilizing real-time EEG operant conditioning as an adjunctive therapy in the treatment of crack cocaine dependence. Journal of Neurotherapy, 9(2), 27-48. Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training—either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given.
Callaway, T.G., Bodenhamer-Davis, E. (2008). Long-term follow-up of a clinical replication of the Peniston Protocol for chemical dependency. Journal of Neurotherapy 12(4), 243 – 259. Introduction. This study is a long-term follow-up of an early replication of the Peniston EEG biofeedback (EEG-BFB) Protocol for chemical dependency (Peniston & Kulkosky, 1989, 1990). Method. This clinical trial included 16 chemically dependent adult participants treated with the Peniston Protocol in a university outpatient clinic between 1993 and 1995. Ten participants were probationers classified as high risk for rearrest. Treatment effects were assessed using pre/posttreatment measures (Beck Depression Inventory, Minnesota Multiphasic Personality Inventory-2) and long-term follow-up of abstinence and rearrest rates. Probationer rearrest rates were compared to an equivalent probation sample (n = 24) that did not receive EEG-BFB. Results. Initial Beck Depression Inventory scores indicated mild/moderate depression but were significantly reduced posttreatment to within normal limits. Substantial differences were noted posttreatment on 7 Minnesota Multiphasic Personality Inventory-2 Clinical scales suggesting less psychopathology following treatment. Long- term (74–98 months) follow-up indicated that 81.3% (n = 13) participants were abstinent. Rearrest rates and probation revocations for the probationer subgroup were lower than the comparison group (40% vs. 79.16%). Conclusion. This study provides evidence of the durability of Peniston Protocol results over time but has the usual limitations of a clinical trial with a small sample, nonrandomized, and uncontrolled design. Implications for further research are discussed including the relevance of recent modifications to the Peniston Protocol and qEEG–based protocols in treating substance abuse.
DeBeus, R. J. (2007). Quantitative electroencephalography-guided versus Scott/Peniston neurofeedback with substance abuse outpatients: A pilot study. Applied Psychophysiology and Biofeedback, 35(4), 146-151. Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training—either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given.
Dehghani-Arani F, Rostami R & Nadali H. (2013). Neurofeedback training for opiate addiction: improvement of mental health and craving. Appl Psychophysiol Biofeedback. 2013 Jun;38(2):133-41. doi: 10.1007/s10484-013-9218-5. Psychological improvements in patients with substance use disorders have been reported after neurofeedback treatment. However, neurofeedback has not been commonly accepted as a treatment for substance dependence. This study was carried out to examine the effectiveness of this therapeutic method for opiate dependence disorder. The specific aim was to investigate whether treatment leads to any changes in mental health and substance craving. In this experimental study with a pre-post test design, 20 opiate dependent patients undergoing Methadone or Buprenorphine maintenance treatment were examined and matched and randomized into two groups. While both experimental and control groups received their usual maintenance treatment, the experimental group received 30 sessions of neurofeedback treatment in addition. The neurofeedback treatment consisted of sensory motor rhythm training on Cz, followed by an alpha-theta protocol on Pz. Data from the general health questionnaire and a heroin craving questionnaire were collected before and after treatment. Multivariate analysis of covariance showed that the experimental group achieved improvement in somatic symptoms, depression, and total score in general mental health; and in anticipation of positive outcome, desire to use opioid, and relief from withdrawal of craving in comparison with the control group. The study supports the effectiveness of neurofeedback training as a therapeutic method in opiate dependence disorder, in supplement to pharmacotherapy.
Fahrion, S. L., Walters, E. D., Coyne, L., & Allen, T. (1992). Alterations in EEG amplitude, personality factors and brain electrical mapping after alpha theta brainwave training: A controlled case study of an alcoholic in recovery. Alcoholism: Clinical & Experimental Research, 16, 547-552. A controlled case study was conducted of effects of EEG alpha and theta brainwave training with a recovering alcoholic patient who experienced craving and fear of relapse after 18 months of abstinence. Training consisted of six sessions of thermal biofeedback to increase central nervous system (CNS) relaxation. Effects were documented with pretreatment and post-treatment personality testing, 20-channel digitized EEG evaluations both under relaxed conditions and under stress, minute-by-minute physiologic recordings of autonomic and EEG data during each training session, blood pressure, and heart rate indications taken both during relaxation and under stress, and by clinical observation. Results replicated those of a previous controlled study with chronic alcoholic patients not abstinent prior to treatment. New findings include post-treatment indications of more relaxed CNS functioning under stress, and of reduced autonomic activation both during relaxation and under stress. Brain-mapping indications of anxiety associated with painful cold-pressor stimulation were seen only in the pretest readings; at post-test the brain map indicated pain-associated EEG activity in the contralateral somatosensory area, but no apparent anxiety-associated EEG activity. At 4 months post-treatment the patient’s wife and colleagues report the patient appears to function in a more relaxed way under the impact of stress, and he reports no longer experiencing craving for alcohol. Overall, support is provided for the possibility that alpha and theta brainwave training may be a useful intervention for the abstinent alcoholic experiencing stress-related craving and fear of relapse.
Goldberg, R. J., et al. (1976). Alpha conditioning as an adjunct treatment for drug dependence: Part I. International Journal of Addiction, 11, 1085-1089. The effects of alpha conditioning on the habits of four methadone-maintained patients were assessed. All four learned some control over alpha activity in the 5-week, 10-session training period. The most striking results, however, related to the subjects’ substitution of self- initiated mental states associated with alpha for previously used drug-seeking or self- medicating methods of coping with everyday problem situations. All four subjects reported a decrease in illicit drug usage and an increased feeling of self-control. Verification of improvement in adjustment and drug abuse was shown by counseling reports and narcotic screens from the maintenance program.
Keith, JR., Ragpay, L., Theodore, D., Schwartz, JM & Ross, JL. (2014). An assessment of an automated EEG biofeedback system for attention deficits in a substance use disorders residential treatment setting. Psychology of Addiction Behaviors: Sept 2014 Early e-pub. Attention deficits are prevalent among individuals with substance use disorders and may interfere with recovery. The present study evaluated the effectiveness of an automated electroencephalogram (EEG) biofeedback system in recovering illicit substance users who had attention deficits upon admission to a comprehensive residential treatment facility. All participants (n = 95) received group, family, and individual counseling. Participants were randomly assigned to 1 of 3 groups that either received 15 sessions of automated EEG biofeedback (AEB), 15 sessions of clinician guided EEG biofeedback (CEB), or 15 additional therapy sessions (AT). For the AEB and CEB groups, operant contingencies reinforced EEG frequencies in the 15-18 Hz (β) and 12-15 Hz (sensorimotor rhythm, “SMR”) ranges and reduce low frequencies in the 1-12 Hz (Δ, θ, and α) and 22-30 Hz (high β) ranges. The Test of Variables of Attention (TOVA), a “Go-NoGo” task, was the outcome measure. Attention scores did not change on any TOVA measure in the AT group. Reaction time variability, omission errors, commission errors, and d’ improved significantly (all p values <.01) in the AEB and CEB groups. AEB and CEB did not differ significantly from each other on any measure. The results demonstrate that automated neurofeedback can effectively improve attention in recovering illicit substance users in the context of a comprehensive residential substance abuse treatment facility.
Kelly, M. J. (1997). Native Americans, neurofeedback, and substance abuse theory: Three year outcome of alpha/theta neurofeedback training in the treatment of problem drinking among Dine’ (Navajo) people. Journal of Neurotherapy, 2(3), 24- 60. This three year follow-up study presents the treatment outcomes of 19 Dine’ (Navajo) clients who completed a culturally sensitive, alpha/theta neurofeedback training program. In an attempt to both replicate the earlier positive studies of Peniston (1989) and to determine if neurofeedback skills would significantly decrease both alcohol consumption and other behavioral indicators of substance abuse, these participants received an average of 40 culturally modified neurofeedback training sessions. This training was adjunctive to their normal 33 day residential treatment. According to DSM-IV criteria for substance abuse, 4 (21%) participants now meet criteria for “sustained full remission”, 12 (63%) for “sustained partial remission”, and 3 (16%) still remain “dependent” (American Psychiatric Association, 1994). The majority of participants also showed a significant increase in “level of functioning” as measured by the DSM-IV Axis V GAF. Subjective reports from participants indicated that theiroriginal neurofeedback training had been both enjoyable and self-empowering; an experience generally different from their usual treatment routine of talk-therapy and education. This internal training also appeared to naturally stimulate significant, but subtle, spiritual experiences and to be naturally compatible with traditional Navajo cultural and medicine-ways. At the three-year follow-up interview, participants typically voiced that these experiences, and their corresponding insights, had been helpful both in their ability to cope and in their sobriety. From an outside perspective, experienced nurses also reported unexpected behavioral improvements during the participant’s initial training. Additionally, administrators and physicians generally found the objective feedback and verification quality of neurofeedback protocols compatible with their own beliefs. An attempt has also been made to conceptualize the outcome analysis of this study within both a culturally specific and universal socio/bio/ environmental context.
Peniston, E. G., & Kulkosky, P. J. (1989). Alpha-theta brainwave training and beta-endorphin levels in alcoholics. Alcohol: Clinical & Experimental Research, 13(2), 271-279. An alpha-theta brainwave-biofeedback training program was applied as a novel treatment technique for chronic alcoholics. Following a temperature-biofeedback pretraining phase, experimental subjects completed 15 30-min sessions of alpha-theta biofeedback training. Compared to a nonalcoholic control group and a traditionally treated alcoholic control group, alcoholics receiving brainwave training (BWT) showed significant increases inpercentages of EEG record in alpha and theta rhythms, and increased alpha rhythm amplitudes. Alcoholics receiving BWT showed a gradual increase in alpha and theta brain rhythms across the 15 experimental sessions. These experimentally treated alcoholics showed sharp reductions in self-assessed depression (Beck’s Depression Inventory) compared to the control groups. Alcoholics receiving standard medical treatment (abstinence, group psychotherapy, antidepressants) showed a significant elevation in serum beta-endorphin levels at the conclusion of the experiment. This neuropeptide is an index of stress and a stimulant of caloric (e.g., ethanol) intake. Application of brainwave treatment, a relaxation therapy, appears to counteract the increase in circulating beta- endorphin levels seen in the control group of alcoholics. 13-month follow-up data indicate sustained prevention of relapse in alcoholics that completed alpha-theta brainwave training.
Saxby, E., & Peniston, E. G. (1995). Alpha-theta brainwave neurofeedback training: An effective treatment for male and female alcoholics with depressive symptoms. Journal of Clinical Psychology, 51(5), 685-693. This was an experimental study of 14 alcoholic outpatients using the Peniston and Kulkosky (1989, 1991) brainwave treatment protocol for alcohol abuse. After temperature biofeedback pretraining, experimental subjects completed 20 40-minute sessions of alpha-theta brainwave neurofeedback training (BWNT). Experimentally treated alcoholics with depressive syndrome showed sharp reductions in self-assessed depression (Beck’s Depression Inventory). On the Millon Clinical Multiaxial Inventory-I, the experimental subjects showed significant decreases on the BR scores: schizoid, avoidant, dependent, histrionic, passive- aggression, schizotypal, borderline, anxiety, somatoform, hypomanic, dysthymic, alcohol abuse, drug abuse, psychotic thinking, and psychotic depression. Twenty-one-month follow-up data indicated sustained prevention of relapse in alcoholics who completed BWNT.
Watson, C. G., Herder, J., & Passini, F. T. (1978). Alpha biofeedback therapy in alcoholics: An 18-month follow-up. Journal of Clinical Psychology, 34(3), 765-769. In an earlier study on patients with alcohol problems, an experimental group given 10 hour-long alpha biofeedback training sessions showed greater improvement on State and Trait Anxiety scores than did a control sample. In the present study an 18-month follow-up was done on those Ss. The differences between the experimentals and controls in State and Trait Anxiety after 18 months were essentially identical to the differences between them immediately after treatment, which indicates that alpha training had long-range therapeutic effects. A difference between the groups on the Alcohol Rehabilitation Follow up Questionnaire also suggested that alpha training may have been associated with some reduction in alcohol consumption as well.