“The literature, which lacks any negative study, suggests that neurofeedback plays a major therapeutic role in many different areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used.”
~ Dr. Frank Duffy, Associate Professor of Neurology, Boston Children’s Hospital
Could neurofeedback be the “next big thing” in the addiction recovery?
Supporters are saying that when neurofeedback is used in conjunction with other accepted, evidence-based treatment options, it helps maximize the odds of successful recovery from drug addiction or alcoholism.
First Things First—What is Neurofeedback?
“Neurofeedback therapy takes abnormal brainwave patterns and makes them normal. When we have normal brainwave patterns, the brain is better to self-regulate itself….”
~ Dr. Guy Annunziata
“Neuro” refers to the how the process monitors electrical activity within the brain, and “feedback” refers to how that information is used to help the addicted patient.
In essence, neurofeedback helps treat substance abuse and emotional disorders by “reprogramming” the addicted brain, using the patient’s own thoughts.
Neurofeedback involves electroencephalography (EEG) monitoring of the patient’s brain and then using the acquired information to aid in self-regulation. Neurofeedback incorporates the brain’s innate ability to change itself, via an adaptive process known as neuroplasticity.
This is the same learning process that happens when we acquire any new skill. When any new task is performed, the human brain learns by making new nerve cell connections. It then utilizes these connections to create pathways linking different areas of the brain. The more often these pathways are used, the more adept the brain becomes at performing that task.
In short, the brain physically changes whenever something is learned, whether it is a skill, a history lesson, or a new way of responding to things.
The idea behind neurofeedback is that the maladaptive responses and behaviors that accompany an actively-addicted lifestyle can be shaped into something more positive by providing reinforcement when a desired healthy response is given.
In other words, neurofeedback is a structured way to assist the addicted patient learn how to produce healthier brainwave patterns through practice and reinforcement.
What Happens During a Typical Neurofeedback Session?
“We are now on the threshold of being able to use this information to understand the neural mechanisms underlying certain disorders and their treatments. Neurofeedback offers great promise as a type of brain training that is directly based on the functional activation of these brain networks.”
~ Dr. Ruth Lanius, Department of Psychiatry, Schulich School of Medicine & Dentistry, the University of Western Ontario
Because substance abuse disorders and other emotional or behavioral conditions are often caused or worsened by over-or-under-stimulation within the brain, the first step during neurofeedback therapy is to create a baseline “brain map” detailing which areas might be abnormally active or inactive.
This map, along with information gained from a detailed initial assessment, allows clinicians to create a retraining program for the patient.
First, EEG sensors are placed on the patient’s head to record brain wave activity. The brain’s electrical impulses are amplified and then analyzed by a special computer program to determine real, at-that-moment activity.
During a session, the client may play a game, listen to music, or watch a video that changes based on their neural activity. In this way, the patient gets immediate feedback as to the desirability of their response. They can then practice responding appropriately.
How Does Neurofeedback Help with Addiction Recovery?
“With neurofeedback, patients are given information about brain activations that may be linked to their particular clinical disorder…”
~ Moses Sokunbi, Researcher at the International School for Advanced Studies
Addiction is characterized by compulsive, disordered thinking and poor coping skills. Stressful situations trigger a relapse, because the person is not properly conditioned to respond in other ways.
Neurofeedback retrains the addicted brain, teaching it how to be relaxed, calm, and focused, instead of angry, upset, or anxious. When the person’s emotional (and associated physical) responses are under control, they can rationally decide how to ACT, rather than simply REACT without thinking.
And through practice, these positive responses soon become second nature.
Is Neurofeedback Therapy Effective?
“These results showed that participants were successfully using neurofeedback to alter their pattern of brain activity according to a predefined objective in specific regions of their brain’s motor cortex, without moving any body part.”
~ Dr. Sylvain Baillet, acting Director of the Brain Imaging Centre at The Neuro, McGill University
According to a 2013 study, neurofeedback is an effective supplement to Medication-Assisted Therapy (MAT). Compared to the control group that only received opioid maintenance therapy, study participants who were also given 30 neurofeedback sessions also achieved:
- Less anxiety and depression
- Higher mental health scores
- Greater anticipation of a positive outcome
- Reduced desire to use opioids
- Decreased drug cravings
- Fewer withdrawal symptoms
These recent encouraging results echo the findings of an earlier 1989 study that focused on alcohol-dependent patients.
Why is Neurofeedback Effective?
“These methods show a direct route for manipulating brain networks centrally involved in healthy brain function and daily behavior.”
~ R. Alison Adcock, Associate Director of the Center for Cognitive Neuroscience, Institute for Brain Sciences, Duke University
Neurofeedback works as a supportive therapy because addiction is a disease of the brain. Intoxicants alter the physical and chemical structure of the brain to support continued use. Surprisingly, these changes start happening from the very first use.
- Laboratory tests indicate that the brain’s dopamine receptors are altered from the very first exposure to alcohol. Dopamine is a neurotransmitter associated with learning, motivation, and reward. Because of the alcohol-induced change, a person LEARNS to associate drinking with a pleasurable REWARD, and are thus MOTIVATED to repeat the behavior.
- Researchers at UC Berkeley discovered that a single dose of cocaine rewires higher-level brain pathways that support memory, learning, and decision-making.
Mice exposed to just one dose of cocaine showed a rapid and robust growth of dendritic spines. within their brains. These spines are structures that connect neurons and help make up the brain’s neural pathways.
The lead author of the research, Linda Wilbrecht, who serves as an Assistant Professor of Psychology and Neuroscience, says “Our images provide clear evidence that cocaine induces rapid gains in new spines, and the more spines the mice gained, the more they show they learned about the drug…The ones that develop the biggest change in preference for the cocaine were also the ones that grew the most spines.”
Bearing this information in mind, it makes a sort of poetic sense to use the brain treat a disease of the brain. When neurofeedback therapy is applied properly, the practiced responses help to reshape the brain in a healthier manner that does not support continued substance use.
Understanding Brainwave Frequencies
Neurofeedback experts say that there are four distinct electrical impulse frequencies produced by the brain. The EEG sensors detect those frequencies to determine which areas of the brain are actively being used during different emotional states of mind.
Let’s take a look at each frequency band.
Delta and Theta Frequencies: Relaxation
Delta and Theta are the slowest frequencies, and when they are produced normally, they promote relaxation and deep, restful sleep.
On the other hand, when there are imbalances or disruptions of the Delta or Theta frequencies, a number of adverse symptoms may present:
- Cognitive impairment
- Emotional disturbance
- Focus issues
- Learning disorders
- Poor social skills
Alpha Frequency: The Idle Brain
Alpha waves are produced when the person is awake, but not particularly focused on an activity required a great deal of concentration. This frequency is most common during everyday tasks.
Alpha imbalances result in:
- Avoidance behavior
- Excessive self-concern
- Passive aggression
- Poor self-esteem
- Social withdrawal
- “Victim mentality”
Beta Frequency: The Engaged Brain
Beta is the fastest frequency, produced when the brain is focused and alert. In healthy brains, these are most measurable during activities involving concentration, critical thought, and higher reasoning.
Beta imbalances and disturbances result in:
- Chronic pain
- Lack of emotional self-awareness
- Obsessive-Compulsive Disorder (OCD)
- Resistance to change
- Tension headaches
How do Brainwave Imbalances Contribute to Addiction?
When the person is in an overly-excited or depressed, apathetic state, they have difficulty making good decisions or coping with difficulties in a healthy manner. When both their emotional and cognitive states are unbalanced, it’s far too easy to fall back on old, dysfunctional coping methods—drinking or using drugs, for example.
Self-Medication as an Addiction Risk Factor
Certain conditions caused by imbalances also increase the likelihood of problematic substance use. Sufferers of these mental disorders will often self-medicate in an attempt to alleviate uncomfortable symptoms:
Can Neurofeedback Help with Other Conditions?
“Our results suggested that neurofeedback might be an effective complementary treatment to make patients feel well again and successfully engage with life. The most promising thing about neurofeedback is it doesn’t cause even mild side effects. It could also improve self-efficacy by participating active, voluntary treatment.”
~ Professor Eun-Jin Cheon, Yeungnam University Hospital, South Korea
In addition to supporting treatment for alcoholism and drug addiction, neurofeedback also benefits:
- Attention Deficit Hyperactivity Disorder (ADHD)
- Affective disorders
This cross-effectiveness is important, because substance abuse frequently co-occur with mental, behavioral, or emotional conditions. And when there are untreated comorbid disorders, each condition can worsen the progression of the other, creating a vicious, self-perpetuating downward spiral.
Pros of Neurofeedback
“Just like athletes in training benefit from a coach’s guidance, feedback from our brain can help us to be more aware of our thoughts. Our findings suggest that the ability to control our thinking improves when we know how the corresponding area in our brain is behaving.”
~Professor Kalina Christoff, Department of Psychology, University of British Columbia
The most obvious “pro” of neurofeedback is the fact that IT WORKS. Up to 85% of patients experience:
- Reduced impulsivity
- Increased focus
- Better regulation of behavior
Neurofeedback is also a non-drug-based therapy. This means NO:
- Invasive injections
- Potential for misuse
Cons of Neurofeedback
For some, the biggest “con” associated with neurofeedback is the cost. Sessions can easily cost $150 or more, and most people realize their desired results after 30 to 40 sessions. Significantly, neurofeedback is not always covered by personal insurance plans.
Similarly, it’s not always easy to find a reputable neurofeedback provider. The Biofeedback Certification International Alliance can assist with searches in your local area.
Does Neurofeedback Replace Other Treatment Options?
“For most of us, most of the time, the ongoing activity of the brain is hidden and not under voluntary control. Brain feedback studies are changing this long-standing, one-way relationship.”
~ Dr. Anna Rose Childress, PhD, University of Pennsylvania School of Medicine.
No, neurofeedback is best used as a supportive, rather than a primary, therapy. The “gold standard” of addiction care is still behavioral counseling combined with FDA-approved medications.
Addiction is a complicated disease that has many contributing factors—genetics, environment, peer pressure, and the presence of co-occurring mental conditions, just to name a few. As such, successful recovery often requires the use of multiple types of therapies that address the disease on multiple levels. Treatment strategies may include:
- Individual counseling
- Peer group therapy
- Behavior modification
- Nutritional guidance
- Art/Pet/Poetry therapy
- Relapse prevention
- 12-Step meetings
- Long-term support
Addiction is incurable, and there is no “one size fits all” therapy that will successfully treat “100% of the people 100% of the time”. Each of these strategies has its limitations on its own, but when the right combination is tailored to the individual, the likelihood of a successful and long-lasting return to sobriety is greatly increased.