Neurofeedback: An Integrative Treatment of Substance Use Disorders

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Neurofeedback, also known as electroencephalographic (EEG) biofeedback, has been applied successfully as an integrative treatment of substance use disorders (SUDs) for more than 30 years. Based on the early work of Kamilya and Green on self-regulation of alpha brainwaves, the treatment of addictions with alpha-theta neurofeedback has its origins in the pioneering research of Eugene Peniston1–3 and is collectively known as the Peniston Alpha-Theta protocol. This neurotherapy approach involves multimodal intervention and integrates independent auditory feedback of 2 slow brainwave frequencies, alpha (8–12 Hz) and theta (4–8 Hz) brainwaves, that are generally associated with a state of relaxation. Research indicates that after 15 sessions of neurofeedback, patients (alcohol abusers) experienced long-term abstinence and positive changes in alcoholic personality variables. Although there is no general consensus as to the exact mechanism of alpha-theta neurofeedback, it is believed to increase beta-endorphin levels related to the stress of abstinence.1,2,4,5A systems approach for addiction recovery is essential, to treat the body, brain, and spirit- to heal the many aspects of a person's life. Judith Ann Miller, PhD, author, Crossing the BarSubstance use disorders are characterized as “maladaptive patterns of substance use leading to clinically severe impairment or distress potentially affecting physical or psychological functioning; personal safety; social relations, roles, and obligations; work; and other areas.”6(p886) Currently, 23.2 million Americans suffer from the deleterious affects associated with drug or alcohol abuse, of these approximately 10% receive appropriate treatment.7 According to Dr Nora Volkow, the director of the National Institute on Drug Abuse, “Addiction is a chronic brain disease—a treatable brain disease—that needs to be understood.”8 Research in neurofeedback has found that acute and chronic drug abuse precipitates significant alteration of brainwave activity that is observable with quantitative electroencephalography (qEEG). As a comprehensive assessment tool endorsed by both the American Psychological Association and the International Society for Neurofeedback and Research, qEEG is used by qualified health care professionals to objectively and scientifically evaluate a patient's brainwave function to determine whether brainwave patterns are abnormal and, if so, where and why these abnormalities occur.BRAINWAVE FREQUENCIESThe brain exhibits different types of brainwaves that occur at various frequencies. These brainwaves are measured in cycles per second or hertz (Hz) and are associated with characteristic activities that correlate with each of the frequency bands. There are 4 basic frequency ranges that measure the human brain9: Delta—associated with deep restorative sleep; very slow brainwaves (0.5–3.5 Hz)Theta—represents a deeply relaxed, daydreaming state (4–8 Hz)Alpha—associated generally with a state of relaxation (8–12 Hz)Beta—represents a state of mental, intellectual activity, outward focused attention; beta brainwave range (12–35 Hz); the lower end of this frequency band (eg, sensorimotor rhythm or SMR) corresponds to a state of relaxed attentiveness (12–15 Hz); the hyperstate of high-frequency beta brainwaves is as high as 35 Hz.It should be noted that each of these brainwave frequencies are always present to some degree in different parts of the brain. For example, if someone is experiencing acute anxiety, an excess of high-frequency beta brainwaves may be present in a certain brain region, or it may be a result of an excessive amount of alpha brainwaves in the executive (frontal) regions of the brain that are associated with the control of emotions.Research has revealed heterogeneity in the EEG brainwave patterns associated with different conditions, such as anxiety and attention deficit disorder/attention-deficit/hyperactivity disorder.10 The diagnostic considerations become even more complex when comorbid problems are present, as is often the case in SUDs.

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