Quantitative Electroencephalography and Neurofeedback Training for the Treatment of Substance Use Disorders: A Randomized Controlled Trial
Phase: NA
Conditions: Substance Use Disorders
Sponsor: Sorlandet Hospital HF

 
 
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QEEG and Neurofeedback Training for the Treatment of Substance Use 
Disorders: A Randomized Controlled Trial 
 
 
 
 
Addiction Unit, Sørlandet Hospital HF 
 
17.03.2017 
 
Approved by the Regional Committee for Medical and Health Research Ethics  
on 04.05.2017 (No. 2017/746) 

 
 
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1. 
Relevance relative to the call for proposals 
 
Substance use disorders (SUD) is considered one of the major public health concerns of our time, with 
high degree of comorbidity and far-reaching individual and societal implications. The dark figures are 
high, as only a small percentage of those affected seek help in treatment facilities, but it is assumed 
that between 10 and 20% of the population will experience problems related to excessive drug use in 
the course of their lives [1]. This makes SUD one of our most prevalent psychiatric conditions, 
compromising physical and psychological health and resulting in impairment in cognition, social 
relationships and quality of life (QoL), at high cost for society.  
 
Of those who do seek treatment, relapse trajectories are discouraging. Some sources suggest that 
twelve-month relapse rates following cessation attempts from various classes of substance use can be 
more than 80% [2], implying that for the majority of those who enter traditional psychosocial or 
medication-based models of treatment relapses to drug use is common. In other words: the treatment 
of the disorder is as exceedingly complicated as is the disorder itself. A patient with a SUD typically 
requires comprehensive and life-long care across the different levels of service providers, from 
primary care to the specialist health care services, and case management for these individuals can be 
resource-intensive and complex. A systemic view of recovery is warranted, an interdisciplinary and 
integrative approach which aims to improve the physiological, psychological and social aspects of the 
disorder. New approaches to treatment, either new, stand-alone modalities or in conjunction with other 
therapies, are therefore constantly being sought.  
 
2. 
Aspects relating to the research project 
 
Background and status of knowledge 
Traditionally, the dominant focus in addiction treatment has been on psychosocial approaches such as 
cognitive behavioral treatment, motivational interviewing, contingency management, 12-step 
programs, and pharmacological programs [3]. However, a growing awareness of the role of 
neurobiology in the development and maintenance of SUD [3, 4], has led to increasingly more 
international research interest being invested in efforts to develop and incorporate neuropsychological 
intervention methods into existing treatment paradigms [4, 5].  
 
Through the use of modern brain imaging techniques such as quantitative electroencephalography 
methods (QEEG), in conjunction with low-resolution electromagnetic tomography (LORETA) or 
functional magnetic resonance imaging (fMRI), researchers have revealed that acute and chronic drug 
abuse can result in significant alteration of a person’s brain activity [4, 6]. For instance, 
electroencephalography (EEG) investigations of patients with alcoholism have documented that even 
after prolonged periods of abstinence, they seem to have lower levels of alpha and theta waves and an 
excess of fast beta brain waves [7], making it difficult for them to relax. Following alcohol intake, 
however, the levels of alpha and theta brainwaves increase to normal levels. Such findings have led 
researchers to postulate that these individuals inadvertently use alcohol as a way of down-regulating 
their brainwave patterns to achieve the desired relaxed mental state. Conversely, psychostimulants can 
be used to “up-regulate” patterns which are associated with negative emotional states, such as 
depression. Thus, for the SUD patient, drug use can be a way of artificially normalizing these 
dysfunctional brain wave patterns. 
 
Modern theories of cortical plasticity foster promise that such disturbed information processing can be 
reversible [8, 9]. One way of influencing brain activity directly is through EEG biofeedback. Also 
known as neurofeedback (NF), the method was first popularized for the treatment of alcohol 
dependence by the works of Eugene Peniston [10-12], and has been employed in the treatment of SUD 
for more than three decades. NF is a method aimed at reorganizing and normalizing brain wave 
patterns. Through electrodes placed on the scalp, oscillatory activity from the cortex is recorded and 
played back to the individual in the form of visual, auditive, and/or tactile stimuli, enabling shaping of 
the brain activity towards more functional patterns [13]. The aim of the NF training is to enable the 

 
 
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individual to develop skills for self-regulation of cortical activity. Because negative emotional states 
can trigger the urge to use drugs to achieve this regulation [2], neurofeedback can potentially prevent 
relapses through its calming effect on the central nervous system. 
 
Peniston’s encouraging outcome results in the eighties generated substantial interest in the addiction 
field, and efforts were made to replicate these findings. Several other studies using the Peniston 
protocol and its modifications reported cases with positive clinical effects, however, studies utilized 
primarily naturalistic design,  sample sizes were small, description of methods insufficient and only 
few of these studies were published in mainstream peer-reviewed journals [14]. Consequently, the 
spread of the method has been slow, and it has not been applied systematically in addiction treatment. 
A recent review concluded that  “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” [14]. Since then, compiling empirical evidence, using 
alpha rhythms as well as other EEG band ranges, has demonstrated its efficacy for various forms of 
substance use disorders [15]. However, despite this growing evidence of its applicability, the method 
remains largely obscure and under-used in clinical applications for this patient population in Norway. 
To our knowledge, the addiction unit at the Clinic for Psychiatry and Addiction Medicine at Sørlandet 
Hospital is at present the only clinic nationwide applying the method systematically. 
 
When neurofeedback was introduced and implemented as an adjunct treatment in our out-patient 
addiction clinic in 2011, many patients reported positive effects on a variety of comorbid 
symptomatology, and the retention rate for those who received the treatment was also significantly 
higher than the norm for this patient group. These observations were confirmed in a pilot study 
conducted at the clinic in 2012, in which the treatment was also rated positively by the patients [16]. 
Furthermore, data from subsequently admitted patients, measured by the same tools as in the pilot, 
have shown generally the same trajectory. These findings have spurred a motivation to conduct a 
larger, randomized controlled study to further investigate the role of NF in the treatment of SUD, this 
time with focus on its add-on effects to the treatment as usual (TAU) regime. Recognizing the high 
cost of treatment failure for society as large, as well as the high emotional cost for the individual, we 
wish to investigate whether the physiological effects of the treatment will help elicit positive 
emotional states which can strengthen coping behavior and aid patients in their efforts to become and 
remain abstinent. Thus, we believe that NF can play an important role in a relapse prevention 
paradigm and that its contribution can be captured with global patient-reported outcome measures 
such as well-being and QoL.   
 
The current research proposal departs from previous studies in four important areas: 
 
1. 
One of the challenges with a technology-driven intervention method such as NF is that 
research often lags behind the rapid technological development. Whereas most of the studies to 
date have utilized NF treatment protocols based on measuring subsets of the EEG activity, divided 
into band rangebandrange frequencies in the 4-30 Hz specter (such as Theta, Alpha, Beta rhythms), 
current clinical interest in some milieus has shifted to slow cortical potentials (SCP). SCPs are 
slow, event-related, direct-current shifts in the EEG, originating from the large cell assemblies in 
the upper cortical layer in the midline of the brain [17]. Newer software and hardware technologies 
have made it possible to isolate and process even slower bandwidths, so-called infra-low frequency 
training (ILF), i.e. frequencies below 0.1 Hz. This particular form of NF training seems to have the 
potential to influence the brain’s resting state networks, which is thought to have a central role in 
underpinning overall brain function [18]. ILF training can thus be said to target core regulatory 
function of the central nervous system, rather than remediating specific deficits or diagnoses. This 
can explain the claimed wide applicability of the method across diagnoses and symptom categories. 
However, although favorably received in some clinical communities, the empirical support for the 
claims for ILF training is as of yet virtually non-existent. It is therefore important to fill this 

 
 
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apparent gap in the literature. 
 
2. 
This study is among the few in the addiction treatment field that has QoL as its main outcome 
measure. The rationale behind this choice of outcome is that improvement of QoL can be viewed as 
an overarching aim of addiction treatment, a generic expression of the patient’s global functioning 
and well-being. A high QoL has been found to correlate with positive affect, and can thus help 
maintain the motivation to stay sober. Nevertheless, in previous studies QoL is rarely assessed; 
reduction in substance use has been given main focus. If living without substance use is to be the 
goal for the SUD patient, this aim will simply not be perceived as ‘‘worth’’ striving towards if it is 
not associated with improved well-being in at least some facets of life. Consequently, patients may 
lose motivation and interest in their rehabilitative process [19]. 
 
3. 
Accordingly, the theoretical framework for this study will be to use NF as a strategy and 
potential tool in relapse prevention. Negative emotional states, such as anger, anxiety, depression, 
frustration, and restlessness are associated with higher rate of relapse to drug use [20]. By closely 
monitoring these variables throughout the project, we will be able to assess whether NF has a 
potential add-on effect on the patient’s ability to cope with such negative emotions and the ensuing 
drug urge and cravings. 
 
4. 
The proposed design has a stronger user involvement than previous research efforts in the 
field. User representatives with personal experience with NF will take an active part in the 
intervention and have regular dialogue meetings with participants, allowing informal exchanges 
about the method (e.g., possible effects and side-effects). We expect this element of the study to 
potentially boost the effect of the intervention. This way of boosting effects of other interventions 
has recently become a recommended strategy in the addiction treatment field [21]. 
 
Approaches, hypotheses, and choice of method 
The overall aim of the study is to acquire more knowledge about the effectiveness of NF in the 
treatment of substance use disorders in general, specifically in relation to its effect on physical and 
psychological distress (e.g. sleep disturbances, anxiety symptoms etc.), and subsequently on its ability 
to improve QoL and prevent relapse. An RCT study will be undertaken to examine whether 
neurofeedback (NF) + treatment as usual (TAU) compared to TAU only can increase the QoL of 
patients with a SUD in the short and long term. We hypothesized that, compared to the TAU condition 
the NF + TAU condition would result in higher QoL at the end of treatment as well as at a 3- and 12-
month follow-up. Included in our QoL assessment measure is perceived functioning in important areas 
such as work and social relations.  
 
Our secondary outcome hypothesis is that the NF+TAU condition will result in better substance use 
outcomes as well as improvement in sleep quality, psychological distress, and symptoms of anxiety 
and depression at the end of treatment and at follow-up compared to controls. Drop-out rates will also 
be compared for the two groups, controlling for baseline demographic and severity variables. 
 
In addition to the RCT, the project group will write up on an extended naturalistic cohort study 
initiated after the previous pilot, and investigate this cohort in relation to similar aims as described 
above. 
 
Inclusion criteria 
Patients with a substance use disorder referred to outpatient addiction treatment, aged >18 of both 
genders.  
 
 

 
 
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Exclusion criteria 
Severe psychiatric disorders (e.g. psychosis) that have not been stabilized with e.g., medication 
(assessed as a part of the clinical process at the clinic). Severe cognitive impairment or language 
problems (inability to converse for interviews). 
 
Experimental design 
The proposed experimental study will have a two-group pre-post design with an intervention group 
(NF+TAU) and a control group (TAU). Participants will include patients referred to outpatient 
addiction treatment at two clinics within Sørlandet Hospital HF, in Kristiansand and in Arendal. 
Because regular attendance is desirable for participation in the project, certain clinical selection 
criteria will apply, but this will be handled not by the project group itself, rather it will reflect ordinary 
practice within the present clinical setting. Thus, patients are thought to be clinically eligible to the NF 
condition after having achieved an initial level of stabile attendance at the clinic. This is congruent 
with the study’s focus on relapse prevention.  
 
Patients meeting the criteria for inclusion will be informed about the project and given the opportunity 
to participate. After providing written, informed consent, those patients who choose to participate will 
be randomly assigned to either NF training + TAU, or TAU alone. The allocation will be determined 
through notes prepared in sealed envelopes by an external researcher based on a block randomization 
design. As a part of the NF+TAU condition, participants will be invited to an informal dialogue 
session within a month of starting the intervention, in which a user representative will be available to 
answer potential questions and share individual experience concerning the treatment. The TAU 
participants will receive standard psychotherapeutic treatment, chosen according to individual needs 
and therapist preference. 
 
The intervention will consist of 20 sessions of symptom-based NF tailored to the individual patient. 
Training will be conducted using the Othmer method of NF from EEGinfo, comprising bipolar, infra-
low frequency training, with the inclusion of synchrony and alfa-/theta training as needed.  
 
All participants will complete the inventory described below at the outset. The instruments are chosen 
for their ability to measure internal states associated with a risk of triggering urges and cravings 
leading to drug use. Cognitive function is assessed because impairment in this domain is associated 
with poorer treatment outcomes, including decreased treatment retention in SUD patients [22]. QEEG 
data will be recorded prior to and after the 5 months intervention period. These data will be analyzed 
by our cooperating partner at Norwegian University of Science and Technology (NTNU) to identify 
possible biomarkers for addiction, and to study the neurophysiological effects of neurofeedback.  
 
Instruments 
In addition to basic demographics and the Mini International Neuropsychiatric Interview (M.I.N.I.) to 
confirm the SUD diagnosis [23], the inventory includes the items and scales below:  
 
Primary outcome 
 Quality of life, measured with  
- QoL-10, a 10-item questionnaire which rates the patient’s subjective experience of life quality. 
The respondents are asked to rate their physical and psychological health as well as the quality of 
their relationships on five-point Likert scales. The scale also includes a subscale about perceived 
functioning in areas such as work, sexual and social relations [24]. 
 
Secondary outcomes  
 Perceived functioning/well-being:  
- Outcome Rating Scale (ORS), a visual analogue scale consisting of four subscales measuring 
the patient’s perceived functioning in the personal, interpersonal and social domains, in addition 
to a general measure of his or her perceived QoL. The respondents are asked to rate their 
perceived functioning in these areas from very low to very high on a 10 cm, unmarked horizontal 
line [25]. This scale was included to corroborate on the measurement of perceived functioning in 

 
 
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the QoL-10 functioning subscale and to be used in the repeated measuring of perceived 
functioning to assess trajectories of change (see below).  
 Negative affect:  
- Mental distress will be measured with the Symptom Check List-10 (SCL-10). This scale is a 10-
item index with a four-point response scale that maps anxiety and depression. It is an abbreviated 
version based on the more comprehensive SCL-90, and has been shown to be valid indicators of 
psychological distress. The corresponding cut-off point to the conventional 1.0 for SCL-90 is 1.85 
[26, 27]. 
- Restlessness and trepidation, measured with a visual analogue scale (VAS) on which the 
respondents are asked to rate their level of uneasiness from “none” to “very high” on a 10 cm, 
unmarked horizontal line [28, 29]. 
 
 Substance use:  
- Measured by selected questions from the European version of the Addiction Severity Index 
(EuropASI), a multi-dimensional interview used to measure a variety of aspects related to 
substance use [30].  
- Measured with two visual analogue scales (VAS), one for alcohol consumption and one for drug 
use, on which the respondents are asked to rate their intake in the last week by inserting a mark 
on a 10 cm, unmarked horizontal line [28, 29]. 
- Perceived severity of substance use: As the study includes persons with both alcohol and drug 
dependence, we will also include a short, overall substance use severity measure at baseline; the 
Survey of Readiness for AA Participation (SYRAAP) severity subscale [31].  
 
 Physiological variables:  
- Sleep quality, measured with a visual analogue scale (VAS) on which the respondents are asked 
to rate their sleep quality from “worst perceivable” to “best perceivable” on a 10 cm, unmarked 
horizontal line [28, 29].  
 
 Cognitive function: 
- Measured with the Montreal Cognitive Assessment (MoCA), a brief screening instrument 
sensitive to mild cognitive impairment. The scale samples behavior across 14 performance tasks 
that engage multiple cognitive domains including attention, language, visuospatial, executive, and 
memory. Total possible score is 30 points, and a score of 26 or greater is classified as within 
normal range, that is, without evidence of cognitive impairment [22].  
- Measured with the QIK test – a continuous performance test devised to yield a reliable pre-post 
measure on attentional variables. It is a go/no-go challenge test, known as a choice reaction time 
test. It measures speed, accuracy and consistency and compares data to norms. 
 
 To assess the trajectories of change in the NF-TAU condition, a simple computer-based 
screening test will be administered weekly to each participant during the project period, 
measuring: a) alcohol and drug use, b) sleep quality, c) restlessness and trepidation and d) 
perceived functioning (ORS). These VAS scales have been described above. 
 
The participants will be reassessed after treatment and at a 3- and 12- month follow-up period. 
Research assistants (RAs) blinded to the patient’s condition assignment will conduct the follow-up 
interviews. Efforts will also be made to examine non-completers. Respondents will be reimbursed 
NOK 250 ($30) for completing the follow-up interviews.  
 
Sample size calculation  
Sample size calculation is based on a previous study of a similar population where patients had a mean 
QoL score at 0.57 (SD 0.17) [32]. A minimal clinical relevant improvement and between group 
difference is considered to be 0.10 [33]. A sample size of 40 in each group has an 80% power to detect 
a 0.10 mean difference between groups with a significance level (alpha) of 0.05 (two-tailed). The 
power calculation was carried out with StatMate ver. 2.0 (GraphPad Software, Inc., San Diego, CA, 
US). We expect a 20% attrition rate at follow-up, thus, 50 patients will be needed in each group. 

 
 
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Statistics  
Baseline variables will be reported with descriptive statistics. Difference between randomized groups 
on primary outcomes will be assessed with Student’s t-test. Secondary outcome will be assessed with 
appropriate tests, e.g., the weekly repeated measures will be analyzed with generalized estimating 
equation (GEE) to test for differences between groups.  
3. 
The project plan, project management, organization and cooperation 
Project group: 
- Principle investigator and PhD supervisor: John-Kåre Vederhus PhD, Addiction Unit (ARA), 
Sørlandet Hospital HF (SSHF) 
- Assistant supervisor: Professor Thomas Clausen MD/PhD: ARA, SSHF and University of Oslo  
- Statistical supervisor: Are Hugo Pripp PhD: Oslo Centre of Biostatistics and Epidemiology, Oslo 
University Hospital 
- User representative: Ariel Khavari  
- Clinical neurofeedback specialist, Karin Gabrielsen, MSc, ARA, SSHF  
 
Advisory board: 
The advisory board consists of national and international specialists on neurofeedback and QEEG [34, 
35]. In addition, we cooperate with a community based researcher who is our link to the local 
municipality [36].   
- Antonio Martins-Mourao, PhD, Clinical Director, London Scientific Neurotherapy 
- Stig Hollup, Associate Professor, NTNU, Trondheim 
- Finn Normann Thoresen, MD, outpatient clinic for social medicine, Østfold hospital 
- Eirik Abildsnes, MD/PhD, Research advisor, Kristiansand Municipality 
 
The specialists have commented on the project description and will participate in writing up on 
articles. In addition, Dr. Martins-Mourao will supervise and train clinicians for the QEEG procedures 
and Professor Hollup will be directly involved in interpretation of the QEEG results.  
 
Existing research infrastructure  
The Clinic for Psychiatry and Addiction Medicine (KPA), Sørlandet Hospital, has a large research 
portfolio. There are currently ten ongoing PhD research fellowships. Statisticians at Oslo University 
Hospital, has supervised previous projects at the site of the current study. 
 
The proposed clinical study is being planned by the Research Department at ARA, Sørlandet Hospital. 
ARA is a subunit of KPA and has been carrying out addiction research since 1987. In the beginning, 
this was mainly naturalistic outcome research, and later intervention studies, randomized controlled 
trials, and registry studies were added to the portfolio [37-39]. A research unit was established in 2001 
and currently comprises a research leader (MD/PhD), two senior researchers and two research fellows. 
Thomas Clausen MD, PhD from the Norwegian Center for Addiction Research (University of Oslo, 
UiO) acts as a research supervisor. Four PhDs at ARA have graduated via UiO or the University of 
Bergen (UiB). The studies of two of these students were supported by grants from the Norwegian 
Research Council; these studies were completed in 2012/2013 [40, 41]. ARA is also taking part in 
other ongoing cooperative projects with national collaborators and local community based research 
projects, as encouraged by the health authorities. Previous collaborations include international 
cooperation, e.g., with US researchers [39, 42].  
 
Feasibility 
Since neurofeedback was introduced to clinical practice at the Addiction Unit at Sørlandet Hospital 
HF (ARA) in 2011, a total of 10 clinicians have undergone training by EEGinfo in the Othmer 
method. Five of these are currently using it actively in their clinical work, constituting an experienced 
team of therapists who are skilled in data collection. The pilot study conducted at the unit in 
2011/2012 [16] provided valuable experience on which to build the proposed study. The main focus of 
the pilot was SUD and comorbid PTSD, and since then outcome data from the treatment sessions have 

 
 
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been systematically collected for clinical use using similar instruments to those proposed here. Thus, 
data collection for the study will follow already established routines at the clinic. Based on the pilot 
study and practice at the clinic, the number of participants needed for this study is realistically 
achievable during the course of the planned two-year inclusion period.  
 
Project time frame  
- 
April 2017: Apply for relevant permissions (e.g., ethical approval). Clinical trial registration. 
Apply for funding.  
- 
Autumn 2017: After ethical approval has been obtained, implement the experimental study in 
lieu of the clinical practice at ARA. Data collection. 
- 
Autumn 2017: Find qualified PhD candidate as soon as funding is secured. Qualified 
graduates (with master’s degrees) are currently doing clinical work at ARA. They are 
expected to apply for the position and will be able to start at relatively short notice. 
- 
January 2018 to December 2019: Continue the experimental study and data collection 
- 
Spring 2018. Start writing the first article based on the naturalistic cohort consecutively 
admitted after the first pilot study. 
- 
January to December 2020: Complete follow-up interviews. 
- 
Spring 2020 – Spring 2021. Write up papers.   
- 
Autumn 2021: Write summary of PhD thesis research. Submit PhD thesis.  
- 
The post-doc will be positioned with a two-year delay to await the on-going data collection.  
 
Budget  
See online application.  
 
4. 
Key perspectives and compliance with strategic documents 
 
Compliance with strategic documents 
The project is in agreement with the Norwegian government’s pronounced aim of making treatment of 
substance use and mental health disorders priority areas. This is intended achieved partly by 
strengthening the diversity in and to improve the quality of the treatment offered, including developing 
new, knowledge-based intervention methods [43]. Government documents also emphasize the 
importance of user involvement both on an individual level and to guide research in the field. 
 
Relevance and benefit to society 
Recognizing substance use disorder as a chronic, relapsing mental disorder, the effective treatment 
approaches should address both its biological, physiological and psychological domain components. 
This complexity calls for an integrative approach, and over the past thirty years NF training has 
surfaced as a medication free adjunct therapy to conventional intervention modalities for this patient 
group.  
 
Preliminary clinical experience indicates that the method represents an intriguing, technology-
intensive option and a refreshing alternative for a treatment-fatigued patient population, resulting from 
offering traditional “talk therapies” only. The proposed study will provide new knowledge about the 
use of neurofeedback in the treatment of SUD, specifically the novel infra-low training methods, 
potentially leading to a more holistic treatment approach, improved retention and relapse rates, and 
reduced detrimental outcomes for a vulnerable and difficult to treat group of patients.  
 
Environmental impact 
The study is not expected to constitute any additional hazard to the environment.  
 
Ethical perspectives 
Participants will be included after they have provided written informed consent to join the study. 
Approval has been sought from the Regional Ethics Committee. Based on six years of clinical 
experience and the outcome of the 2012 pilot study, no adverse side effects are expected for the 
patients. In order to secure equal treatment to all participants, the TAU group will be offered NF after 

 
 
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study completion. The project group has decided against including a placebo control in the study, as 
the practice of offering 20 sessions of non-active feedback was deemed unethical. 
 
Gender issues 
Participants of both genders will be included, and it is expected that the sample will mirror the typical 
gender distribution of patients referred to addiction treatment. A female clinician with a master’s 
degree will be engaged as clinical coordinator for the study and will be the natural candidate for the 
doctoral research fellowship position.  
 
Dissemination and communication of results 
At least six scientific papers are planned to be written, three of which will form the basis for a PhD 
dissertation, and three for the post-doc position. All are intended to be published in international peer-
reviewed journals, such as Substance Abuse Treatment, Prevention, and Policy; Addiction Science & 
Clinical Practice; Journal of Psychiatry and Neuroscience, and Applied Psychophysiology and 
Biofeedback. The results will also be communicated in relevant national and international research 
arenas and targeted to decision makers in the addiction and health fields, as well as to the existing 
clinical network and their associated websites and social media sites. Moreover, the results will be 
used to expand and improve the practice of neurofeedback for the addiction population by providing 
further documentation of its effectiveness.  
 
Tentative titles for the papers are as follows: 
1. “Feasibility and effectiveness of neurofeedback in substance use treatment: Experiences from 
a naturalistic pilot study”  
2. “Clinical effectiveness of neurofeedback in a mixed substance abuse population as measured 
by quality of life. A randomized controlled trial” 
3. “Do effects last? Follow-up results 12 months after completing a neurofeedback intervention 
program for substance use disorders” 
4. “Can neurofeedback reduce psychological distress in patients with substance use disorders? 
Secondary outcomes of an RCT.”  
5. “Does cognitive function predict effectiveness of and treatment retention in a neurofeedback 
treatment regime?” 
6. Hangin’ in there: Can neurofeedback reduce drop-out rates and prevent relapse in addiction 
treatment? Assessment of costs and benefits.  
 
Communication with users  
Cooperation has been established with a user representative who has partaken actively in the entire 
research process. From an early phase, the representative has been instrumental in bringing in the user 
perspective in preliminary considerations, commenting on relevant questionnaires, thereby securing 
more useful outcome measures for the project. During the data collection phase, she will aid in the 
recruitment process and constitute a link to the research participants by taking part in patient 
interviews and screenings, encouraging their participation in the project, and highlighting its 
significance for the user population, both directly and through user organizations. Specifically, she is 
intended to play an active role in pre-treatment information and dialogue sessions, to which the NF-
TAU participants are invited to discuss the program and ask any questions they may have concerning 
the intervention. She is also intended to aid in distribution of the results in relevant user forums in 
order to raise awareness of the method and its application for the SUD population. External user 
organizations will also play a part toward this end.  
 
5. 
Additional information specifically requested in the call for proposals 
A patient with a SUD is typically a frequent user of local health care services across his or her 
lifespan, and in comparison, the time spent in specialist treatment facilities is relatively short. A close 
cooperation between the services, both on a clinical level and with a view to research, is therefore 
paramount to treatment success with this patient group, and to secure life-long healing and QoL for the 
individual. In line with the Government’s Coordination reform intentions, the neurofeedback 
intervention can be viewed as a potential addition to the support yielded at the municipal level, 

 
 
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reducing the need for these services and further strengthening the cooperation between the service 
providers[44]. Experience from the pilot study indicates that neurofeedback is welcomed by our local 
cooperating partners as a method for enhancing the function of their clients, and may thus serve as an 
additional useful tool in the continuum of care of the individual. 
 
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