The Treatment of Addictive Disorders by Brain Wave Biofeedback: A Review and Suggestions for Future Research

INTRODUCTION This paper is presented as one of a series of papers in a focal issue of Clinical EEG describing and reviewing clinical brain wave biofeedback. The objective of this paper is to review the reported work on EEG biofeedback in Psychoactive Substance Use Disorder (PSUD) to date, the critical studies that have been undertaken. and to suggest further research directions. In the latter, the paper does not purport to offer the last word on possibilities for future research of EEG biofeedback and PSUD, but will make some contributions to that ongoing dialogue. This paper will give some mention of two other disorders featured in this issue, attention deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI), as important comorbidities in terms of their confounding impact on brain wave biofeedback of PSUD. No attempt will be made to review the field of biofeedback or of addictive disorders generally, although references will be made to specifics that are pertinent to a discussion of some emerging concepts of EEG biofeedback as a treatment for PSUD. In reviewing the findings reported to date on the use and effectiveness of EEG biofeedback in the treatment of PSUD, one is hampered by the paucity of published studies. Unfortunately, large controlled multi-center studies have yet to be reported, and a review of the existing literature is limited to case studies, open clinical trials and a few small controlled and randomized studies mainly focused on alpha-theta feedback. This paper will summarize those reports, as well as reports from several controlled placebo condition studies that have focused on assessing the specificity of alpha-theta to therapeutic effect. Before there is wide acceptance of brain wave biofeedback clinically, much more research is needed. In research design, the existing broad literature on outcome assessment of PSUD and PSUD psychiatric comorbidity needs to be taken into account. This paper will not attempt to review the literature generally related to outcome design and comorbidity, but will focus on specifics from these areas related to brain wave biofeedback study design. As discussed in the following sections, brain wave biofeedback was originally conceptualized as a way to augment insight and motivation through guided imagery in alcoholics, and the focus of initial implementation was on achieving very relaxed hypnagogic states using occipital slow wave feedback. However, much information has come to the fore regarding specific EEG aberrations in PSUD. It is beyond the scope of this paper to review the voluminous literature on EEG and QEEG in PSUD. However, several QEEG studies point to very specific abnormalities likely associated with drug neurotoxicity, suggesting that specific EEG biofeedback protocols may be studied for effect on these conditions. This is especially so in light of the potential for EEG biofeedback to address neurologically based problems such as TBI and ADHD that also may be associated with specific EEG abnormalities. This paper will selectively discuss some of these findings that may be pertinent to study design.