Neurofeedback and Substance Use Disorders

Updated: Jul 13

EEG neurofeedback has been applied to substance use disorders for over 30 years, demonstrating promising results in well-controlled intervention studies, such as good adherence, reduced addiction severity, and psychosocial benefits even in patients with severe substance abuse. For example, neurofeedback training has been shown to reduce temptation and craving for drugs, as indicated by an attentional bias towards drug-related stimuli, in patients addicted to cocaine (Horrel et al., 2010), and can decrease mental health symptoms associated with alcohol abuse (Peniston & Kulkosky, 1991).

The Neural Imbalance:

EEG alterations are dependent upon several factors, such as the type of substance or duration of use (Sokhadze et al., 2008). For example, in alcoholic patients, most studies report EEG alterations in the beta and/or alpha bands ​(Bauer, 2001; Costa & Bauer, 1997; Ehlers & Philips, 2007; Rangaswamy et al., 2004; Finn & Justus, 1999), while in chronic marijuana users, a persistent “alpha hyperfrontality” (i.e., elevations of alpha absolute power, relative power, and interhemispheric coherence over the frontal cortex) has been found in several studies (Andriot et al., 2022; Struve et al., 1999, 2003).

The Protocol:

The Peniston protocol (or alpha-theta training) is the classical neurofeedback protocol for substance use disorders (Peniston & Kulkosky, 1989; Peniston & Kulkosky, 1990). It measures EEG activity in an eyes-closed resting condition while patients aim to increase parietal alpha (8-12 Hz) and theta (4-7 Hz) which are associated with a relaxed state, thereby reducing EEG hyperarousal and augmenting coping skills. The Peniston protocol has been supplemented with initial sessions that aim to enhance central sensorimotor rhythm (SMR; 12-15 Hz), called the Scott-Kaiser modification. This composite protocol has been efficacious in individuals with polydrug abuse and high levels of impulsivity (Scott & Kaiser, 1998; Scott & Kaiser, 2005).

Given the variation in type, duration, and severity of substance use, a neurofeedback protocol targeted to the observed brain activity has been advocated (Sokhadze et al., 2008).

The Evidence:

A recent review (Schmidt et al., 2017) identified seven EEG neurofeedback clinical intervention trials in substance use disorders since 2010, including four randomized controlled trials (RCTs). Across all seven studies, substances used included opiates (Dehghani-Arani et al., 2010; Dehghani-Arani et al., 2013), stimulants like cocaine and methamphetamine (Hashemian, 2015; Horrel et al., 2010; Rostami & Dehghani-Arani, 2015), alcohol (Lackner et al., 2015), as well as mixed substances and polydrugs (Keith et al., 2015).

Sample sizes ranged from 10 to 100 participants, and the number of neurofeedback sessions varied from 10 to 30. Neurofeedback protocols were mainly the Peniston protocol and Scott-Kaiser modification. In all studies, neurofeedback supplemented other interventions (e.g., pharmacotherapy, cognitive behavioral therapy [CBT]).

The studies reported positive addiction-related outcomes, especially reductions of addiction severity and craving. There were also global psychological and health improvements in most studies.


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