Biofeedback Therapy for Alcoholism and Substance Abuse

Biofeedback is an integrative medical treatment that teaches patients enhanced mind-body awareness and control so that they can play active roles in their healthcare.

What is biofeedback therapy?

EEG biofeedback, which is also called neurofeedback and neurotherapy, uses biofeedback devices called electroencephalographs to detect and display the brain’s electrical activity back to the patient. Personal EEG biofeedback training is an innovative and exciting treatment for alcoholism and substance abuse.

What are alcoholism and substance abuse?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association defines alcohol abuse as continued drinking despite repeated negative consequences. Alcoholism or alcohol dependence combines alcohol abuse with tolerance (reduced effectiveness of alcohol), withdrawal (rebound nervous system excitability after drinking has stopped), and an uncontrollable motivation to drink alcohol. Substance abuse is the repeated consumption of a drug despite repeated negative consequences.

Do alcoholics only suffer from physical dependence on alcohol?

Many alcoholics suffer from other psychiatric disorders in addition to alcohol dependence. These comorbid disorders include physical dependence on other drugs (36%), depression (30-50%), anxiety disorders (33%), antisocial personality disorder (14%), and schizophrenia (3%). Many alcoholics may have initially consumed alcohol to treat the symptoms of these disorders.

How dangerous is alcoholism?

While there are many different patterns of alcoholism, it is usually progressive and robs patients of 10-12 years of their lives. Alcoholism is responsible for about 100,000 American deaths each year.

Who is mainly affected?

The 2004 National Survey on Drug Use and Health (NSDUH) estimated that 14.8 million Americans were dependent on or abused alcohol and 3.8 were dependent on or abused illegal substances.

How do biofeedback providers assess patients?

After a medical and psychiatric evaluation of the patient’s health and physical dependence on alcohol and other substances, a comprehensive treatment plan will be developed to help the patient safely withdraw from alcohol and other substances, remain off these drugs, prevent relapse, and treat the medical complications caused by the intake of these drugs.

A biofeedback specialist may monitor the patient’s EEG, finger temperature, heart rate variability, respiration, shoulder, neck, and facial muscles, and finger sweat gland activity during the resting, mild stressor, and recovery conditions of a psychophysiological profile.

Common findings during biofeedback stress tests of alcoholics include:

• excessive fast-wave activity (beta rhythm) and deficient slow-wave activity (theta and alpha rhythms) in the EEG
• constriction of the small arteries of the fingers
• reduction of heart rate variability
• shallow, rapid breathing
• contraction of muscles in the upper shoulders, neck, and forehead
• increased sweat gland activity

How does biofeedback training treat alcoholism and substance abuse?

Biofeedback instruments can increase the effectiveness of drug therapy and psychotherapy in maintaining abstinence from drugs. A biofeedback practitioner uses the results from the psychophysiological profile to develop a training program to help correct abnormal resting or stress-evoked physiological responses that may be associated with distress or drug craving. Biofeedback instructions can teach alcoholics to reduce their risk of relapse.

Clinicians may use multiple types of biofeedback training methods to treat alcoholism and substance abuse, including:

• EEG biofeedback (brain electrical activity)
• EMG biofeedback (skeletal muscle activity)
• heart rate variability biofeedback (timing between heartbeats)
• respiratory biofeedback (breathing patterns)
• skin conductance biofeedback (sweat gland activity)
• temperature biofeedback (blood flow through small arteries)

EEG biofeedback is one of the most exciting and promising treatments for these disorders.

How does EEG biofeedback monitor your brain?

Biofeedback electrodes placed on the scalp and earlobes listen to the electrical activity of the neurons in the brain. A biofeedback device called an electroencephalograph detects the symphony of brainwaves that reflect cognitive and emotional activity.

What are EEG rhythms?

EEG rhythms are generated when neurons send electrical messages to their neighbors many times each second. Neurotherapists describe these brainwaves by their shape, frequency, and scalp location, and patient activity when they are recorded. They measure brainwave frequency in units called Hertz (Hz), which stands for messages or cycles per second.

What do the main EEG rhythms indicate?

The main EEG rhythms include the delta, theta, alpha, sensorimotor, beta, and gamma rhythms:

• The delta rhythm ranges from 0.5 to 3.5 Hz and is increased in adults during Stage III and Stage IV sleep, and in cases of brain injury, brain tumor, or developmental disability.
• The theta rhythm ranges from 4 to 7 Hz, is the most powerful rhythm in the EEGs of 1-2 year-olds, and accompanies drowsiness, the transition to sleep, rapid eye movement (REM) sleep, and information processing.
• The alpha rhythm ranges from 8 to 13 Hz, is present in about three-quarters of adults when they are calm and awake, and is replaced by the faster beta rhythm when you move, read, or solve problems.
• The sensorimotor rhythm (SMR) ranges from 12-15 Hz and appears when you stop moving and relax your muscles.
• The beta rhythm is divided into low beta, which ranges from 13-21 Hz, and appears when you focus your attention, and high beta, which ranges from 20-32 Hz, and appears when you experience anxiety and worry, and when you achieve peak performance.
• The gamma rhythm ranges from 36-44 Hz and appears when you focus your attention and recognize patterns like hidden figures in a picture.

How does training with EEG biofeedback equipment work?

EEG biofeedback transforms these complex signals into videogame displays to teach patients to increase their awareness and control of the brain’s electrical activity. Researchers have shown that the biofeedback techniques employed in neurofeedback can produce long-lasting improvement in the way that people use their brains.

A well-researched treatment strategy teaches patients to replace excessive beta activity, which may be associated with unpleasant emotional states, with slower alpha and theta activity. Neurotherapy with alpha wave and theta wave biofeedback duplicates the calming effects of alcohol without its damaging consequences.

How effective is EEG biofeedback training?

Biofeedback clinical trials have shown that EEG biofeedback can help patients abstain from alcohol. In one study that combined EEG biofeedback with temperature biofeedback, relaxation training, and several psychological strategies, 8 of 10 experimental patients and none of the control patients remained abstinent from alcohol after 24 months.

The Association for Applied Psychophysiology and Biofeedback’s (AAPB) Evidence-Based Practice in Biofeedback and Neurofeedback by Carolyn Yucha, PhD, and Christopher Gilbert, PhD, awarded this treatment the third-highest rating of probably efficacious.

Who should treat these disorders?

Biofeedback providers who are experienced in treating alcoholism and substance abuse and certified by the Biofeedback Certification Institute of America (BCIA) in General Biofeedback or EEG biofeedback are qualified to treat these disorders.

Is there insurance coverage for biofeedback?

Coverage of biofeedback services varies across insurance companies and states. Even when insurance companies reimburse these services, there may be lower allowables than for medical treatment and coverage may be limited to specific types of biofeedback and for certain diagnoses. Some psychologists bill biofeedback services as psychotherapy so that insurance will reimburse treatment.

There is compelling evidence that biofeedback training is a bargain for patients and insurers when you consider savings from fewer emergency room visits and hospitalizations, and reduced medication use.