Substance Abuse and Addiction Disorders


allaway, T.G., Bodenhamer-Davis, E. (2008). Long-term follow-up of a clinical replication of the Peniston Protocol for chemical dependency. Journal of Neurotherapy 12(4), 243 – 259.

Introduction. This study is a long-term follow-up of an early replication of the Peniston EEG biofeedback (EEG-BFB) Protocol for chemical dependency (Peniston & Kulkosky, 1989, 1990). Method. This clinical trial included 16 chemically dependent adult participants treated with the Peniston Protocol in a university outpatient clinic between 1993 and 1995. Ten participants were probationers classified as high risk for rearrest. Treatment effects were assessed using pre/posttreatment measures (Beck Depression Inventory, Minnesota Multiphasic Personality Inventory-2) and long-term follow up of abstinence and rearrest rates. Probationer rearrest rates were compared to an equivalent probation sample (n = 24) that did not receive EEG-BFB.

Results. Initial Beck Depression Inventory scores indicated mild/moderate depression but were significantly reduced posttreatment to within normal limits. Substantial differences were noted posttreatment on 7 Minnesota Multiphasic Personality Inventory -2 clinical scales suggesting less psychopathology following treatment. Long-term (74–98 months) follow-up indicated that 81.3% (n = 13) participants were abstinent. Rearrest rates and probation revocations for the probationer subgroup were lower than the comparison group (40% vs. 79.16%).

Conclusion. This study provides evidence of the durability of Peniston Protocol results over time but has the usual limitations of a clinical trial with a small sample, nonrandomized, and uncontrolled design. Implications for further research are discussed including the relevance of recent modifications to the Peniston Protocol and qEEG–based protocols in treating substance abuse.


rCannon, R., Lubar, J., Sokhadze, E., & Baldwin, D. (2008). LORETA Neurofeedback for addiction and the possible neurophysiology of psychological processes influenced:  A Case Study and region of interest (ROI) analysis of LNFB in right anterior cingulate cortex (ACC). Journal of Neurotherapy ,12(4), 227-242.

Introduction. This case study explores the efficacy of low-resolution electromagnetic tomographic (LORETA) neurofeedback (LNFB) in the right anterior cingulate cortex (ACC) as a method for addiction treatment and examines the frequency specific effects of this training in eight other regions of the cortex identified as playing an important role in substance use disorders.

Methods. This case study was completed with one right-handed, 28-year-old female participant with 3 years of continuous abstinence from polysubstance abuse; her drugs of choice were heroin and alcohol, and she reported an 8-year history of alcohol abuse and a 4-year history of heroin use (IV). She completed 25 sessions of LNFB training in which she increased 14–18 Hz activity in the right ACC. We utilized electrophysiological measures to assess the increase or decrease in eight regions of interest (ROI): the right hippocampus, the right amygdaloid complex, the right orbitofrontal cortex (OFC), the right occipital lobe, the right insular cortex, the right uncus, and two regions in the left prefrontal cortex and compared them using complex linear mixed model and partial correlation procedures. Results. The data indicate significant associations between these limbic and cortical regions. The linear increase in the right ACC was in the desired direction; however, this will require more than 25 sessions to reach significance. The effects of training in the right ACC show significant increase and decrease for all frequencies in specific regions of interest.

Conclusion. This is the first study of its kind to explore the relationship between these nine ROI as influenced by LNFB in the right ACC. The data suggest that these regions may play an intricate role in behaviors and characteristics involved in addiction; specific changes in the alpha frequency in limbic regions and increases in associations between regions in the theta frequency may influence personality and other behaviors associated with addictive traits. This case study illustrates the possible neural mechanisms involved in the negative self reference associated with addiction even after a significant period of abstinence and possibly offers insight into antecedents to the onset of substance use disorders.


deBeus, R. J. (2007). Quantitative electroencephalography-guided versus Scott/Peniston neurofeedback with substance abuse outpatients: A pilot study. Applied Psychophysiology and Biofeedback , 35(4), 146-151.

Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. 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. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given.


Dehghani-Arani F, Rostami R & Nadali H. (2013). Neurofeedback training for opiate addiction: improvement of mental health and craving. Appl Psychophysiol Biofeedback. 2013 Jun;38(2):133-41. doi: 10.1007/s10484-013-9218-5.

Psychological improvements in patients with substance use disorders have been reported after neurofeedback treatment. However, neurofeedback has not been commonly accepted as a treatment for substance dependence. This study was carried out to examine the effectiveness of this therapeutic method for opiate dependence disorder. The specific aim was to investigate whether treatment leads to any changes in mental health and substance craving. In this experimental study with a pre -post test design, 20 opiate dependent patients undergoing Methadone or Buprenorphine maintenance treatment were examined and matched and randomized into two groups. While both experimental and control groups received their usual maintenance treatment, the experimental group received 30 sessions of neurofeedback treatment in addition. The neurofeedback treatment consisted of sensory motor rhythm training on Cz, followed by an alpha-theta protocol on Pz. Data from the general health questionnaire and a heroin craving questionnaire were collected before and after treatment. Multivariate analysis of covariance showed that the experimental group achieved improvement in somatic symptoms, depression, and total score in general mental health; and in anticipation of positive outcome, desire to use opioid, and relief from withdrawal of craving in comparison with the control group. The study supports the effectiveness of neurofeedback training as a therapeutic method in opiate dependence disorder, in supplement to pharmacotherapy.


Hanlon CA., Hartwell KJ., Canterberry M., Li X., Owens M., Lematty T., Prisciandaro JJ., Borckardt J., Brady KT. & George MS. (2013). Reduction of cue-induced craving through real time neurofeedback in nicotine users: The role of region of interest selection and multiple visits. Psychiatry Res. 2013 Jul 30;213(1):79-81. doi: 10.1016/j.pscychresns.2013.03.003.

This multi-visit, real-time functional magnetic resonance imaging feedback study demonstrates that treatment-seeking smokers can effectively modulate their behavioral and brain responses to smoking cues. They are more effective at decreasing activity in functionally defined regions involved in "craving" (e.g. ventral anterior cingulate cortex [vACC]) rather than increasing activity in regions involved in "resisting" (e.g. dorsal medial prefrontal cortex [dmPFC]).


Keith, JR., Ragpay, L., Theodore, D., Schwartz, JM & Ross, JL. (2014). An assessment of an automated EEG biofeedback system for attention deficits in a substance use disorders residential treatment setting. Psychology of Addiction Behaviors: Sept 2014 Early e-pub.

Attention deficits are prevalent among individuals with substance use disorders and may interfere with recovery. The present study evaluated the effectiveness of an automated electroencephalogram (EEG) biofeedback system in recovering illicit substance users who had attention deficits upon admission to a comprehensive residential treatment facility. All participants (n = 95) received group, family, and individual counseling. Participants were randomly assigned to 1 of 3 groups that either received 15 sessions of automated EEG biofeedback (AEB), 15 sessions of clinician guided EEG biofeedback (CEB), or 15 additional therapy sessions (AT). For the AEB and CEB groups, operant contingencies reinforced EEG frequencies in the 15-18 Hz (β) and 12-15 Hz (sensorimotor rhythm, "SMR") ranges and reduce low frequencies in the 1-12 Hz (Δ, θ, and α) and 22-30 Hz (high β) ranges. The Test of Variables of Attention (TOVA), a "Go NoGo" task, was the outcome measure. Attention scores did not change on any TOVA measure in the AT group. Reaction time variability, omission errors, commission errors, and d' improved significantly (all p values < .01) in the AEB and CEB groups. AEB and CEB did not differ significantly from each other on any measure. The results demonstrate that automated neurofeedback can effectively improve attention in recovering illicit substance users in the context of a comprehensive residential substance abuse treatment facility.


Saxby, E., & Peniston, E. G. (1995). Alpha-theta brainwave neurofeedback training: An effective treatment for male and female alcoholics with depressive symptoms. Journal of Clinical Psychology, 51(5), 685-693.

This was an experimental study of 14 alcoholic outpatients using the Peniston and Kulkosky (1989, 1991) brainwave treatment protocol for alcohol abuse. After temperature biofeedback pretraining, experimental subjects completed 20 40-minute sessions of alpha theta brainwave neurofeedback training (BWNT). Experimentally treated alcoholics with depressive syndrome showed sharp reductions in self-assessed depression (Beck's Depression Inventory). On the Millon Clinical Multiaxial Inventory -I, the experimental subjects showed significant decreases on the BR scores: schizoid, avoidant, dependent, histrionic, passive - aggression, schizotypal, borderline, anxiety, somatoform, hypomanic, dysthmic, alcohol abuse, drug abuse, psychotic thinking, and psychotic depression. Twenty-one-month follow-up data indicated sustained prevention of relapse in alcoholics who completed BWNT.


Simkin, DR., Thatcher, RW. & Lubar, J. (2014). Quantitative EEGB and Neurofeedback in Children and adolescents: Anxiety disorders, depressive disorders, comorbid addiction and attention-deficit/hyperactivity disorder and brain injury. Child and Adolescent Psychiatric Clinics of North America :23(3). 427-464.

This article explores the science surrounding neurofeedback. Both surface neurofeedback (using 2-4 electrodes) and newer interventions, such as real-time z-score neurofeedback (electroencephalogram [EEG] biofeedback) and low-resolution electromagnetic tomography neurofeedback, are reviewed. The limited literature on neurofeedback research in children and adolescents is discussed regarding treatment of anxiety, mood, addiction (with comorbid attention-deficit/hyperactivity disorder), and traumatic brain injury. Future potential applications, the use of quantitative EEG for determining which patients will be responsive to medications, the role of randomized controlled studies in neurofeedback research, and sensible clinical guidelines are considered.