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Addiction / Subtance-Abuse

Updated: Aug 24, 2023

All living organisms depend on the environment for their own survival. Coping with the demands and stresses of one’s environment captures the essence of the survival instinct, where the main priority of every living creature comes down to the pursuit or avoidance of different stimuli. Detecting threats and avoiding harm or injury is a deeply inborn reflex that has neurological underpinnings, but carries a high metabolic demand. Depending on the severity of the threat with which one is faced, the outcome of this survival instinct can have long-lasting consequences that are clinically categorized as posttraumatic stress. These self-protective mechanisms of trauma have immense survival utility, but can become maladaptive, and especially with each exposure to another threat can greatly disable one’s ability to cope with everyday life. One of the world’s leading specialists and researchers in the area of trauma, and author of the best-selling The Body Keeps the Score, Bessel van der Kolk Ph.D, defined trauma as “not the story of something that happened back then, but the current imprint of that pain, horror, and fear living inside the individual”.

It is due to the physiological demand of traumatic experiences, that it becomes more difficult for the brain to maintain physiological, cognitive, and emotional health. This compromise in health and stability greatly increases the chance of developing co-occurring symptoms of major depressive disorder, anxiety, fibromyalgia, cardiovascular, and many other modern diseases that often precipitate substance use disorder (SUD).

In modern psychiatry the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines SUD as a pattern of behaviors and symptoms that arise from an addiction to a substance despite negative effects. The most simple way to understand addiction is that it is a learned behavior, which is often exhibited in response to the individual’s attempt to regulate their function and emotion. As emotion is the basis of the human experience it provides intoxicating substances a very powerful although short-term advantage in overcoming perceived stressors. The occurrence of a stressful event that entices an individual to use a substance in order to cope with the physiological and emotional demand that accompanies it, becomes a learned and ingrained behavior that is more likely to repeat whenever similar circumstances present themselves. Post-traumatic stress disorder (PTSD) is the extreme version of a stressor that often leads to issues with substance use.

However, despite the fact that not all addiction is considered to be rooted in PTSD, it is always rooted in another mental or physical disease or dysfunction that the individual faces. Whether from chronic pain, anxiety, major depressive disorder, or even all the way through the mental disorder spectrum including borderline personality disorder or schizophrenia, individuals become addicted to substances because of the perception that it helps them cope with their given stressors. Addiction is often seen as a disease in itself, but due to the fact that it is always accompanied by another comorbidity, the interpretation of it as a symptom allows clinicians deeper insight into not only its causes, but also its potential remedies. Furthermore, addiction is not only a symptom of another issue but it also creates additional disruptions to the brain that have to be overcome.

Current treatments of addiction mainly come down to either medically managed detox, or residential and outpatient rehabilitation programs, which at most show only a 50% success rate. The success of such programs are less due to their design but more to the mismatch between their scope of influence and the actual neurological root of the addictive process. The management of addiction requires a level of detail that conventional techniques cannot target in the brain, including the specific activities linked to the symptom of craving. Since the feelings of restlessness, irritability, nausea, and insomnia that typify cravings are the main challenges of addiction, an intervention that is able to reduce their occurrence would prove to be distinctly advantageous in the rehabilitative context.

The advantage that neurofeedback technology is able to offer is that it is able to target the exact anatomical regions of the brain whose activity is associated with the learned behaviors of addiction. Various structures of the brain are closely linked to specific functions, and advances in neuroscience have made great progress in revealing which parts of the addicted brain are universal across individuals, as well as substances. The two main structures of the brain whose abnormal activity has been clinically verified in the process of addiction are the associated regions of the prefrontal cortex (PFC), and the posterior cingulate cortex (PCC).

In the application of neurofeedback the PCC has been a well-known site of reference, where one of several techniques known as Alpha-Theta has shown remarkable results. Alpha-Theta is commonly used to target the PCC in subjects addicted to everything from nicotine and alcohol, to heroin, or even behavioral addictions like gambling. Originally named the Peniston protocol after its founder Eugene Penistion, Ph.D. who pioneered treatment for alcohol abuse in combat veterans at the original VA Medical Center in Fort Lyon, in the 1980’s. The effect of Alpha-Theta neurofeedback had successful results for no less than 70% of all outpatients, and was so strong that there was even a common response in patients that became known as the “Peniston Flu” where 50% of the subjects experienced an allergic reaction to their substance of abuse.

Additionally the role of the PFC which is known as the foundation of distinct human characteristics is universally evident in any type of addictive behavior. The dysfunction of the PFC’s role in the regulation of thought, action, and emotion, which drive abilities like learning, planning, and impulse control, underpins the associative learning process that occurs in addiction.. One of the standard and classic approaches that has been successfully implemented in clinical application of neurofeedback is to target the reinforcement of the sensorimotor rhythm (SMR). SMR is a brainwave range (12-15Hz) that has been established as the basis of functional stability of the frontal lobe of the brain, which is the anatomical foundation of the PFC. SMR neurofeedback has been used to help stabilize the broad regulatory brain function such as sleep, attention, and homeostasis, which are so consistently impacted by addiction.

In the ever changing environment of the modern world the ability to adapt to its demands may also require a modernized update to those very same skills. The technological and political landscape of the modern era presents novel pressures that have never existed before, that exert novel challenges on the psychophysiology of both brain and body. In many cases where these novel challenges are not surmounted they leave an imprint that increases the chance of developing an addiction. Addiction carries a heavy burden on many individual’s personal and professional lives, which carryover damage upon society at large. It is the main premise of medicine to alleviate suffering and provide the public with interventions that restore quality of life. The development of neurofeedback offers new hope for modulating the performance of the brain to keep up with the ever changing modern world. Neurofeedback epitomizes the definition of a non-invasive modality that holds so much promise for the alleviation of drug and alcohol addiction, and provide people with the opportunity to regain one’s health and life.

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