Evidence-based treatment for addiction includes neurofeedback!

Addiction studies have suggested that sobriety rates can be improved using evidence-based neurofeedback, which complements and enhances the efficacy of a 12-step or faith-based addiction recovery program.  The largest and most efficacious addiction study to date is a n=121 randomized controlled trial conducted by UCLA, which was published in a 2005 edition of The American Journal of Drug and Alcohol Abuse, titled, “Effect of an EEG Biofeedback Protocol on a Mixed Substance Abusing Population“.  The results of this study has been replicated multiple times.  To follow is an abstract from one successful replication of the Scott-Kaiser modifications of the Peniston Protocol was published in August 2013.

Neurofeedback: an integrative treatment of substance use disorders – Ross SM

Substance use disorders are exceedingly complicated as is the treatment.  Neurofeedback has been applied successfully as an integrative treatment of SUDs for more than 30 years. Highlighted research that includes Scott-Kaiser modifications of the Peniston protocol has shown that SUD treatment when combined with conventional treatment has the potential to improve measurable parameters and significantly increase positive outcomes. Published Study

Neurofeedback Training for Opiate Addiction: Improvement of Mental Health and Craving – Fateme Dehghani-Arani

Psychological improvements in patients with substance use disorders have been reported after neurofeedback treatment.  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.  This study supports the effectiveness of neurofeedback training as a therapeutic method in opiate dependence disorder, in supplement to pharmacotherapy.  Published Study

The Evolution of the Scott-Peniston Protocols

Rehab Centers Share How They Replicated These Research Results

Click dates on the timeline for details & copies of studies:

 1989 Peniston Study 1993 Scott-Peniston Study 2005 UCLA Study 2014 UCLA & UNC Study 
Small Peniston-Kulkosky Pilot Study, 1989, n=10

In 1989, Drs. Eugene Peniston and Paul Kulkosky develop a therapeutic alpha-theta protocol for addiction recovery and prevention of its relapse.
Based upon the earlier groundbreaking work of Elmer Green, Alyce Green and Dale Walters, Peniston and Kulkosky modify the original alpha-theta
protocol. They combine systematic desensitization, temperature biofeedback, guided imagery, constructed visualizations, rhythmic breathing, and
autogenic training incorporating alpha-theta (3-7 Hz) brainwave neurofeedback therapy.  They complete a small successful pilot study (n=20) in
which Peniston and Kulkosky name the protocols "alpha-theta brainwave neuro-feedback therapy (BWNT)". The protocols have also been referred to 
as the Peniston-Kulkosky Protocols and the Peniston Protocols. 

PROTOCOLS USED:
- Alpha Theta
- 12-Step

CONCLUSIONS:
- 79% abstinence for neurofeedback group 12 months after treatment (based on collateral contacts, in addition to self-report);
- Significant improvements in 5 of the 10 MMPI-2 scales, which are the most frequently used personality tests in mental health.

WHY WAS THIS STUDY SO SIGNIFICANT?
- The design was based on anecdotal observations by Dale Walters.
- It was the first neurofeedback study for an addictive population.

Complete copy of Peniston-Kulkosky Study
 
Scott-Peniston Outcome Study, 1993, n=24

In 1995, Bill Scott & Eugene Peniston teamed up to help 24 Veterans who had PTSD and alcoholism in a successful outcome study at the Northland
Recovery Center in Grand Rapids, MN.  Delta inhibit was added to the original Peniston-Kulkowsky Protocol to prevent abreactions. Abreactions
with the original Peniston-Kulkowsky protocol included flashbacks, which caused the Veterans to re-experience the trauma. When Scott and 
Peniston inhibit delta during the alpha-theta session, the Veterans become an observer of their past history while emotionally in a neutral state.

Scott & Peniston conducted a follow up 12-18 months after treatment, and 79% remained abstinent from PTSD and alcoholism.

PROTOCOLS USED:
- Alpha Theta
- 12-Step
- Delta Inhibit* (This component is added to the original Peniston Protocol for the first time.)

* Delta inhibit was added to the original protocol to prevent abreactions.  Abreactions included flashbacks, which caused Veterans
to re-experience the trauma.  When Delta was inhibited the Veteran would become an observer of their past history while emotionally
in a neutral state.

CONCLUSIONS:
- 100% of the subjects had no PTSD per DSM-iii-r
- 79% of the subjects remained abstinent after 12-18 months

WHY ARE THE SCOTT-PENISTON PROTOCOLS SO SIGNIFICANT?
- They are the only protocols proven effective in a large randomized controlled trial, and later replicated in other studies.
- The study was conducted by a reputable university and published in the distinguished journal.
- Symptom-based protocols are much more cost effective to implement than other EEG biofeedback methodologies.
- The Scott-Peniston protocols are the only methodology that uses alpha-theta feedback, a necessary protocol for 
people with emotional issues and past trauma.
 
UCLA Randomized Controlled Addiction Study, 2005 (Published), n=121

This is a landmark study in that it is the first large (n=121) randomized controlled trial in the field of EEG biofeedback. The results of this study have
since been replicated by other reputable institutions.

PROTOCOLS USED:
- Alpha Theta
- 12-Step
- Delta Inhibit (This component was first added to the original Peniston Protocol in the 1993 Scott-Peniston Study.)
- Beta & SMR* (This component is added to the original 1993 Scott-Peniston Protocols for the first time.)

* Based on an outcome study by Steve Fahrion in which he tried the original Peniston protocol and failed to yield significant results, 
Bill Scott added beta & SMR to the original Scott-Peniston protocol for the UCLA research design.  Fahrion's study was with an addictive
prison population who were primarily polysubstance abusers, therefore, had more neurophysiologic deficits.  It seemed prudent for the UCLA
study to add beta and SMR protocols first to stabilize the brain before beginning alpha theta training which work on defense mechanisms and
fear conditioning.

CONCLUSIONS:
- 77% abstinence for neurofeedback group 12 months after treatment (based on collateral contacts, in addition to self-report)
- 44% abstinence for the control group 12 months after treatment
- 60% reduction in clients premature leaving treatment against medical advice (AMA) in the neurofeedback group
- Significant improvements in 7 of the 10 MMPI-2 scales, which are the most frequently used personality tests in mental health

WHY IS THE UCLA ADDICTION STUDY SO SIGNIFICANT?
- This study was conducted by a reputable university (UCLA) and published in the distinguished journal, The American Journal of Drug and Alcohol Abuse.
- Symptom-based protocols are much more cost effective to implement than other EEG biofeedback methodologies, and this study proved their effectiveness.
- The Scott-Peniston protocols are the only methodology that uses alpha-theta, a necessary protocol for people with emotional issues and past trauma.
- The study was published in the reputable American Journal of Drug and Alcohol Abuse.




UCLA ADDICTION STUDY SUMMARIZED

TITLE:
Effect of an EEG Biofeedback Protocol on a Mixed Substance Abusing Population

SCIENTISTS:
PRINCIPAL INVESTIGATOR: William (Bill) C. Scott, B.S.W., C.C.D.P.
OTHER RESEARCHERS: David Kaiser, Ph.D., Siegfried Othmer, Ph.D. and Stephen Sideroff, Ph.D.

PUBLISHED IN:
American Journal of Drug and Alcohol Abuse
Vol: 31:445-469, 2005

RESULTS:
        - 77% abstinence for neurofeedback group 12 months after treatment
        - 44% abstinence for the control group 12 months after treatment
        - 60% reduction in clients premature leaving treatment against medical advice (AMA) in the neurofeedback group
        - Significant improvements in 5 of the 10 MMPI-2 scales, which are the most frequently used personality tests in mental health

METHOD:
        - Symptom-based neurofeedback was selected as the sole methodology used for the study.
        - 121 volunteers undergoing an inpatient addiction program were randomly assigned to the EEG biofeedback or control group.
        - Protocols of Beta and SMR were used to address attentional variables, followed by an alpha-theta protocol.
        - The Test of Variables of Attention (TOVA), and MMPI, were administered with both test and subject blind as to group placement to obtain unbiased baseline data.

CONCLUSIONS:
    EEG biofeedback enhanced:
        - Treatment retention
        - Variables of attention
        - Abstinence rates one year following treatment

Complete copy of UCLA Addiction Study
 
UCLA & UNC Randomized Controlled Study, 2014 (Submitted for publication in Addiction), n=96

TITLE:
Electroencephalogram (EEG) Biofeedback and Attention in Recovering Substance Users with Attention Deficits: Clinician-Guided versus an Automated
System in an Inpatient Setting

SCIENTISTS:
PRINCIPAL INVESTIGATOR: Julian Keith, PhD, Department of Psychology, University of North Carolina, Wilmington
OTHER RESEARCHERS: Lobsang Rapgay, PhD, UCLA's Neuropsychiatric Institute, Jeffrey Schwartz, MD, UCLA's Neuropsychiatric Institute, 
Don Theodore, MFT, CRI-Help

ABSTRACT:
Aim. We evaluated the effects of an automated EEG biofeedback (EB) and a clinician guided EB system on attention and time-in-treatment in recovering,
in-patient, substance abusers with attention deficits. Design: Randomized experiment comparing automated EB (AEB) versus clinician guided EB (CEB) 
and treatment-as-usual (TAU) only controls.  Setting: A residential treatment program in Hollywood, California. Subjects: Ninety-six dependent illicit
drug users seeking treatment.  Interventions.  All subjects received group, family, and individual counseling (treatment as usual, TAU). Additionally,
the CEB and AEB groups received 15 EB sessions. Operant contingencies reinforced EEG frequencies in the 15–18 Hz (beta) and 12–15 Hz (SMR) ranges and 
reduce frequencies in the 1-12 Hz (delta, theta and alpha) and 22–30 Hz (high beta) ranges. Main outcome measures.  The Test of Variables of Attention 
(TOVA) and time participants remained in the treatment program.  Results.  Attention scores did not change on any TOVA sub-measure in the TAU only group.  
Reaction time variability, omission errors, commission errors, and d’ improved significantly (all p values < .01) in both EB groups. The two EB groups 
did not differ significantly on any measure.  Median length of stay in treatment was 92 days for participants who received TAU, 149 for CEB, and 156.5 
for AEB group.  Conclusions.  EB improved treatment compliance and objective measures of attention.  The automated EB system performed as well a system 
manually operated by an expert EB clinician.  It is feasible to implement automated EB in the context of an in-patient substance abuse treatment facility. 

DECLARATION OF INTEREST: This work was supported in part by a grant from the National Center for Complementary and Alternative Medicine
All authors report no competing interests:

We will furnish the results of this study upon publication in 2014.[/dspp_content][/dspp_panel]

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