Addiction is a multidimensional chronic illness rather than an acute disease (Hser, Hamilton, & Niv, 2009). The progression of alcohol and substance dependence includes periods of experimentation, abstinence, relapse and treatment. There is no singular cause for addiction, but is known to result from a combination of genetic and environmental factors (Dick & Agrawal, 2008). Treatment for this illness has made little change since the first formal treatment center opened in Minnesota in the early 1940s despite the inefficacy of successful rehabilitation and the lack of engagement on the part of the client (Quinn, Bodenheimer-Davis, & Koch, 2004). However, with the advent of managed care, treatment professionals are beginning to include evidence based practices to assist in the success of their clients (Meara & Frank, 2005). One such empirically supported modality is quantitative EEG neurofeedback (qEEG), a form of self regulation in which the brainwaves are monitored by an electroencephalogram (EEG) which digitizes brainwave activity into auditory and visual feedback via a computer (Quinn, Bodenheimer-Davis, & Koch, 2004). Neurofeedback identifies abnormal brainwave patterns that may be responsible for certain disruptive behaviors and uses principles of operant condition to train the brain to illicit a normalized pattern of brainwaves (Kaiser, 2005).
Prevalence rates of addiction disorders are surveyed each year by the Substance Abuse and Mental Health Services Administration through the Department of Health and Human Services (Substance Abuse and Mental Health Services Administration, 2009). In 2008, there were approximately 22 million people aged 12 years and older considered to have a substance dependence disorder or substance abuse disorder in the past year. This calculates to around 8.9 percent of the U.S. population. The numbers have little fluctuation over the past 6 years.
Survey responses were further reviewed to show that of these 22 million people, 3.1 million fell under the diagnosis of dependence or abuse of alcohol and illicit drugs, 3.9 million were dependent or abused only illicit drugs, and 15.2 million were dependent or abused alcohol only (Substance Abuse and Mental Health Services Administration, 2009). The survey showed that 7.3 percent of the U.S. population, or 18.3 million people, were clearly diagnosed with alcohol dependence or abuse.
The cause of addiction is not yet known, however several factors have been linked with the likelihood of developing a dependence upon alcohol and illicit substances. Genetics appear to have an influence as shown in twin and adoption studies (Dick & Agrawal, 2008). In this study, the heritability for alcohol dependence was calculated to be approximately 50-60 percent for both genders. The range for illicit substance abuse was slightly wider and shown to be approximately 45-79 percent. There is evidence to suggest this genetic influence may manifest in a predisposition to externalizing disorders, the metabolism of certain drugs and the brains electrical wave pattern. Specifically, when an individual with alcohol or drug dependence are monitored using EEG and compared to the EEG reports of their children, there is a distinct reduction in the amplitude recorded on the parietal region of the brain. This has led researchers to conclude that this abnormality may signal a genetic predisposition to alcohol or drug dependence. Interesting to note is that the decrease in the size of brain waves is more distinct in those with illicit substance dependence or abuse. Unfortunately, attempts at identifying a specific genetic phenotype for alcoholism has been unsuccessful, however, there are currently many heavily funded projects that are seeking to rectify this situation.
Alcohol and drug dependence and abuse directly affect the mesocorticolimbic system of the brain and the neurotransmitters responsible for behavior (Wand, 2008). It is believed that the changes produced in this region of the brain are responsible for the progression of alcohol and drug use to the state of dependence. Wand (2008) states in his study that alcohol and other drugs can activate the stress response. In addition, the stress hormones, glucocorticoid and corticotrophin-releasing factor, mediate the rewarding experience in the brain associated with alcohol and drugs in the mesocorticolimbic dopamine system. This creates more internal imbalance within the body hypothesized to be responsible for the increase in self administration of more alcohol and/or illicit substances. The act of self administration then becomes a self-medication to relieve the stress and continue to feel the rewarding effects of the substances. As this cycle continues, the reward system becomes impaired to such a degree that heavier use is needed to maintain the rewarding experience and to relieve the body of a continuous state of anxiety. Once an individual’s use escalates to withdrawal symptoms if the substances are not consumed, severe impairment has been done to the reward system to the point at which the individual must continue the use mainly to relieve the negative effects of constant anxiety. Even after the individual discontinues using the substance, this impairment to the brain continues to affect how treatment is received by the individual often resulting in relapse if left unattended.
To understand what may prompt an individual to begin using alcohol or illicit substances, it is best to look at defining characteristics inherent in those with abuse or dependence disorders. Personality characteristics, such as impulsivity, have been identified that may increase the risk of alcohol and substance use that become dependence (de Wit, 2008). Impulsivity is broadly defined as the “tendency to engage in inappropriate or maladaptive behaviors” (p. 23). This characteristic is believed to be multidimensional in the fact that it functions as both a precursor to and consequence of addiction. The complexity of this construct has made it difficult to consistently measure its direct role in maladaptive drug use. However, when observing behavioral inhibition, impulsive decision making and attentional lapses, it was found that the more impulsive the youth, the more likely they are to experiment with drugs, use drugs regularly and develop alcohol and/or drug dependence. Impulsivity also plays a part in the abstinence from alcohol and/or drugs in that it increases the risk of relapse behaviors.
Alcohol and Drug Treatment
Historically, treatment for alcohol and illicit substances has followed the Minnesota Model of recovery despite the low rates of continued abstinence (Quinn, Bodenheimer-Davis, & Koch, 2004). This model generally utilizes individual therapy, group therapy and peer support strongly dependent upon a 12 step program. The counseling theory most often utilized are of a cognitive and behavioral approach focused on changing the client’s thoughts about their use and enlightening the client of the consequences of their behavior. The place of the counselor is one of ultimate authority, while the client is viewed as being in a state of disillusion about their drug use and the effects it has upon their quality of life. It is the purpose of the counselor to assist the client to reconnect with “reality”. The underlying belief is that the client is unable to be honest enough with themselves and the counselor and therefore has no ability to take an active role in their recovery other than following the directions of the counselor and/or a 12 step sponsor. It is therefore not difficult to understand why the success rates of standard alcohol and substance abuse treatment remain low. In fact, empirical evidence tends to support that the “one treatment fits all” approach is ineffective in treating multiple types of individuals with addiction. In particular, traditional treatment has often lacked the ability to engage the client in the services as they are provided. Neurofeedback has shown in research to not only engage the client, but also lengthens the days in which the client stays in treatment (Scott, Kaiser, Othmer, & Sideroff, 2005).
Quantitative EEG Neurofeedback
Neurofeedback, or qEEG neurotherapy, records the individual’s unique brainwave patterns and utilizes auditory and visual feedback to train brainwaves to a normalized pattern (Quinn, Bodenheimer-Davis, & Koch, 2004). Alcoholics and illicit substance users show similar abnormal brainwave patterns outside the range of individuals without dependence upon alcohol or illicit substances. In alcoholics, the alpha and theta waves show low amplitude and increased activity, while high beta waves are more dominant than in a non-user brain. Illicit substance abusers differ dependent upon their substance of choice. For example, in cocaine and methamphetamine users, the alpha and theta waves show excessive activity in the frontal region of the brain. It is these typical patterns that are targeted in neurofeedback sessions although each treatment protocol is flexible, in that it can be specified to individual clients.
Training consists of EEG sensors placed on the scalp connected to an amplification system, which then feeds the electrical activity of the brain into the computer. Software systems allow the neurotherapist to set conditions in which the client is rewarded. Training sessions are performed at a minimum twice per week, for approximately 40 sessions. When treating substance abuse issues, more intensive therapy is often recommended (5 days per week). You can find a local practitioner by going to www.bcia.org.
Dependence upon alcohol and illicit substances is a complex illness that involves the medical, psychological and social aspects of an individual. Formalized treatment has been available for the past 70 years, however, low success rates for standard treatment imply the inefficacy of current modalities. EEG neurofeedback has shown through research that it qualifies as an efficacious adjunct therapy that can dramatically improve the likelihood for recovery. Specifically, the use of the Peniston protocol for alcoholism and the Scott-Kaiser modification for illicit substance users are shown to positively affect abstinence rates, client engagement and MMPI-2 scores.
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