Review of Rationale for Neurofeedback Application in Adolescent Substance Abusers with Comorbid Disruptive Behavioral Disorders

Abstract

Neurofeedback is a type of operant conditioning in which an individual modifies the frequency, amplitude, or other characteristic of his or her own brain activity as measured by EEG. Neurofeedback-training-based neurotherapy is one of the potentially efficacious nonpharmacological treatment options for substance use disorders (SUD) in adults, but it is also a very promising as a treatment modality for adolescents, especially those with stimulant abuse and attention and conduct problems. There is practically no literature on the use of neurofeedback in adolescent drug abusers. Treatment of attention-deficit/hyperactivity disorder (ADHD) with neurofeedback has already gained substantial empirical support in recent years. Short-term effects were shown to be comparable to those of stimulant medication at the behavioral and neuropsychological level, leading to significant decreases of inattention, hyperactivity, and impulsivity. In addition, neurofeedback results in concomitant improvement and normalizations of neurophysiological patterns assessed with EEG, event-related potentials (ERPs), and fMRI. Neurofeedback techniques may be of special interest for adolescent medicine because of the high comorbidity of SUD and ADHD in adolescents. ADHD is often comorbid with other disruptive behavioral disorders such as conduct disorder and oppositional defiant disorder. Techniques that combine classic ADHD neurofeedback approaches with behavioral addiction treatment hold special interest for adolescents with dual diagnosis. They are medication free and thus both minimize opportunities for prescribed medication misuse and diversions and are free of medication side effects. Furthermore, neurofeedback directly acts on the specific brain activity that are known to be altered in SUD and ADHD. By providing low-risk and medication-free therapy for both ADHD and SUD, neurofeedback is an option for practitioners reluctant to prescribe controlled substances to ADHD adolescents at risk for substance abuse.