A systematic review on the role of EEG and fMRI-Neurofeedback training in the treatment of substance use disorders and behavioral addiction.

Neurofeedback (NF), a form of biofeedback, is used to enhance the self-regulation of brain functions by assessing brain activity and delivering feedback signals to ameliorate emotional attributes, cognitive functions, and behaviors. Despite the potential role of NF in substance use disorder (SUD) treatment, a number of gaps such as variations in NF methods persist. This study aims to address such gaps and present comprehensive insights into EEG and fMRI-NF applications in SUD management. This study has been conducted according to the PRISMA guidelines. The search spanned four major databases: Web of Science, Scopus, PubMed, and Embase. The search terms encompassed "Neurofeedback" OR "EEG biofeedback" OR "neurotherapy" OR "Functional near-infrared spectroscopy Neurofeedback" OR "fNIRS-Neurofeedback" AND addiction OR Drug OR "substance dependence" OR "substance abuse" OR Heroin OR Opioid OR Cannabis OR Marihuana OR Cocaine OR Crack OR Amphetamine OR Methamphetamine OR Hallucinogen. Our systematic review yielded 32 articles, including 18 EEG-, 11 fMRI-neurofeedback, and 3 fNIRS-neurofeedback studies. The primary outcome was reduced drug craving and some aspects of mental health and EEG-NF studies consistently indicated a preference for the alpha-theta protocol, whereas the high heterogeneity among fMRI-NF protocols limited direct comparisons. In conclusion, the results of this systematic review indicate that NF shows promise as an adjunctive intervention for treating SUD.