Heart Rate Variability (HRV) Biofeedback for Alcohol Abuse

In previous posts I briefly reviewed the evidence for two natural supplements for reducing symptoms of hangover and withdrawal following drinking: Red Ginseng and St. John’s wort. In this post I review research findings on a novel biofeedback technique in which the intrinsic variability of heart rate is monitored and used to reduce alcohol craving. Heart rate variability (HRV) biofeedback training is now widely used to treat anxiety disorders. Emerging findings reviewed in this post suggest that this biofeedback approach may significantly diminish alcohol craving and reduce the risk of relapse.

How HRV-biofeedback training works

HRV-biofeedback improves the beat-to-beat fluctuations of the heart rate (HRV) in response to relaxed breathing. Brain regions involved in autonomic regulation of the heart overlap with brain regions that modulate mood and arousal such as the pre-frontal cortex and the amygdala (Devinsky 1993). Such functional ‘integration’ of different brain regions may help explain why individuals who report reduced alcohol craving also experience reduced anxiety.

HRV biofeedback training for reducing alcohol craving: A concise review

Recent research findings suggest that impaired cardiac parasympathetic (the part of the autonomic nervous system involved in slowing down heart rate) function is associated with increased craving (Quintana 2013). Findings of two small studies suggest that individuals who engage in regular heart rate variability (HRV) biofeedback while enrolled in a rehabilitation program for alcohol dependence report greater reductions in alcohol craving and anxiety compared to individuals undergoing rehabilitation only (Penzlin et al 2015; Eddie et al 2014). In one study (Penzlin et al 2017) 48 individuals undergoing inpatient rehabilitation treatment for alcohol use disorder were randomly assigned to receive either HRV-biofeedback in addition to standard rehabilitative care or rehabilitative care only. Individuals enrolled in the study used validated HRV-biofeedback systems such as StressPilot™ and BioSign™ which permitted subjects to continuously visualize their HRV data.

Subjects were instructed to breathe slowly six times per minute to increase the parasympathetic tone and HRV. Individuals in the HRV-biofeedback group underwent three 20-minute sessions of HRV-biofeedback training per week over two weeks and control subjects did not undergo biofeedback. Measurements of cardiac and autonomic function were taken before the first biofeedback session, after completion of the last session, and three and six weeks after the study ended. Individuals who participated in a conventional rehabilitation program while undergoing HRV-biofeedback training had reduced risk of relapse compared to those receiving rehabilitative treatment only.

One year later, individuals who had done HRV biofeedback training while undergoing conventional rehabilitative therapy showed a trend toward higher long-term abstinence rates compared with those receiving conventional rehabilitative treatment only. The significance of the above findings is limited by small study size, and that fact that only 27 out of 48 subjects completed and returned questionnaires. Although the above findings are preliminary, they are consistent with findings of another study in which HRV-biofeedback training reduced craving in a group of 48 individuals addicted to alcohol and drugs, resulting in sustained improvement in autonomic cardiac function following completion of training (Eddie et al 2014).

Bottom line

HRV-biofeedback training is an established intervention for treating anxiety. Findings of two small controlled trials support that HRV-biofeedback training may diminish alcohol craving and reduce the risk of relapse in abstinent alcoholics. Large studies are needed to further elucidate underlying neurophysiological mechanisms and to determine the optimal frequency and duration of HRV-biofeedback training needed to reduce alcohol craving and reduce relapse risk. It is prudent to consult with an addiction specialist or enroll in a rehabilitation program before trying HRV-biofeedback for a drinking problem.