SUBSTANCE USE AND ADDICTION AFFECT MORE THAN THE BRAIN: THE PROMISE OF NEUROCARDIAC INTERVENTIONS

doi:10.1007/s40429-021-00379-3

. 2021 Sep;8(3):431-439.

doi: 10.1007/s40429-021-00379-3. Epub 2021 Aug 9.

SUBSTANCE USE AND ADDICTION AFFECT MORE THAN THE BRAIN: THE PROMISE OF NEUROCARDIAC INTERVENTIONS

David Eddie¹, Julianne L Price², Marsha E Bates², Jennifer Buckman²

Affiliations

¹ Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School.
² Department of Kinesiology and Health, Center of Alcohol and Substance Use Studies, Rutgers University.

PMID: 35449896
PMCID: PMC9017547
DOI: 10.1007/s40429-021-00379-3

SUBSTANCE USE AND ADDICTION AFFECT MORE THAN THE BRAIN: THE PROMISE OF NEUROCARDIAC INTERVENTIONS

David Eddie et al. Curr Addict Rep. 2021 Sep.

. 2021 Sep;8(3):431-439.

doi: 10.1007/s40429-021-00379-3. Epub 2021 Aug 9.

Authors

David Eddie¹, Julianne L Price², Marsha E Bates², Jennifer Buckman²

Affiliations

¹ Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School.
² Department of Kinesiology and Health, Center of Alcohol and Substance Use Studies, Rutgers University.

PMID: 35449896
PMCID: PMC9017547
DOI: 10.1007/s40429-021-00379-3

Abstract

Purpose of review: Addiction and excessive substance use contribute to poor mental and physical health. Much research focuses tightly on neural underpinnings and centrally-acting interventions. To broaden this perspective, this review focuses on bidirectional pathways between the brain and cardiovascular system that are well-documented and provide innovative, malleable targets to bolster recovery and alter substance use behaviors.

Recent findings: Cardiovascular signals are integrated via afferent pathways in networks of distributed brain regions that contribute to cognition, as well as emotion and behavior regulation, and are key antecedents and drivers of substance use behaviors. Heart rate variability (HRV), a biomarker of efficient neurocardiac regulatory control, is diminished by heavy substance use and substance use disorders. Promising evidence-based adjunctive interventions that enhance neurocardiac regulation include HRV biofeedback, resonance paced breathing, and some addiction medications.

Summary: Cardiovascular communication with the brain through bidirectional pathways contributes to cognitive and emotional processing but is rarely discussed in addiction treatment. New evidence supports cardiovascular-focused adjunctive interventions for problematic substance use and addiction.

Keywords: addiction; evidence-based interventions; heart rate variability; holistic; substance use.

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Figures

**Figure 1.**
Schematic highlighting the subjective, physiological, and neurological effects of heart rate variability biofeedback and resonance paced breathing on the continuum of substance use behaviors.

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Eddie D, Pietrzak A, Ham J. Eddie D, et al. Appl Psychophysiol Biofeedback. 2023 Dec;48(4):433-437. doi: 10.1007/s10484-023-09597-z. Epub 2023 Jul 12. Appl Psychophysiol Biofeedback. 2023. PMID: 37436518
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References

1. Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L, Dua T et al. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition. Lancet. 2016;387(10028):1672–85. doi:10.1016/s0140-6736(15)00390-6. - DOI - PubMed
1. Heiss S, Vaschillo B, Vaschillo EG, Timko CA, Hormes JM. Heart rate variability as a biobehavioral marker of diverse psychopathologies: A review and argument for an “ideal range”. Neurosci Biobehav Rev. 2021;121:144–55. doi:10.1016/j.neubiorev.2020.12.004. - DOI - PubMed
2. This recent work hypothesized that both decreased HRV and elevated HRV may be indicators of psychopathology and that biofeedback interventions could target an “ideal range” of HRV.
1. Lehrer PM, Gevirtz R. Heart rate variability biofeedback: how and why does it work? Front Psychol. 2014;5:756. doi:10.3389/fpsyg.2014.00756. - DOI - PMC - PubMed
1. Leyro TM, Buckman JF, Bates ME. Theoretical implications and clinical support for heart rate variability biofeedback for substance use disorders. Current opinion in psychology. 2019;30:92–7. doi:10.1016/j.copsyc.2019.03.008. - DOI - PMC - PubMed
2. Gaps were identified in the substance use and HRV literature, and directions for future work that would best elucidate the factors that optimize HRV biofeedback interventions on an individual level were proposed.
1. Eddie D, Bates ME, Buckman JF. Closing the brain–heart loop: Towards more holistic models of addiction and addiction recovery. Addiction Biology. In press. doi:10.1111/adb.12958. - DOI - PMC - PubMed
2. This review identified the necessary role of cardiovascular functions and brain-body feedback in the contemporary biobehavioral models of addiction.

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[1] Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L, Dua T et al. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition. Lancet. 2016;387(10028):1672–85. doi:10.1016/s0140-6736(15)00390-6. - DOI - PubMed

[2] Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L, Dua T et al. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition. Lancet. 2016;387(10028):1672–85. doi:10.1016/s0140-6736(15)00390-6. - DOI - PubMed

[3] Heiss S, Vaschillo B, Vaschillo EG, Timko CA, Hormes JM. Heart rate variability as a biobehavioral marker of diverse psychopathologies: A review and argument for an “ideal range”. Neurosci Biobehav Rev. 2021;121:144–55. doi:10.1016/j.neubiorev.2020.12.004. - DOI - PubMed

This recent work hypothesized that both decreased HRV and elevated HRV may be indicators of psychopathology and that biofeedback interventions could target an “ideal range” of HRV.

[4] Heiss S, Vaschillo B, Vaschillo EG, Timko CA, Hormes JM. Heart rate variability as a biobehavioral marker of diverse psychopathologies: A review and argument for an “ideal range”. Neurosci Biobehav Rev. 2021;121:144–55. doi:10.1016/j.neubiorev.2020.12.004. - DOI - PubMed

[5] This recent work hypothesized that both decreased HRV and elevated HRV may be indicators of psychopathology and that biofeedback interventions could target an “ideal range” of HRV.

[6] Lehrer PM, Gevirtz R. Heart rate variability biofeedback: how and why does it work? Front Psychol. 2014;5:756. doi:10.3389/fpsyg.2014.00756. - DOI - PMC - PubMed

[7] Lehrer PM, Gevirtz R. Heart rate variability biofeedback: how and why does it work? Front Psychol. 2014;5:756. doi:10.3389/fpsyg.2014.00756. - DOI - PMC - PubMed

[8] Leyro TM, Buckman JF, Bates ME. Theoretical implications and clinical support for heart rate variability biofeedback for substance use disorders. Current opinion in psychology. 2019;30:92–7. doi:10.1016/j.copsyc.2019.03.008. - DOI - PMC - PubMed

Gaps were identified in the substance use and HRV literature, and directions for future work that would best elucidate the factors that optimize HRV biofeedback interventions on an individual level were proposed.

[9] Leyro TM, Buckman JF, Bates ME. Theoretical implications and clinical support for heart rate variability biofeedback for substance use disorders. Current opinion in psychology. 2019;30:92–7. doi:10.1016/j.copsyc.2019.03.008. - DOI - PMC - PubMed

[10] Gaps were identified in the substance use and HRV literature, and directions for future work that would best elucidate the factors that optimize HRV biofeedback interventions on an individual level were proposed.

[11] Eddie D, Bates ME, Buckman JF. Closing the brain–heart loop: Towards more holistic models of addiction and addiction recovery. Addiction Biology. In press. doi:10.1111/adb.12958. - DOI - PMC - PubMed

This review identified the necessary role of cardiovascular functions and brain-body feedback in the contemporary biobehavioral models of addiction.

[12] Eddie D, Bates ME, Buckman JF. Closing the brain–heart loop: Towards more holistic models of addiction and addiction recovery. Addiction Biology. In press. doi:10.1111/adb.12958. - DOI - PMC - PubMed

[13] This review identified the necessary role of cardiovascular functions and brain-body feedback in the contemporary biobehavioral models of addiction.

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SUBSTANCE USE AND ADDICTION AFFECT MORE THAN THE BRAIN: THE PROMISE OF NEUROCARDIAC INTERVENTIONS

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SUBSTANCE USE AND ADDICTION AFFECT MORE THAN THE BRAIN: THE PROMISE OF NEUROCARDIAC INTERVENTIONS

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