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Abstract

Strategies are needed to improve adolescent substance abuse treatment outcomes. For example, during outpatient substance abuse treatment, up to 80% of adolescents continue to use. Following residential substance abuse treatment, 88% of adolescents relapse within 6 months.

Psychosocial stress plays an important role in the maintenance of substance use and also in relapse. A study of 2031 16- to 24-year-olds with past-month marijuana use showed that 56% used marijuana in the past month to cope with life stress. Furthermore, in a study of 81 adolescents (aged 13–18 years) followed for 6 months after treatment, 67% of those who relapsed reported a stressful event just prior to relapse. Therefore, treatment outcomes might be improved by interventions that help teens cope with stress.

Heart rate variability (HRV) biofeedback may be a good intervention for this population because it reduces stress in adolescents who are not receiving treatment for substance abuse. Furthermore, HRV patterns of low amplitude and coherence are found in adults with substance use disorders during craving states and in youth with disorders (eg, oppositional defiant disorder and conduct disorder) that frequently lead to substance use. HRV biofeedback also reduces mean salivary cortisol levels, and corticotropin-releasing factor inhibitors have been shown to reduce stress related relapse in animal models. Despite these findings, there are no controlled studies examining the role of HRV biofeedback to help prevent relapse following substance abuse treatment.