Mass General Brigham researchers have demonstrated that a wearable heart rate variability biofeedback device can significantly reduce substance use and cravings in people recovering from addiction. The phase 2 clinical trial, published in JAMA Psychiatry, found that participants using the device were 64% less likely to use substances on any given day compared to those receiving standard care.
The study, supported by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, enrolled 115 adults with severe substance use disorder in their first year of recovery. Participants were randomized to either receive the Lief HRVB Smart Patch or continue with their existing recovery plan, which included recovery meetings, psychotherapy, or medications.
Targeting the Stress-Craving Cycle
"One of the hallmarks of early addiction recovery is poor self-awareness of emotional states," said corresponding author David Eddie, a Harvard-Mass General psychologist at the Recovery Research Institute at Massachusetts General Hospital. "People in recovery can experience a lot of stress, but they often don't have great awareness of it or proactively manage it."
The research addresses a critical challenge in addiction recovery: the interconnected cycle of stress and cravings. For people in early recovery, stress often triggers cravings, and the struggle to resist those urges creates additional stress. Both stress and cravings are associated with lower heart rate variability (HRV), which reflects the natural variations in time between heartbeats and indicates how well the body adapts to stress.
AI-Powered Real-Time Intervention
The Lief HRVB Smart Patch uses artificial intelligence to detect when users are experiencing stress or cravings through heart rate variability monitoring. When low HRV is detected, the device provides visual or auditory cues to guide breathing adjustments that can raise heart rate variability and help regulate mood and improve cognitive control.
"The latest HRV biofeedback devices can detect when people are stressed or experiencing cravings, and, using AI, prompt them to do a brief burst of biofeedback," Eddie explained. "This allows people to get out in front of risk."
Clinical Trial Results
Over the eight-week study period, participants reported their mood, cravings, and any substance use twice daily using their smartphones. Those assigned to the biofeedback device were asked to complete at least 10 minutes of scheduled practice daily and at least five minutes of prompted practice when the device detected stress or cravings.
Participants using the biofeedback device demonstrated significant improvements across multiple measures. They experienced fewer negative emotions, reported reduced cravings for alcohol or drugs, and showed a 64% reduction in likelihood of substance use on any given day. These results suggest the intervention successfully disrupted the typical cycle of craving and substance use.
Clinical Implications for Early Recovery
The study specifically focused on individuals in their first year of abstinence-based recovery, a period recognized as particularly challenging for maintaining sobriety. Eddie's previous research had already established that biofeedback could reduce craving and anxiety in people with substance use disorders, providing the foundation for this larger clinical trial.
"The first year of recovery is immensely challenging," said Eddie. "Our goal is to find tools that not only bridge people during that first year, but also help them manage their stress for the rest of their life."
The researchers acknowledge that future studies are needed to determine whether the intervention provides sustained benefits beyond the initial treatment period. The current findings represent a significant advancement in non-pharmacological approaches to addiction treatment, offering a real-time, technology-based solution that could complement existing recovery programs.
