Heart Rate Variability Biofeedback for Substance Use Disorder: Health Policy Implications

Substance use disorder (SUD) exacts massive individual and public health burdens, in part because of its relapsing nature. First-line SUD treatments aim to strengthen affective and cognitive control to help individuals override impulses to use alcohol and other drugs, yet automatic physiological processes compromised by SUD interact with affective states and the environment, compromising effortful cognitive control and undermining attempts to avoid substance use. While existing first-line SUD treatments may indirectly help offset these vulnerabilities, none target them. Heart rate variability biofeedback (HRVB) involves rhythmic breathing that directly targets these deficits, complementing first-line SUD treatments. HRVB has evolved from a clinic-based treatment to an ambulatory intervention utilizing wearable biosensors and smartphone applications with capacity for just-in-time support of affective and behavioral self-regulation. There is evidence supporting the efficacy of HRVB for SUD, but more research is needed to fully assess HRVB's potential to support SUD recovery and inform policy.