Additional comments on Marijuana, Medical Marijuana, and Amotivation Syndrome

One of the most under-reported uses of EEG neurofeedback is its applications related to marijuana. 

Neurofeedback tends to spontaneously diminish marijuana use.  I and other clinicians have unexpectedly observed over the years that people who come for ADHD treatment and have been using marijuana regularly and heavily tend to stop using it. 

This surprising shift away from marijuana use is not usually an original goal of the patient (to say the least!) and has not been directly addressed during the treatment.  It just seems that people lose interest in using marijuana when their brains are working better, their minds are clearer.

I assume that the well-known "amotivation syndrome" of marijuana dependence  thus responds to EEG Neurofeedback indirectly through two mechanisms, re-turning executive function and refining self-regard, while generally increasing brain efficiency and self-regulatory capacity.

Medical Marijuana

Under federal law (the Controlled Substances Act of 1970) marijuana use for any purpose is illegal. The federal law has not stopped a number of states from enacting medical marijuana legislation. California was one of the first.

On November 5, 1996, the people of California passed Proposition 215. Through this Initiative Measure, Section 11362.5 was added to the Health & Safety Code, and is also known as the Compassionate Use Act of 1996. The purposes of the Act include, in part:

"...To ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes where the medical use is deemed appropriate and has been recommended by a physician who has determined that the person's health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief..."

Despite conflict with federal law, the Medical Board of California positively sanctions medical marijuana as " an emerging treatment modality."

COMMENT: It seems to me, however, that most of the indications for medical marijuana--other than appetite stimulation and glaucoma--usually respond to neurofeedback. 

My opinion is that, for those suffering the more extreme conditions of pain, spasticity, sleep disorder and chemotherapy side-effects, most people would do well to consider neurofeedback and the  powerful LENS system before turning to medical marijuana.

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HEAD INJURY--Often Forgotten and Too Often Dismissed

Head Injuries are a common cause of many patients' problems with attention, concentration, ability to  plan  efficiently and carry out their plans.  Recent work also suggests that a substantial number of substance abusers may have had head injuries before their drug and alcohol use got out of control.  Yet, a significant number of those patients have "forgotten" their accident of injury (see Dr. Daniel Amen's many books or his web site BrainPlace.com for some helpful examples). Patients with significant lingering problems in functioning often have to be asked repeatedly whether they have had a concussion or head injury.

And it is common for patients who suffered a sharp blow to the head to have temporary impairment of consciousness or confusion--yet even those with significant problems who have been medically checked out are often dismissed because a clinical neurological examination or MRI can came out "normal" (an MRI can only reveal the anatomical disruption, not the kind of disruption that happens at the microscopic level where brain cells function--it takes a special examination of brain function such as a SPECT or PET brain scan to such injuries).  Careful neuropsychological testing would reveal cognitive impairments, but these tests require hours of examination by a specialized psychologist. (Incidentally, at our office, we have a standardized computer-based cognitive screening battery that takes an hour to complete that can document impairments in several spheres of mental functioning).

Concussions with transient loss of consciousness may be associated with an absence of memory for the injury and even a few moments before ("retrograde amnesia").  But the phenomenon of underplaying the importance of, and forgetting, head injuries seems to be a separate issue.

Len Ochs, PhD, who devised the LENS neurofeedback system, has a theory that right after minor brain injuries and other "insults" the brain sort of seals itself off--builds an inhibition network--as a self-protective device.  An analogy would be "muscle bracing" after a physical injury.  We know empirically that LENS neurofeedback is remarkably effective for reversing cognitive effects of so-called "minor" head injury (and see Stephen Larsen's book, The Healing Power of Neurofeedback for examples of recovery from more substantial injuries and stroke).

On January 30, 2008 , the Wall Street Journal ran a piece about the serious effects of long-forgotten injuries entitled, "Studies Cite Head Injuries As Factor in Some Social Ills", discussing new research indicating that hidden traumatic brain injuries can cause social or educational failure, such as alcoholism or homelessness.  Two quotes from the article highlight the significance of this issue:

• "Unidentified traumatic brain injury is an unrecognized major source of social and vocational failure," says Wayne A. Gordon, director of the Brain Injury Research Center at Mount Sinai School of Medicine in New York, where much of the research is being done. 
• In 2006, Mount Sinai's Dr. Gordon began to work with Common Ground, a New York nonprofit that builds housing for the homeless. About 70% of 100 homeless people they tested came out in the 10th percentile or lower for memory, language or attention, says the group's director of psychiatric services, Jennifer Highley. Questioning uncovered that 82% had a significant blow to the head prior to becoming homeless, usually from severe parental abuse during childhood.

Definition of Neurofeedback

Adopted by the International Society for Neurofeedback & Research, 2009

Like other forms of biofeedback, NFT uses monitoring devices to provide moment-to-moment information to an individual on the state of their physiological functioning. The characteristic that distinguishes NFT from other biofeedback is a focus on the central nervous system and the brain. Neurofeedback training (NFT) has its foundations in basic and applied neuroscience as well as data-based clinical practice. It takes into account behavioral, cognitive, and subjective aspects as well as brain activity. Thus, it meets the American Psychological Association's definition of an evidence-based intervention since NFT is "...the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preference."

NFT is preceded by an objective assessment of brain activity and psychological status. During training, sensors are placed on the scalp and then connected to sensitive electronics and computer software that detect, amplify, and record specific brain activity. Resulting information is fed back to the trainee virtually instantaneously with the conceptual understanding that changes in the feedback signal indicate whether or not the trainee's brain activity is within the designated range. Based on this feedback, various principles of learning, and practitioner guidance, changes in brain patterns occur and are associated with positive changes in physical, emotional, and cognitive states. Often the trainee is not consciously aware of the mechanisms by which such changes are accomplished although people routinely acquire a "felt sense" of these positive changes and often are able to access these states outside the feedback session.

NFT does not involve either surgery or medication and is neither painful nor embarassing. When provided by a licensed professional with appropriate training, generally trainees do not experience negative side-effects. Typically trainees find NFT to be an interesting experience. Neurofeedback operates at a brain functional level and transcends the need to classify using existing diagnostic categories. It modulates the brain activity at the level of the neuronal dynamics of excitation and inhibition which underly the characteristic effects that are reported.

NFT has been found to be a successful intervention in modifying seizures, attention, traumatic brain injury, chronic pain, autistic behaviours, headache/migraine, depression, anxiety, addictions, and sleep problems. Also, it has been applied effectively in meeting educational goals such as resolving reading and math disabilities. Moreover, it has been used to help maximize the performance of athletes, artists, and executives. Lasting positive changes have been documented after successful NFT.

Being a self-regulation method, NFT differs from other accepted research-consistent neuro-modulatory approaches such as audio-visual entrainment (AVE) and repetitive transcranial magnetic stimulation (rTMS) that provoke an automatic brain response by presenting a specific signal. Nor is NFT based on deliberate changes in breathing patterns such as respiratory sinus arrhythmia (RSA) that can result in changes in brain waves. At a neuronal level, NFT teaches the brain to modulate excitatory and inhibitory patterns of specific neuronal assemblies and pathways based upon the details of the sensor placement and the feedback algorithms used thereby increasing flexibility and self-regulation of relaxation and activation patterns.

The International Society for Neurofeedback and Research (see www.isnr.org) is the largest group of licensed professionals involved in the practice, teaching, and research of NFT. Some members of ISNR have sought and received certification by the Biofeedback Certification Institute of America (see www.bcia.org). Members of ISNR subscribe to a code of ethics providing an added measure of accountability to the standards of their profession. Additionally, ISNR is committed to supporting new developments by publishing a professional journal and newsmagazine, by producing a well-attended annual conference, and by encouraging large studies of NFT through the ISNR Research Foundation.

This definition was ratified by the ISNR Board of Directors on January 10, 2009

Sleep, Nightmares, and REM-state Problem Solving

Recently, I noted that more people were landing on this web site from the keyword "Nightmares" than from EEG Neurofeedback, or ADHD, or marijuana (numbers 2 through 4 in popularity).  Presumably the reason is that neurofeedback and LENS are being recognised as first-line treatment for sleep disorders.  It's clear I must blog more about sleep disturbances, anxiety and nightmares.

In the meantime, I've come across an interesting study reported on the BBC web site (http://news.bbc.co.uk/2/hi/health/8090730.stm) confirming the common wisdom that "sleeping on a problem" can provide creative solutions.  In this UC San Diego study with 77 volunteers, problem solving was improved by 40% if they took a nap and demonstrated REM-stage sleep. The REM sleep was important, compared to dream-less sleep and an equal length awake period.  Lead author Sarah Mednick assumes that dream sleep enhances brain plasticity.  As the BBC reports, "The researchers believe REM sleep allows the brain to form new nerve connections without the interference of other thought pathways that occur when we are awake or in non-dream-state sleep."

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