A new study by investigators from Mass General Brigham shows that a non-drug, wearable device can help people with substance use disorders (SUD) manage stress, reduce cravings, and lower their risk of relapse in real time. Their results are published in JAMA Psychiatry.
"One of the hallmarks of early addiction recovery is poor self-awareness of emotional states," said corresponding author David Eddie, PhD , a Mass General Brigham 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."
For people in early recovery, stress often triggers cravings, and the struggle to resist those urges can create even more stress. Together, cravings and stress can lead to relapse. Stress and craving also tend to be associated with lower heart rate variability (HRV) — the natural variations in time between heartbeats, which reflects underlying health as well as how the body adapts to stress.
Special breathing exercises can raise HRV and help regulate mood and improve cognitive control. Newer HRV biofeedback devices can detect low HRV and provide visual or auditory cues to guide breathing adjustments. Eddie's previous studies have found that biofeedback can reduce craving and anxiety in people with SUD.
In their nationally funded study, the researchers tested whether an HRV biofeedback device can support SUD recovery by conducting a phase 2 clinical trial of 115 adults with severe SUD in their first year of recovery. Half of the participants got a biofeedback smart patch device (the Lief HRVB Smart Patch), and the other half followed the recovery plan they had in place, such as recovery meetings, psychotherapy, or medicines. Over eight weeks, participants reported their mood, cravings, and any substance use twice a day with their smartphone.
"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 said. "This allows people to get out in front of risk."
Participants were asked to do at least 10 minutes of scheduled practice a day and at least five minutes of prompted practice. The participants who got a biofeedback device had less negative emotions, reported fewer cravings for alcohol or drugs and were 64% less likely to use substances on any given day, suggesting that the intervention interfered with the cycle of craving and substance use.
The study focused only on people in the first year of an abstinence-based recovery attempt, and future studies are needed to determine if the intervention has sustained benefits.
"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."
Authorship: In addition to Eddie, Mass General Brigham authors include Marina Nguyen and Katherine Zeng. Additional authors include Sara Mei and Noah Emery.
Disclosures: Eddie is on the scientific advisory boards of mental-healthcare companies ViviHealth and Innerworld and is a partner in Peer Recovery Consultants. The remaining authors declare that they have no known potential competing financial or personal interests.
Funding: This research was supported by National Institute on Drug Abuse award R21DA056468. The first author was also supported by National Institute on Alcohol Abuse and Alcoholism award K23AA027577.
Paper cited: Eddie D et al. "Heart Rate Variability Biofeedback for substance use disorder: A randomized clinical trial" JAMA Psychiatry DOI: 10.1001/jamapsychiatry.2025.2700
