This document summarizes research into using brain-computer interfaces (BCI) to treat addiction. In an initial trial, researchers gave 14 addicted subjects BCI training to control craving-inducing images, finding they developed better ability to resist than controls. However, desire levels did not change. Researchers now aim to develop the treatment into a serious video game combining BCI, transcranial direct current stimulation and virtual/augmented reality to further reduce craving and involve subjects. They will seek Horizon 2020 funding to create a prototype for wider network testing.

1. GAMES FOR HEALTH EUROPE CONFERENCE 2018
BE YOUR BRAIN©
TREATING ADDICTION THROUGH BCI
N.S. Bonfiglio1,2, R. RenaC1,2, E. Pessa2, M.P. Penna3
2University of Pavia
3University of Cagliari
1

2. FRAMEWORK (1)
• PSYCHOTROPE SUBSTANCES, MEDICINES, ALCOHOL, SMOKE, GAMBLING, FOOD,
INTERNET, SHOPPING, WORK AND EXERCISE ... The old and new dependencies
represent a serious social problem that has a big impact on young people and adults
wellbeing, as well as on public health policies.
• Every year cigareOe smoking causes 6 million deaths worldwide (WHO)
• 10.9 million Italians smoke an average of 13 cigareOes a day (DOXA)
• In Italy, 2.3 million people substance dependent; 7,000 are gamblers who have been
treated in public health services, another 800,000 are at risk.
• Every year in Italy € 1.55 billion is spent on addic_on treatment (Department of
An_-Drug Policies)
FIND INNOVATIVE WAYS TO TREAT ADDICTIONS IS A CENTRAL ISSUE IN HEALTH
AND SOCIAL FIELD

3. WHAT ABOUT ADDICTION?
Addic_on is a cronically relapsing disorder, that involves elements of both
impulsivity and compulsivity that yeld a composite addic_on cycle

4. NEW FRONTIERS IN ADDICTION TREATMENTS
FOCUS ON NIBS, BRAIN COMPUTER INTERFACE
AND SERIOUS GAMES

5. MAIN GOAL
Development of a treatment protocol able to help addicts to manage
craving and impulsivity, s_mula_ng the development of self-control
and the intrinsic mo_va_on to change, focal resources for the
maintenance of abs_nence
Use of Brain Computer Interface (BCI), which helps pa_ents to control
his own craving and impulsivity towards the specific substance of abuse
or addic_ve behavior

6. WHAT HAVE WE DONE SO FAR?
• The experimenta_on began in 2015 with a first protocol that used only the
BCI (Brain Computer Interface)
• In 2016, tDCS was added to the treatment and interven_on protocol
• In 2016, the protocol was approved by the ethics commiOee of the University
of Pavia
The project was presented to the European Commission HORIZON 2020 SME
INSTRUMENT PHASE 1 and in 2017 it won the SEAL OF EXECELLENCE.

7. BACKGROUND AND HYPOTHESIS
Effec_ve approaches in addic_on treatments (Koskina et al., 2013; Mon_ et al., 1999):
• Training for the Improvement of Coping Strategies (CST)
• Treatments with Cue Exposure (CET)
HYPOTHESIS
The presenta_on of trigger s_muli that recall the substance should help the subject to
ac_vate strategies to resist and self-control when facing the substance; especially when the
pa_ent can ac_vely manipulate the cue.

8. FIRST TRIAL: SUBJECTS
28 addicted subjects (alchol and cocaine) divided into 2 groups:
• With BCI training (N = 14)
• Sham - Without BCI training (N = 14)
Esclusion criteria:
• no psychiatric symptoms to the SCL 90 test (Symptom Check List-90)
(Deroga_s, 1994)
• no presence of cogni_ve deficits measured by ENB
(Brief Neuropsychological Examina_on 2, Mondini, Mapelli, Vestri, Arcara, Bisiacchi, 2011)

9. FIRST TRIAL: MEASURES AND DESIGN
• SAD (Self-efficacy and Desire Scale -
Minervini et al., 2011)
• COPE-NVI (Coping Orienta_on to
Problems Experiences - New Italian
Version - Sica et al., 2014)
• MEASURES ADMINISTERED 3 TIMES:
T0, T1, T2 (one month follow-up)

10. FIRST TRIAL: TRAINING AND PROCEDURE
TRAINING consisted in the exposure , through ad hoc sokware connected to
BCI helmet, to 30 images that recall the substance. The images were chosen
by the subject himself, together with the researcher, in order to iden_fy those
that for the subject had a greater salience.
The TASK of the subject was to manipulate the images moving them on the PC
screen, using the BCI system (Mazzoleni et al., 2017).
EMOTIV Epoc Helmet www.emo_v.com

11. FIRST TRIAL: TRAINING AND PROCEDURE
TAILORING
SELECTION OF
IMAGES AND
MUSIC TOGETHER
WITH THE USER
T0
EVALUATION WITH
TEST AND
ADDICTION
STROOP
TRAINING 5 WEEKS
3 SESSION A WEEK
PRESENTATION OF
30 TRIGGERS TO
MOVE WITH THE
“MIND” (BCI)
DEACTIVATION: 10
RELAXING IMAGES
AND MUSIC
T1 (Evalua_on as T0)
T2 (Evalua_on as T0

12. T0 T1 T2
training 181,7 187,5 187,8
no training 173,8 173,0 171,3
150,0
155,0
160,0
165,0
170,0
175,0
180,0
185,0
190,0
mean
ABILITY TO RESIST
Results: desire (mean 114, sd=53) and ability to resist (mean=167, sd=56)
FIRST TRIAL: RESULTS
* *
T0 T1 T2
training 178,0 181,6 177,3
no training 165,0 169,0 164,0
150,0
155,0
160,0
165,0
170,0
175,0
180,0
185,0
190,0
mean
DESIRE

13. • We see how,
• The levels of desire of the substance remain unchanged for both groups,
both soon aker and aker a follow-up of one month
• The experimental subjects developed a beOer ability to resist and decreased
the use of avoidance strategies, unlike the control subjects
• This results suggested us the necessity to include a tDCS protocol in order to
reduce the craving (desire) of the substance.
FIRST TRIAL: FINAL REMARKS

14. WHAT WE STILL HAVE TO DO…
• The results obtained by our experimenta_on with the BCI interface
encourage us to restructure the training in the form of a Serious Video
Game.
• The BCI allows to work on several levels at the same _me and to obtain a
high level of involvement and mo_va_on to the treatment

15. WHAT WE STILL HAVE TO DO…
• Prepare for the call of the Community HORIZON 2020 EMS
INSTRUMENT STAGE 2 - 2019-
• The aim is to get the financing necessary to develop the
complete Serious Game sokware, which involves the joint use of
specific devices already tested BCI, tDCS and the addi_on of new
equipment such as: the mask for Virtual/Augmented Reality.
• To do this, it is necessary to develop the SERIOUS GAME
guidelines and work in a network to produce an opera_ng
prototype of the Serious game (MOCKUP) to be submiOed
to the European Commission.
• It will thus be possible to start a network experimenta_on with
public and private clinics; this will allow us to test the goodness
of the instrument and the treatment.

16. THANK YOU FOR YOUR ATTENTION!
s.bonfiglio@noahealth.it
r.rena[@noahealth.it