Wearable biofeedback device may help reduce relapse risk in addiction recovery

A new study by investigators from Mass General Brigham and Harvard suggests that a non-drug wearable device may help people with substance use disorders manage stress, reduce cravings, and lower their risk of relapse in real time. The findings were published in JAMA Psychiatry.

Researchers say the device works by helping users become more aware of stress and physiological signals that are often linked to cravings and relapse risk.

“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.

He explained that individuals in early recovery often experience high levels of stress but may struggle to recognize or manage it effectively, which can increase the risk of substance use.

How stress and cravings are connected

In early recovery, stress frequently triggers cravings, and cravings themselves can create additional stress. Together, these factors significantly increase the risk of relapse.

Researchers also note that both stress and cravings are associated with lower heart rate variability (HRV), a physiological marker reflecting the variation in time between heartbeats and the body’s ability to adapt to stress.

Breathing exercises are known to increase HRV, helping regulate mood and improve cognitive control. New biofeedback technologies can detect drops in HRV and guide users through breathing exercises using visual or audio prompts.

Previous research by Eddie and colleagues has shown that biofeedback may reduce both craving and anxiety in people with substance use disorders.

Clinical trial results

In a phase 2 clinical trial supported by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, researchers tested a heart rate variability biofeedback device in 115 adults in early recovery from severe substance use disorder.

Participants were divided into two groups: one using a wearable biofeedback smart patch (the Lief HRVB Smart Patch), and a control group following standard recovery care, including therapy, support meetings, or medication.

Over eight weeks, participants reported their mood, cravings, and substance use twice daily through a smartphone app.

“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 using the device were asked to complete at least 10 minutes of scheduled breathing exercises daily, along with at least five minutes of prompted sessions when stress signals were detected.

Key findings

Compared with the control group, participants using the biofeedback device showed:

  • Lower levels of negative emotions
  • Reduced cravings for alcohol and drugs
  • A 64 percent lower likelihood of substance use on any given day

Researchers say these results suggest the device may help interrupt the cycle between stress, craving, and substance use.

What the results mean

The study focused on individuals in the first year of abstinence-based recovery, a period considered especially vulnerable to relapse. Researchers caution that longer-term studies are needed to determine whether the benefits persist over time.

“The first year of recovery is immensely challenging,” Eddie said. “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.”

Future research will explore whether wearable biofeedback can provide sustained support for long-term recovery and be integrated into broader treatment approaches for substance use disorders.

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