Neuroimaging in Addiction: Principles of Functional Near-infrared Spectroscopy and Its Emerging Role in De-addiction: A Narrative Review
Medala Kalpana, Maheshkumar K, Madhusudhan Umesh, Vidya Ganji, Archana Gaur, Anish Singhal, Madhuri Taranikanti, Nitin Ashok John, Naveen Ravi, Vidya SingaraveluBackground
Substance use disorders (SUDs) remain a major global health challenge with high relapse rates. Functional near-infrared spectroscopy (fNIRS), a non-invasive, portable modality enabling real-time monitoring of cortical haemodynamic changes, is well suited to studying addiction neurobiology in ecologically valid settings. This review examines fNIRS principles and applications in addiction research and de-addiction therapy.
Summary
PubMed, Scopus and Web of Science were searched (2000–2025) using terms including fNIRS, addiction, substance use disorder, prefrontal cortex, neurofeedback and de-addiction. fNIRS reliably detects altered prefrontal cortex (PFC) haemodynamic responses during cue-reactivity and cognitive tasks in addiction. Findings include reduced dorsolateral PFC activation with prolonged abstinence, differential orbitofrontal cortex activation across substances, and use as a treatment-response biomarker. Emerging applications include neurofeedback and machine-learning-based classification. fNIRS offers portability and ecological validity over conventional neuroimaging. Future research should standardise protocols, validate biomarkers in multicentre trials, and integrate fNIRS with EEG and fMRI.
Key Message
fNIRS is a portable, non-invasive tool that reliably detects altered prefrontal cortex activation in substance use disorders. Cue-reactivity and cognitive paradigms identify biomarkers of craving, executive dysfunction and relapse risk. fNIRS-based neurofeedback shows early promise for improving self-regulation and reducing relapse. Wearable fNIRS with machine learning and multimodal integration enables personalised addiction monitoring.