Mindfulness for Addiction treatment

There is now a huge variety of evidence-based treatment available for addiction recovery. Cognitive behavioural therapy, family therapy, motivational interviewing, contingency management – all have shown significant promise when it comes to treating people with substance use disorders.

However, in recent years, another form of therapy has grown in popularity: mindfulness-based therapy.

So what is mindfulness? And how can it help people to deal with their substance addictions?

Mindfulness is about living in the moment, and not allowing ourselves to get carried away by powerful emotions.

Mindfulness can help people with substance use disorders in a number of ways.

  • Strong emotions often lead to relapses. Mindfulness promotes calmness and tranquillity.
  • Mindfulness-based addiction therapy offers a number of relapse prevention strategies.
  • Mindfulness is effective for mental health disorders as well as substance use.

Read on for more information about this cutting-edge addiction therapy.

What is mindfulness?

Mindfulness is ‘the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us.’ [1]

In other words, it is about being fully aware of the present moment, whilst still being calm and reflective.

In daily life, especially when we do the same things over and over, we can start to do things on autopilot. Mindfulness attempts to take us out of autopilot mode, and help us to rediscover a childlike curiosity in the world around us.

Why? Because doing so helps us to be less judgemental, and more joyful.

Mindfulness promises to help us eliminate some of the negative thoughts and feelings which hamper us and prevent us from reaching our full potential. It does so by teaching us how to step back from pressing thoughts and desires, and view them from a distance.

Modern life can be incredibly busy and stressful. We all have commitments, and most of us have access to a constant stream of information via the Internet.

The appeal of mindfulness is twofold. It gives us the tools to remain calm in an increasingly hectic world; and it shows us how to take pleasure in the small things.

What are the key skills which mindfulness teaches?

Mindfulness teaches six skills, known as the ‘what’ skills – observe, describe and participate – and the ‘how’ skills: non-judgementally, one-mindfully, and effectively.

We summarise these skills briefly below.

The ‘what’ skills:

  • Observe. As you are going about your daily life, try to focus on the evidence of your senses: touch, taste, smell, hearing and sight. What can you observe? Try to not to place value judgements on your observations. Simply relax, and allow your senses to do the work.
  • Describe. See if you can put your experiences into words, e.g. ‘I see a black cat’, or ‘I notice that I feel anxious, and my heart rate is faster than usual.’ Again, try not to make any judgements about what you are describing.
  • Participate. Throw yourself into whatever experience you are having. This means actively involving yourself in what you are doing, rather than experiencing things in a passive way.

The ‘how’ skills:

  • Non-judgementally. Being non-judgemental involves looking at the world through an objective lens. Judgements such as ‘I am useless’ are unhelpful and unlikely to produce happiness. Try to reframe these judgements as statements about your opinions/thoughts, e.g. ‘I am having a thought that I am useless’. This allows you to take a step back from your judgements and view them with a more dispassionate eye.
  • One-mindfully. To do something ‘one-mindfully’ means to focus on one thing at a time, without allowing oneself to get distracted by something else. In today’s super-productive and hyperconnected world, this can be more difficult than it sounds. However, being one-mindful will make you happier and more focused.
  • Effectively. When we are ineffective, it is often because we allow emotions to cloud our judgements, or we get annoyed with other people for falling short of our expectations. Being effective involves doing the best with what you have, and being aware of your limitations.

A very brief history of mindfulness in addiction treatment

Mindfulness comes from sati, which is part of the Buddhist tradition. It became popular in the West thanks to individuals like Herbert Benson and Jon Kabat-Zinn.

In the realm of addiction treatment, the psychologist Alan Marlatt was the first to start using mindfulness as part of therapy in the 1980s. He used a form of mindfulness called Vipassana to treat patients who were suffering from severe substance use disorders.

How can mindfulness help people in addiction recovery?

You may be wondering how all this has any bearing on addiction.

Though mindfulness was not originally created for people with addiction, it can be very useful for those in recovery.

One simple way in which mindfulness helps with addiction is by slowing down your thought stream. Paying attention to little details helps to calm you down and stops you from dwelling on things you cannot control. Strong emotions – both negative and positive ones – often cause people to use substances. By remaining calm, you increase your chances of staying sober.

Another way in which mindfulness can help with substance use is by forcing you to notice the beauty in the world. Substance use is sometimes motivated by a need to escape, triggered by a sense that the world is terrible. Mindfulness counters this idea by making people pay attention to the evidence of their senses. We are surrounded by beauty: start noticing that beauty, and the world won’t seem quite so awful any more.

A third way that mindfulness can help with addiction is through the skill of being ‘non-judgemental’. How many times do you find yourself having negative thoughts about yourself or others? Do these thoughts ever lead you to into negative spirals, which ultimately cause you to use substances?

If so, that’s a very common experience to have. And it’s one that mindfulness can help you to avoid.

Our thoughts often happen so quickly that it can be difficult to pick one out and challenge it. But that’s exactly what you need to do if you find yourself starting a negative thought spiral. Observe your thought process as it is occurring, and, if you find a judgement, stop and interrogate it.

Being dispassionate about your opinions and ‘self-talk’ will help you to take a step back and avoid getting anxious or stressed. It will also help you to prevent negative thought spirals, which in turn will help you not to use substances.

If you allow it to, this skill of being ‘non-judgemental’ will even teach you about yourself. It will help you to realise how certain things make you react, which will give you a better understanding of what triggers you to use substances.

How can mindfulness help with relapse prevention?

Mindfulness-based relapse prevention (MBRP) programmes have also become popular in recent years. These programmes apply the skills taught in mindfulness to relapse prevention, showing how mindfulness can help with cravings, triggers and so on.

One of the key ideas in MBRP is ‘urge surfing’. This is a mindfulness strategy used for withstanding urges to drink or use drugs. Rather than allowing yourself to be carried away by the ‘wave’ of an urge or craving, MBRP suggests ‘surfing’ the wave. By ‘surfing’ the wave, MBRP means ‘allowing it to pass over you’, rather than suppressing it, or avoiding it.

The wave is a good image to represent cravings: it is powerful but temporary. Cravings, too, feel very powerful when they arrive, but they will pass eventually.

If you’d like to learn more about urge surfing, you can access a fact sheet here.

How does mindfulness fit in with addiction treatment?

You can access mindfulness-based therapy at a drug or alcohol rehab, where there will be trained therapists and practitioners.

First, however, you will need to go through a drug or alcohol detox. This is where you get rid of all the toxins in your body. It is best undertaken in the care of medical staff who can monitor your withdrawal symptoms and provide medication if needed.

After a detox, you will be able to choose from a range of therapy options, including mindfulness-based therapy, cognitive behavioural therapy, dialectical behavioural therapy, family therapy, and so on.

Evidence for mindfulness-based addiction therapy

Since mindfulness-based addiction therapy is a relatively new branch of therapy, there is not as much evidence on its effectiveness as other, more established forms of therapy.

However, the evidence we have suggests that it does have some positive impact.

One metanalysis concluded that MBIs (mindfulness-based interventions) ‘reduce substance misuse and craving by modulating cognitive, affective, and psychophysiological processes integral to self-regulation and reward processing.’ [2]

Another study found that mindfulness-based treatment was most effective at reducing levels of ‘perceived craving, negative affectivity, and post-traumatic symptoms’, and moderately effective at reducing symptoms of depression and anxiety. [3]

On the basis of this evidence, mindfulness-based treatment looks like a good alternative to other popular forms of addiction therapy.

Final thoughts

Mindfulness-based therapy is an exciting form of addiction therapy that promises to help individuals understand their relationship with substances, as well as giving them the tools to overcome cravings and remain calm in the face of high-risk situations.

If you or a loved one are suffering from addiction and would like to explore therapy options, mindfulness-based therapy is worth your consideration.

References

[1] https://www.mindful.org/what-is-mindfulness/

[2] ‘Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research’, Eric L. Garland and Matthew O. Howard.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5907295/

[3] ‘The Clinical Efficacy of Mindfulness-Based Treatments for Alcohol and Drugs Use Disorders: A Meta-Analytic Review of Randomized and Nonrandomized Controlled Trials’, Cavicchioli et al.
https://www.karger.com/Article/Fulltext/490762

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