Mindfulness to Treat Addiction
A New Approach to Substance Abuse Treatment
What is Mindfulness?
Mindfulness is a concept that has gained significant popularity over the past few years, but what exactly is it? It’s the practice of being fully present. Practitioners seek to be aware of where they are and what they are doing and not to react to what is going on around them. Mindfulness is a state of being that everyone possesses, but to live mindfully, it is important to practice. Mindfulness does not happen by itself. It can be practiced intentionally by anyone. Mindfulness in addiction treatment can be used in recovery programs at rehab facilities.
More Awareness, Less Judgment
Mindfulness involves the nonjudgmental awareness of thoughts, feelings, and surroundings. Practitioners focus on being aware of what their senses are experiencing, what state of mind they are in, and what emotions and thoughts they are having.
All too often, people get caught up in the stress of the day-to-day, going through the motions of their days as an almost automatic process without stopping to take in their surroundings, what they are doing, and how they are feeling. Being mindful aims to wake up “the inner workings of our mental, emotional and physical processes.”1
Observing Without Acting
Importantly, it’s about not reacting to automatic thoughts or feelings. For example, rather than getting angry and acting out either verbally or physically, being mindful involves stopping, observing the anger and how it feels physically, and waiting for the feeling to pass.
What Are The Basics?
How is mindfulness practiced? While everyone will have their own unique experience practicing, here are the basics, as outlined by the nonprofit organization “Foundation for a Mindful Society”:1
The Basics of Mindfulness Practice:
SET ASIDE TIME
OBSERVE THE PRESENT MOMENT
The goal of being mindful is to pay attention to the present moment, to one’s thoughts and feelings in that moment, and to one’s surroundings. Mindfulness is not trying to achieve calm or relaxation, or to stop any incoming thoughts; it is merely observing one’s thoughts and feelings as they are.
LET JUDGMENTS ROLL BY
When practicing, sometimes, judgments will arise. Practitioners can make a note of these judgments and feelings and let them pass by without dwelling on them.
RETURN TO THE PRESENT MOMENT
When practicing, it is typical for the mind to wander and to get carried away in thought. Practitioners need to always return to the present moment and to observe their thoughts and feelings in the present moment. When they find their minds wandering, they try to bring them back to the present.
BE KIND TO THE WANDERING MIND
It is natural for the mind to wander. It isn’t helpful to judge whatever thoughts come up during the practice of mindfulness. Practitioners acknowledge that their minds have wandered and then try to re-center themselves back in the present moment.
IT’S NOT AS SIMPLE AS IT SEEMS
Mindfulness sounds simple, but in reality, it is not. There is no concrete way to know that it is being practiced correctly, and its impacts on life can be subtle and hard to notice. It is important to practice regularly to see changes to overall life over time.
Mindfulness might come easier to some people than it does to others, and there is no perfect way to practice. At the end of the day, even just taking a few moments to check in with self, thoughts, and feelings can be beneficial. In today’s fast-paced society, it can be easy to feel busy and distracted all the time. Practitioners may find that stopping to become aware of feelings helps them to take better care of their physical and emotional well-being.
HOW LONG SHOULD YOU PRACTICE?
There is no one-size-fits-all length of time for practicing mindfulness or meditation. In general, it takes about 20 minutes for the mind to become focused. Once a practitioner can manage 20 minutes, experts recommend trying to increase to 45 minutes.2 To experience the full benefits of mindfulness, it is best to try to practice it almost every day.
What Are The Benefits Of Mindfulness?
Research shows that there are many benefits to practicing mindfulness and that it can help to change the brain and patterns of thinking, which can be useful in addiction treatment. Some of the benefits of practicing mindfulness include:
STRESS REDUCTION
STRENGTHENING NEURAL CONNECTION
Practicing regularly builds new neural pathways and networks in the brain. This improves concentration, flexibility, and awareness.
IMPROVING WELL-BEING
It has been shown to improve overall well-being. Practicing can help people to enjoy the good moments in life and be really present for them, and can also help them to deal with negative or unpleasant events. When practitioners focus on the present moment, they are less likely to worry about the past or the future.
IMPROVING PHYSICAL HEALTH
IMPROVING MENTAL HEALTH
Mindfulness and meditation have become more and more popular in psychotherapy. Mindfulness has been shown to help treat depression, substance use disorders, eating disorders, anxiety disorders, and obsessive-compulsive disorder.
UNDERSTANDING PAIN
Mindfulness can help people to understand and engage with mental and physical pain. Rather than avoiding pain, it helps them to face pain, think about what they are feeling, and stay present in the moment.
IMPROVING FOCUS
People who find that their minds often wander while they are at school, having a conversation with someone, or reading a book, may find that mindfulness can help them to become more focused. When they actively try to focus on the task at hand, they are less likely to become distracted.
IMPROVING PERFORMANCE
SPARKING CREATIVITY
It might help people tap into their creative sides. In writing poetry, drawing, painting, or creating music, focusing on the task at hand can help spur creativity.
Common Misconceptions
Misconception #1: Meditation Is the Same Thing
Mindfulness and meditation are not the same things. Meditation is a tool or method for practicing mindfulness, but mindfulness is a practice that can be done at any time, not just during meditation. Additionally, not all meditation practices are mindful; some practices may vary.
MISCONCEPTION #2: IT’S JUST RELAXATION
Some people believe that it’s just reaching a state of relaxation. This is not accurate. Mindfulness has less to do with relaxing and more to do with the intentional observation of thoughts and feelings and truly being present in the moment. While people might feel relaxed when practicing, that is just a benefit of the practice rather than the practice itself.
MISCONCEPTION #3: IT’S ABOUT CONTROLLING THOUGHTS AND ATTENTION
A common misconception about mindfulness is that it is all about controlling thoughts, feelings, and attention. Rather than controlling thoughts, it’s about allowing thoughts to arise naturally, noticing them, and then drawing the attention back to the present and focusing on sensations.
MISCONCEPTION #4: IT’S ABOUT NOT HAVING ANY THOUGHTS OR CLEARING THE MIND
On the flip side, many people think that mindfulness is about clearing the mind and not having any thoughts at all. This is also not true. The goal isn’t to stop having any thoughts; rather, the goal is to observe thoughts, allow them to happen, and then return attention to the present and focus on breathing.
A common misconception about mindfulness is that it is all about controlling thoughts, feelings, and attention. Rather than controlling thoughts, it’s about allowing thoughts to arise naturally, noticing them, and then drawing the attention back to the present and focusing on sensations.
MISCONCEPTION #5: IT’S A RELIGIOUS PRACTICE
Some people believe because meditation is rooted in Buddhism, that mindfulness is also a religious practice. While there might be religious influences on mindfulness, it is not a religious practice in and of itself.
On the flip side, many people think that mindfulness is about clearing the mind and not having any thoughts at all. This is also not true. The goal isn’t to stop having any thoughts; rather, the goal is to observe thoughts, allow them to happen, and then return attention to the present and focus on breathing.
A common misconception about mindfulness is that it is all about controlling thoughts, feelings, and attention. Rather than controlling thoughts, it’s about allowing thoughts to arise naturally, noticing them, and then drawing the attention back to the present and focusing on sensations.
Does Mindfulness Work For Drug Rehab?
According to the National Survey on Drug Use and Health, substance abuse affects approximately 24 million Americans.1 Traditional treatment often centers on avoiding triggers that might cause cravings (e.g., not going to parties where there will be drugs or alcohol). While such treatments might work for some people, they do not help to change the way people’s brains react to things, and thus many people end up relapsing within a year. Mindfulness, on the other hand, works on undoing the harm that has been done to the brain by alcohol or drugs.
Recent Research
Recent research and clinical trials have shown that mindfulness can be very beneficial in addiction treatment. The techniques used can help to target psychological, neural, physiological, and behavioral processes involved in substance abuse.4 It can help in the recovery process by targeting stress, emotions, and behavioral urges such as cravings. This happens because mindfulness practices help to target multiple brain regions, and connections between those brain regions, that are affected by substance abuse.4 While it has not been formally tried as a stand-alone treatment, it is thought to be a useful addition to other therapies and forms of treatment.
Addiction Treatments That Use Mindfulness
While mindfulness can be practiced alone, with a psychotherapist, or in a group setting, there are mindfulness-based interventions (MBIs) specific to substance abuse. They include:
Mindfulness-Based Relapse Prevention (MBRP)
Mindfulness-Based Relapse Prevention for alcohol and illicit substance use is an 8-week, group-based intervention that integrates traditional cognitive-behavioral relapse prevention strategies with meditation and mindfulness.4 Originally designed to help patients with chronic pain or other chronic health conditions to deal with stress and pain, MSRP was adapted for use in addiction treatment.
MBRP is intended to help patients learn to tolerate uncomfortable sensations such as cravings and to learn not to react automatically when feeling anger, fear, or other negative emotions. It helps patients to face the uncomfortable feelings they experience and work through them rather than react by turning back to substance use. MBRP helps patients to disengage from automatic and addictive behaviors and to learn to react differently to thoughts and feelings such as cravings. The MBRP treatment includes mindful movements such as light stretching and other movements.4
Mindfulness Training to Quit Smoking
Similar to the MBRP model of treatment, mindfulness training for smoking cessation focuses on increasing attention and focus. Patients learn to accept themselves in a non-judgmental manner and to interpret and experience their inner thoughts, feelings, and physical sensations without feeling the need to react.
Mindfulness techniques can help smokers to quit by helping them tolerate withdrawal symptoms, face unpleasant feelings, and unlearn automatic response patterns within their brains. For example, rather than reacting to the urge to smoke another cigarette, patients would pay attention to that urge and that feeling, accept it, and continue to focus on their breathing until the urge passes.
An important part of fighting urges is taking a moment to focus on the feeling of the craving and to realize that there is a choice to be made and one doesn’t have to give in to the craving.4
Mindfulness-Oriented Recovery Enhancement (MORE)
Mindfulness-Oriented Recovery Enhancement is a group-based intervention that takes place over ten sessions. The goal of MORE, which was adapted from Mindfulness-Based Cognitive Therapy (MBCT) for depression treatment, is to “disrupt cognitive, affective and physiological mechanisms implicated in alcohol dependence.”4 MORE includes practices such as mindful breathing, body scans, mindfulness of perceptions and sensations, mindful walking, and compassion meditation.4
Similar to mindfulness training for smoking cessation, MORE focuses on methods of coping with cravings and fighting the urge to use substances. It also focuses on learning how to identify and change mental processes such as thought suppression, aversion, and attachment which are characteristics of alcohol dependence and substance abuse. One of the differences between MORE and other mindfulness-based treatments is that MORE includes a session on spirituality and training in self-transcendence.4
Original Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5907295/
How Effective Is Mindfulness In Addiction Treatment?
Although there aren’t a large number of clinical trials that have looked into the efficacy of mindfulness in addiction treatment, trials that have been conducted show great promise.
MBRP Effectiveness
A trial conducted with 168 adults with substance use disorders found that MBRP resulted in much lower rates of substance use two months after treatment compared to a control group that received traditional treatment.4 The results of the study showed that the decrease in substance use after completing MBRP could be explained by weakened cravings that could have resulted from mindfulness practices.4 Being mindful targets specific cognitive brain mechanisms, re-wiring them to not respond to cravings in the same way.
Another study published in JAMA Psychiatry compared MBRP with a standard relapse-prevention program and a tradition 12-step program.3 A year after treatment, MBRP had the best results for decreased drinking and drug use.4
Mindfulness Training for Smoking Cessation
A recent trial was conducted with 88 tobacco users who completed eight sessions of mindfulness training (twice a week for 4 weeks).3 The results showed a greater reduction in cigarette use among the patients in the trial compared to patients in the widely used American Lung Association Freedom from Smoking program. 17 weeks after the intervention, those who had completed mindfulness training had higher rates of abstinence than those who had completed the American Lung Association program.4
MORE Effectiveness
During a randomized-controlled trial, 37 alcohol-dependent adults from a residential therapeutic community took part in the MORE program.4 The results showed that the patients in the MORE program had better outcomes than patients in an evidence-based support group. Patients in the MORE program had better stress reduction, better thought suppression, and better physiological recovery from cravings.4
How to Practice Mindfulness
While some people believe that mindfulness and meditation are the same, this is not true. Meditation is one way to practice mindfulness, but it is not the only way. It is important to remember that being mindful is not the emptying of the mind. Rather, it is an intentional focus on the present moment.
Mindful Driving
For example, it’s possible to practice while driving. Often people drive home from work, zone out, and think about other things entirely. Rather than zoning out and thinking about what’s for dinner, a mindful driver zones in on exactly what they are doing. They feel their hands on their steering wheel, the sounds happening around them, the wind blowing through the car; they may notice the street signs, the houses and the cars surrounding them. They pay attention to everything they are doing.
Other Mindful Activities
It’s also possible to practice by going for a mindful walk, taking a mindful shower, or eating a mindful meal. Essentially, there are no rules for when to practice; people can practice it in the midst of any of their daily activities.
Practice Strengthens the Mind
There is no requirement for how long or how often it’s practiced, but practice strengthens the mind, training it to respond to situations actively rather than simply reacting. This can allow practitioners to become more in control of their thoughts and feelings and to tackle anything that comes their way.
Tips For Practicing
People who find meditation or daily mindfulness practice too time-consuming can start by practicing mindfulness during everyday routines – while eating, driving, showering, walking the dog, eating, etc.
Breathing is key to center the mind and focus on the present.
Redirecting is also crucial. If the mind starts to wander, practitioners can take note of their thoughts and bring themselves back to the present moment. People who struggle with mindfulness are most likely letting their minds wander too far without focusing back in on the present.
Persistence matters. It’s best not to stress about missing a meditation session or not practicing every day. Mindfulness is a practice that takes time to get the hang of, just like everything else. Practicing mindfulness just a couple of times is not going to be life-changing; habits take time to build. Practitioners should keep trying and aim to become consistent with their mindfulness practices.
Full sensory engagement, noticing everything that is felt, seen, heard, tasted and smelt, enriches mindfulness.
Meditation
Meditation is a practice that originates in Buddhism. It involves transforming the mind to encourage and develop concentration, clarity, emotional positivity, and calmness. People often feel that many things in life are out of their control. Meditation is a way of taking control of the mind, learning its patterns and habits, and finding more positive ways of existing. When meditating, practitioners focus on the inner workings of their minds, the sensations they experience, their emotions, and their thoughts. This sounds similar to mindfulness because it is. Meditation, however, is a specific exercise, whereas mindfulness is a practice that can be done at any time during the day and during other activities.
Physical Tips for Meditation
To meditate, people often sit on a meditation cushion or bench, but any comfortable and quiet place is appropriate for meditation. The “Foundation for a Mindful Society” outlines the following steps for a simple meditation practice:1
Sit Comfortably
Find a comfortable place to sit, whether that be on the floor, on a cushion, on a chair, or on a meditation bench that is stable and solid.
TAKE NOTICE OF LEG POSITION
People sitting on the floor or a cushion cross their legs comfortably in front of them. People on a chair or a bench place the bottoms of their feet on the floor.
STRAIGHTEN THE UPPER BODY
Sit up straight in a way that feels natural, not stiffening the backs and necks, but relaxing into a natural posture.
Take Notice of Arm Position
Arms should be parallel to the upper body. You can rest your arms on the side of the chair or rest the palms of the hands on their thighs or legs. Neither arms nor legs should be dangling freely.
RELAX THE FACE
You can drop your chins a little bit and let the gaze fall naturally towards the floor. You may either close their eyes or let their eyes stay open without focusing on anything in particular.
FOCUS ON BREATHING
Practitioners focus on their breathing, what it feels like, the air moving through the nose and mouth, the chest rising and falling. They try to breathe naturally.
Mental Tips for Meditation
Take Note of Mental Wandering
The mind is likely to wander, which is natural, but practitioners always try to bring their focus back to their breathing. They do not need to try to block any of their thoughts out; they simply pay attention to them and then return to their focus.
ALLOW THE MIND TO WANDER
It is normal for practitioners’ minds to wander and for thoughts to occupy their minds when they are not physically doing something else. Practitioners learn to not judge themselves for their thoughts, but simply to observe them without reacting, sitting and pay attention to their thoughts while always bringing their attention back to their breath.
GENTLY LIFT THE GAZE
When practitioners feel ready, they open their eyes (if they were closed) and lift their gazes. They notice their environment, the sounds around them, the sensations in their body, and how they feel. They take note of their emotions and take a moment to reorient themselves.
Resources
- “Getting Started with Mindfulness,” Mindful.
- “Benefits of Mindfulness,” Harvard Health.
- Emily Nauman, “Can Mindfulness Help Stop Substance Abuse?” Greater Good Magazine, July 14, 2014.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646290/
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