There are many schools of thought when it comes to combating addiction. Some of them have arisen from recent developments in psychiatry and medicine, and others have been around for much, much longer. As we understand more about the human condition and the things that drive some people to dangerous behavior, we can apply new treatment methods to help heal the body and mind. One of these methods is what we call mindfulness, and it can play a vital role in recovery.
Mindfulness: ‘Living Life in the Moment
Psychology Today explains what mindfulness is: actively paying attention to the present moment, taking stock of what you're thinking and feeling, and offering no criticism or judgment. Mindfulness is simply making a neutral, comprehensive inventory of what you're experiencing. The idea of “living life at the moment” comes from being mindful.
Mindfulness can also mean a state of mental awareness and focuses that have been traditionally used in meditation practices and have recently become popular as an element of certain types of cognitive-behavioral therapy, such as Mindfulness-Based Cognitive Therapy, Acceptance and Commitment Therapy, and Dialectic Behavior Therapy.
When you are mindful, you are aware of both your external surroundings and your inner experience, including your responses to what is going on around you in the present moment. The goal of mindfulness is to become aware without becoming attached to anything you are experiencing.
There are three primary components of mindfulness:
• It is intentional. The patient has to make a conscious effort to catalog what he is going through from one moment to another.
• It is accepting. The patient cannot deny what she is sensing.
• It is nonjudgmental. A patient who criticizes himself for what he is feeling is not being genuinely mindful, in the same way, that a patient who thinks highly of his emotions has not achieved actual mindfulness.
By achieving this sense of balance, patients learn how to regulate their emotions and thoughts. While this has several applications in everyday life, mindfulness can play a significant role in substance abuse recovery: patients learn how to rethink the nature of stressful situations and stimuli that may otherwise trigger a harmful train of thought that leads to drinking or using. Before a mindfulness intervention, patients may have been oblivious to the various factors that start the chain reaction of negative thinking and unhealthy behavior. Mindfulness treatment gives them the chance to examine those factors on a level playing field in a calm, supportive and safe environment. In time, the triggers become less daunting and more manageable.
A study in the journal Clinical Psychology Review found that constant worry or stress directly leads to depression and anxiety (which can lead to substance abuse), and mindfulness therapy effectively reduces the fear that many depressive and addicted patients feel.
Mindfulness as Part of Drug and Alcohol Recovery
The practice of mindfulness can trace its origins back to Buddhist meditations (and Buddhism itself has been used as a form of substance abuse therapy). Still, a secular approach to thinking about mindfulness was developed by Jon Kabat-Zinn, Professor of Medicine Emeritus and creator of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. Kabat-Zinn developed a program he calls Mindfulness-Based Stress Reduction, which combines meditation, yoga, and psychotherapy techniques to teach people the art of mindfulness to reduce their stress and improve their relaxation and quality of life.
One of the most basic ways people feel better is by slowing things down so you aren't rushing from one activity to another or even one thought to another. By quieting the mental chatter, you can achieve a sense of tranquility that is often why people choose to use drugs such as alcohol, marijuana, and opiates.
While relaxation is always good, the focus of mindfulness has dozens of specific health benefits that make it a valuable tool in the recovery armamentarium. A study published in the Journal of Psychosomatic Medicine found that 25 patients who had eight weeks of mindfulness training had better immune systems than 16 patients who received no such training. This is relevant because of the effect of drug and alcohol abuse on the immune system. Alcohol, for example, reduces the effectiveness of white blood cells in their function of killing germs. The more alcohol a patient drinks, the fewer white blood cells can multiply and attack invasive diseases.
Another way that mindfulness can make you feel better is by allowing you to notice many wonderful sensory experiences that occur in everyday life that we often don't see. When you allow the beauty of the world around you to fill your consciousness, the world doesn't seem like such a wrong place to be
Similarly, methamphetamine and excessive marijuana consumption can damage the body's ability to fight off infection by directly attacking the immune system and weakens the lungs, respectively.
A patient who has just completed a detoxification course has a fragile immune system (which is one of many reasons why detox should not be tempted in a domestic environment). Teaching mindfulness as part of the therapeutic stage of recovery will significantly affect the patient's recovery, both from the physical and psychological impact of drugs and alcohol on their system.
What Does Mindfulness Involve?
Skills taught in mindfulness include:
• Participation: Becoming involved in an activity without being self-conscious about it • Observation: Paying close attention to what is going on around you • Description: Being able to say what happened and how you felt in words • Taking a Nonjudgmental Stance: Accepting things as they are rather than judging them • Focusing on One Thing in the Moment: Without distraction from other ideas or events • Effectiveness: Doing what works rather than second-guessing yourself
Mindfulness also involves recognizing when you are running on “automatic pilot” — acting without thinking about what you are doing and developing an attitude of “loving-kindness” — a friendly, uncritical attitude towards yourself and others.
Mindfulness and Healthy Eating in Recovery
Another area of physical care in recovery has to do with diet. Drugs and alcohol abuse wreak havoc on a body's digestive system, often depriving critical organs and methods of the nutrients they need to function. The National Institute of Alcohol Abuse and Alcoholism explains that the liver and the pancreas can be significantly compromised. A detoxing patient will be very physically weak due to the withdrawal process's diarrhea and vomiting. For that reason, food rich in carbohydrates, vitamins, and amino acids is essential. Good nutrition can help a patient's body to strengthen during recovery, and bad eating habits can even lead to a relapse.
Mindfulness can be incorporated into a treatment program to help patients practice “mindful eating.” Instead of unwittingly replacing an alcohol addiction with a food addiction, patients can learn how to savor the food they have by being aware of their bodies' hunger cues and learning where those cues come from and what causes them. Then, instead of simply indulging in more food, the patients can apply this greater understanding to better address the underlying causes of their compulsion to overeat. In doing so, they can improve their eating habits, lose weight and avoid a relapse pitfall.
In this way, mindfulness can also be the primary treatment method for patients who have an eating disorder. Mindfulness can help a patient focus on her “internal hunger,” in the words of a professor emeritus of psychology at Indiana State University, and not their “external hunger.” The idea is that by focusing on eating a small (or moderate) amount of food mindfully, patients can enjoy the experience much more than if they ate a more significant amount. Addicts, who by nature have demonstrated impulse control issues (as with eating and substance abuse disorders), can benefit from the heightened sense of awareness that mindfulness teaches them about recognizing their levels of hunger and fullness.
Mindfulness and Emotional Regulation in Relationships Affected by Addiction
Since emotional regulation is a big part of the mindfulness approach, the effect that mindfulness has on relationships also plays a crucial role in recovery. Couples who embark on mindfulness training together report being more satisfied with their relationships, and individual partners have a greater sense of optimism and relaxation within their union. A study published in the journal Behavior Therapy found that mindfulness helped couples enjoy more profound satisfaction levels with (and within) the relationship – benefits that persisted three months after the training concluded. Happiness and stress levels were improved, and various coping methods with stress were used.
This is good news for people looking to grow closer to their significant others or heal a struggling relationship, but relationships and addiction overlap in some vital areas. Substance abuse and intimacy are linked, says PsychCentral, explaining that if addiction issues are present in a relationship, the addicted partner will pull out every stop to prioritize the addiction over the connection.
The psychological effects of drug or alcohol dependency on addictions are well known, but the physiological effects of such substances are complex. A 2013 study by the University of Granada of 605 men (550 of whom abused drugs) discovered that male drug addicts were sexually impotent even after completing rehabilitation. The study's authors wrote in the Journal of Sexual Medicine that the abuse of cocaine, heroin, and alcohol (the substance that has the most significant negative impact on a man's ability to perform sexually) caused a long-term negative effect sexual climax in men.
Such a form of sexual dysfunction is problematic on its own, but its damage to a relationship can be immense. A November 2002 survey conducted by the Journal of Urology on 168 men with erectile dysfunction found that men who reported their impairment having any effect on their lives also reported suffering from depression and anxiety.
Issues like these demonstrate how mindfulness can help couples going through recovery together.
Mindfulness and Dialectical Behavior Therapy
The idea of regulating emotions that mindfulness espouses is a cornerstone of Dialectical Behavior Therapy is one of the primary therapy lines used in drug and alcohol recovery.
When looked at through the perspective of Dialectical Behavior Therapy (or DBT), mindfulness is used to help patients accept their emotions. This may seem like an easy concept, but the idea of denying the reality behind experiencing powerful impulses to engage in self-destructive and harmful behavior is what often drives patients to seek comfort and relief in that destructive behavior. Instead, mindfulness teaches them to nonjudgmentally acknowledge what they are feeling and then to use that
acknowledgment as a stepping-stone toward regulating themselves.
For example, a patient might attempt to control his behavior by setting limits or goals for himself. This is admirable on its own, but when those plans inevitably go awry (perhaps through no fault of his own), he reacts with negativity and frustration, feeling compelled to give up on the idea of learning to regulate his behavior.
Mindfulness encourages patients to try again by teaching them that there is never a point of no return. Even after a failure, the patient is still capable of trying again – a perspective he may have been robbed of by his compromised state of mind.
Dialectical Behavior Therapy was developed by Marsha M. Linehan, who wrote on the subject that patients who cannot regulate their emotions become trapped by inflexible patterns of thoughts, which compel them to focus on negative perceptions.
Mindfulness plays a vital role in the administration of DBT because it teaches patients to be in the present moment – not rigidly dwelling on their impressions of depression or stress, but accepting those impressions as part of a bigger picture, and then using the other dynamics in that picture to better control their emotions and thoughts.
Mindfulness in Treating Violent Moods
This is also why mindfulness has found success in helping prison inmates reduce their anger, hostility, and unpredictable moods. As inmates understand how and why they react as antagonistically as they do, mindfulness plays a vital role in their recovery (in the cases of substance abuse) and their rehabilitation and reintegration following their release from prison. A mindfulness program at the Lowell Correctional Institute for Women in Ocala, Florida, yielded inmates who learned how to:
• Consider their thoughts before acting
• Be more aware of their emotions and physical sensations
• Manage their panic and anger more effectively, choosing to not only withdraw from confrontation but to also help talk down other inmates who were about to engage in fights
A 2007 study published in The Prison Journal enrolled 1,350 inmates in drug units in six prisons in the Massachusetts Department of Corrections in 113 mindfulness-based stress reduction courses. Inmates self-reported “highly significant” improvements in measures of hostility, self-esteem, and emotional regulation. The study's authors were encouraged by the effectiveness of mindfulness-based stress reduction and called for more excellent implementation of such programs.
Mindfulness: ‘Significantly Greater Extent'
With drug and alcohol recovery itself, mindfulness therapy has enjoyed a significant amount of success and validation from the mental health community. The journal of Substance Use & Misuse published two articles in April 2014 on the topic: one that found mindfulness-based interventions reduced the consumption levels of opiates, cocaine, marijuana, alcohol, cigarettes, and amphetamines to a “significantly greater extent” than other treatment methods; and another that said that substance abuse programs are either making mindfulness a standalone component to their practices or using mindfulness in conjunction with other treatment models.
In the slightly more technical terms of Frontiers in Psychology, “Mindfulness Training Targets Neurocognitive Mechanisms of Addiction.” Modern science, says the article's authors, has only just begun to understand the many ways that mindfulness training addresses the connections between addiction, thoughts, and emotions.
How Is Mindfulness Achieved?
When a patient feels strong emotions that threaten to overwhelm her, her therapist might suggest concentrating on breathing. Simply being aware of breathing in and breathing out can divert feelings of panic and anger and calm the patient down.
Next, the patient will be told to pay close and specific attention to every sense she can: sights, sounds, and smells that would usually be lost in the noise of stress or muffled by depression can help ground the patient her something tangible to focus on.
Similarly, being aware of the body's physical sensations achieves the same purpose. It could be as simple as focusing on the tactile feeling of clothes on the skin or how the body rests on a chair or couch. Little details like these provide a sense of reality that the patient can use as a lifeline.
Lastly, and with encouragement, the patient should acknowledge that even the most harmful or overpowering thoughts are momentary at worst. At best, they do not define the patient. This may be incredibly difficult to remember or even accept for some patients, but guided and curated insights like those are the key to breaking the hold of negative thought patterns.
A specific form of meditation known as “mindfulness meditation” can impart these lessons. Psychology Today explains how such a practice can improve the amount of activity in the amygdala, the part of the brain that deals with regulating emotions. A healthy amygdala is necessary for moderating the body's natural anxiety response. Even in stressful moments, the heart rate will slow, breathing will become more profound, and the body's release of adrenaline slows down. While such flight-or-fight responses have their uses, uncontrolled reactions can be very harmful to people who do not know how to calm themselves down.
With practice, mindfulness meditation can strengthen the brain's region that is responsible for feelings of optimism and well-being. In this way, mindfulness can rewire a suffering brain by teaching it new and better ways to respond to problems. The senior author of a study conducted by the Massachusetts General Hospital and published in Psychiatry Research: Neuroimaging said that just two months of mindfulness meditation provides active psychological benefit to patients in improving their senses of self and empathy and decreasing their stress levels.
Mindfulness-Based Relapse Prevention
A Mindfulness-Based Relapse Prevention program has recently been developed, which combines cognitive-behavioral therapy approaches to preventing relapse with mindfulness practice and relapse prevention. Mindfulness-Based Relapse Prevention includes the following elements:
• Automatic pilot and relapse
• Awareness of triggers and cravings
• Mindfulness in daily life and high-risk situations
• Acceptance of whatever is happening and acting skillfully
• The role of thoughts in relapse
• Taking care of yourself as part of a healthy lifestyle
• Social support and keeping your mindfulness practice going
Ben Lesser is one of the most sought-after experts in health, fitness and medicine. His articles impress with unique research work as well as field-tested skills. He is a freelance medical writer specializing in creating content to improve public awareness of health topics. We are honored to have Ben writing exclusively for Dualdiagnosis.org.