For successful treatment of addictions, interventions which focus on relapse prevention is of the upmost importance. Many interventions have been developed to help those in treatment manage drug cravings and in recent years the use of mindfulness has been explored as a method for reducing craving and relapse in populations of substance misusers. Whilst the research in this area is only beginning results so far have highlighted a promising avenue to explore with beneficial outcomes for drug users.
What is mindfulness?
Mindfulness is a form of meditation, based in Buddhist tradition. Its central processes emphasise the benefit of paying attention to the current moment or “here and now”. Mindfulness does not aim to change or suppress thoughts but to develop a non-judgemental relationship with them as they occur (Kabat-zinn, 2006). Drawing attention to the present moment provides the opportunity to interpret feelings with non-judgement without reacting to them. Whilst some individuals have dispositional mindfulness (known as trait mindfulness) the tradition is based on the assumption that anyone is able to develop these skills through practice.
How can it help in recovery from substance misuse?
In relation to substance misuse the potential benefit of mindfulness is straight forward. Experiences of craving and negative affect are strongly associated with relapse. Being able to observe negative affect or craving and tolerate them without action may increase ability to cope with triggers. This in turn helps break the automatic and habitual cycle of substance use. For example, an alcohol misuser may feel anxious. With mindfulness they are able to notice this feeling of anxiety, accept it without judgement and do not act on this feeling to change it by consuming alcohol. With continued practice it is theorised that experiencing such cues without acting will weaken the intensity of craving. Where some interventions focus on specific triggers and environmental cues, mindfulness training is more general. One potential benefit of this is the more general approach may equip individuals with skills to practice awareness and non-judgement in novel situations that may otherwise trigger craving. In the event of relapse mindfulness can be beneficial as it can foster understanding of the events and feelings leading up to relapse and allow individuals to accept these with non-judgment. As a result the impact of feelings such as blame and guilt that can occur as a result of relapse may be mitigated to some extent.
The suggestion is not that mindfulness be introduced as a standalone treatment but that it can be used to complement and accentuate recovery alongside other treatments. Several interventions incorporate aspects of mindfulness into treatment including acceptance and commitment therapy (ACT) and dialectical behaviour therapy (DBT) (See Zgierska et al., 2009 for a more comprehensive review of mindfulness treatments in substance use). The development of Mindfulness Based Relapse Prevention (MBRP) introduced an intervention for substance misuse which combines cognitive behavioural skills with mindfulness practice. Based on Mindfulness Based Cognitive Therapy (Witkiewitz, et al., 2013) which has shown strong outcomes for depression, MBRP has shown positive outcomes for substance users with improvement in craving, awareness and acceptance. Individuals report less days where drugs are used, lower levels of heavy drinking and reduced reactions to cues associated with substance use (For example, Garland et al., 2012). A reduction of the relationship between motivation to drink and alcohol use has also been reported (Ostafin, Bauer & Myxter, 2012); people may be more able to experience urges to drink without acting on them.
Where to now?
Whilst preliminary results indicate positive outcomes further work is required to ensure consistency across mindfulness programmes in both content and in therapist coherence. Randomised controlled trials would allow for a robust examination of outcomes with prolonged follow-ups to examine the long term impacts of mindfulness interventions on substance use as findings emphasise the importance of continued mindfulness practice.
For more studies using MBRP click HERE
Garland, EL., Boettiger, CA., Gaylord, S., Chanon, VW., & Howard, MO (2012). Mindfulness is inverselt associated with attentional bias among recovering alcohol-dependent adults. Cognitive Therapy Research. Vol 36, No. 5, pp 441 – 450.
Kabat-zinn, J. (2006). Mindfulness- Based Interventions in Context: Past, Present and Future. Clinical Psychology: Science and Practice. Volume 10, No. 2, pp 144 – 156.
Ostafin, B., Bauer, C., & Myxter, P. (2012). Mindfulness decouples the relation between automatic alcohol motivation and heavy drinking. Journal of Social and Clinical Psychology. Vol. 31, No. 7, pp. 729 – 745.
Witkiewitz, K., Bowen, S., Douglas, H. & Hse, SH. (2013). Mindfulness- based relapse prevention for substance craving. Addictive Behaviours. Vol 28, No. 2, PP 1563 – 1571.
Zgierska, A., Rabado, D., Chawla, N., Kushner, K., Koehler, R. & Marlatt, A., (2009). Mindfulness meditation for Substance Use Disorders: A systematic Review. Substance Abuse. Volume 30, No. 4, pp266 – 294.
The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.