Mindfulness meditation, when done properly, can significantly improve addiction treatment outcomes.
There are many different kinds of meditation: mindfulness (also called “vipassana”), zazen, kundalini, qigong, transcendental, guided visualization, trance-based and heart-based (with a focus on emotional states), etc.
This has struck a chord with many western practitioners — and with recovery professionals. They cite the growing body of evidence that mindfulness works better than — or at least as well as — traditional therapies to reduce cravings and prevent relapse.
In mindfulness meditation, the concept is simple: observe feelings and thoughts, and then let them go without judgment or reaction.
Basic goals of meditation
Meditation is a centuries-old practice that can be found in every major religion. Some of the main goals of meditation, in religious or nonreligious settings, are to:
- promote relaxation
- increase energy
- develop positive human traits (such as compassion, love, patience, generosity and forgiveness)
One of the first to popularize the use of mindfulness to treat stress and depression was Jon Kabat-Zinn, who developed the “Mindfulness-Based Stress Reduction” protocol and subsequently founded the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School.
Mindfulness in early recovery
Mindfulness has become a highly utilized meditation technique in alternative treatment for addiction. Marc Gomez, L.Ac., MATCM, Dipl. O.M., is an acupuncturist and spiritual teacher at Promises who creates individualized meditation practices for his clients with substance use disorders.
Mindfulness is especially effective in early recovery because it exercises parts of the brain that help people tolerate cravings. “In mindfulness, there is no preference for negative or positive thoughts,” Gomez says. “We’re just practicing not identifying with them — this internal dialogue is not you.”
Meditation can be a variety of things, adds Steve Sussman, PhD, a professor of preventive medicine and psychology at the University of Southern California. “When done appropriately, it is a discipline of ‘not acting out’ — of keeping still and letting thoughts pass, and observing them as they do, and of being in touch with the present moment,” he says. “Thus, through meditation, one can ‘clean out the tapes,’ be better able to tolerate frustration, and become more aware of one’s own thoughts and sensations.”
Increasing the evidence base
Mindfulness and meditation-based approaches for treating substance use disorders are gaining traction in the clinical research community. Several studies out of leading labs suggest that these approaches can be effective when used in lieu of or in addition to traditional “treatment as usual” approaches.
In a 2009 Substance Abuse study, a team of University of Washington researchers, led by addiction specialist Sarah Bowen, PhD, conducted the first randomized-controlled trial looking at mindfulness-based relapse prevention for substance use disorders. In it, they evaluated the efficacy of an eight-week outpatient Mindfulness-Based Relapse Prevention (MBRP) program as compared to treatment as usual (12 step group therapy).
Of the participating 168 adults with substance use disorders who had recently completed intensive inpatient or outpatient treatment, they found significantly lower rates of substance use and cravings in the MBRP group as compared to the treatment as usual group when assessed four months later.
In another study, published in 2010 in the Journal of Alternative and Complementary Medicine, researchers supplemented standard care in a residential treatment center with qigong meditation — a practice of traditional Chinese medicine that uses relaxation, breathing, guided imagery, inward attention and mindfulness to bring about a tranquil state.
They found that patients in the qigong group were significantly more likely than patients in a stress management and relaxation training group to complete treatment and experienced fewer cravings, as well. The researchers note that the quality of meditation mattered. “Participants whose meditation was of acceptable quality reported greater reductions in craving, anxiety and withdrawal symptoms than did those whose meditation was of low quality,” they wrote.
In two recent studies published this year led by Katie Witkiewitz, PhD, an associate professor of psychology at the University of New Mexico, scientists found that MBRP was more effective than a “gold standard” relapse-prevention program at reducing substance abuse for up to one year following treatment.
How mindfulness helps prevent relapse
In essence, Witkiewitz has been studying what happens on a neurobiological level when someone in recovery is practicing mindfulness-based techniques. Because craving and a negative state of mind are major triggers for relapse, MBRP was designed to specifically address these thought-feelings. Basically, MBRP aims to help people become aware of their thoughts, rather than automatically reacting to them.
“Individuals struggling with addiction and alcohol use disorders often live on auto-pilot and use drugs and alcohol as an immediate reaction to distress or craving,” Witkiewitz says. “Meditation teaches awareness of direct experience and provides the ability to ‘stay with’ distress or craving, without reacting.
Witkiewitz has found that practicing mindfulness can literally change the brain, affecting specific areas that can be linked to specific behaviors. For instance, engaging in mindfulness can increase awareness of the present moment, improve attention, increase self-awareness, help people develop and implement new ways of approaching discomfort, and reduce reactivity to substance cues, among others.
Starting a mindfulness practice
Witkiewitz says that a number of addiction specialists have been developing meditation-based strategies for treating addiction. In addition to MBRP, these programs include Mindfulness-Oriented Recovery Enhancement, Sit-to-Quit Mindfulness Training for Smokers and Craving-to-Quit. “The core components of many of these interventions include training in basic breath meditation, body awareness, using brief meditations in the moment to reduce reactivity to craving and distress, as well as loving-kindness meditation and forgiveness training,” she says.
Gomez likes to tailor his program to the individual — there’s no reason to force someone into a technique that does not feel right, he says. He recommends finding a teacher that you have an affinity for and resonate with. “There are so many different traditions, but it’s the teacher that makes the difference,” he says. And if you can’t do that, he advises watching YouTube videos of leading practitioners like Pema Chodron, Jon Kabat-Zinn and Alan Watts.
With newcomers to his practice, Gomez usually begins by asking them to slow down their breathing on the exhale, or simply sit and listen to their surroundings for a few minutes. “We start with simple things that help to calm the nervous system,” Gomez says. “Listening is a tool you can use to turn off your thoughts.”
As anyone who has struggled with the feelings and thoughts that surround cravings knows, turning off “the noise” is not easy — recovery takes hard work and practice. “It is not magic, and I would conjecture that the process comes easier to some people than others,” Sussman says. “For people in recovery from an addiction, which goes way beyond alcohol or drug misuse in my opinion, meditation can help them not act impulsively, strengthen executive processes, and sometimes be able to enjoy more elemental aspects of living.”