“A hallmark of any person I’ve ever treated with addiction is that they’re very rarely in the Now. They’re either regretting the past and all their mistakes and really ruminating on that and dreading that, or they’re dreading the future, or just wanting a fix,” Witkiewitz says. “So what we’re doing is actually training them to be in the moment again, and to be OK with the stress.”
By Katelyn Newman, US News, January 29, 2020
Joe Fox’s drug of choice is alcohol. And while he says he’s previously tried programs such as Alcoholics Anonymous to help him stop drinking, the 37-year-old Atlanta resident says it wasn’t until he tried a treatment option tied to the psychological practice of mindfulness that he was able to put the bottle down.
“Mindfulness was for me … for lack of a better term, the ticket to putting this behind me,” says Fox, who celebrated one year of sobriety on Jan. 7.
After a month of detoxifying and living in rehabilitation housing, Fox says he spent two months receiving outpatient services at Centered Recovery in the Atlanta area, spending weekday mornings at the treatment center and participating in its meditation class on Saturdays.
“It was the meditation I learned there that really got me sort of past anything I could be taught in a classroom,” says Fox, who continues to meditate daily.
Deployed through various techniques, mindfulness is the process of focusing one’s attention on the present to become more aware of thoughts, feelings and bodily responses, processing and accepting them without judgment. While skeptics may view mindfulness and related meditation as new age, mind-over-matter nonsense, researchers across the country have been examining its potential to treat addiction by curbing cravings and reducing the risk and severity of relapse – and they’ve seen promising results.
“Meditation has a reputation of being fluffy or kind of an alternative, hippie approach that doesn’t really have much substance, and that’s just not the case – it’s actually a very systematic approach to understanding behavior and our minds and habits,” says Sarah Bowen, an associate professor of psychology at Pacific University who has been studying mindfulness-based relapse prevention since the early 2000s.
“I wouldn’t say it’s a miracle cure – it’s hard work, to meditate and to develop mindfulness practice,” says Katie Witkiewitz, a professor of psychology at the University of New Mexico. “But what we have found over the years is that people who can develop mindfulness practice and greater mindfulness skills tend to have much better outcomes,” such as reducing or stopping their consumption of alcohol, tobacco, opioids or methamphetamine.
Relapse, or the return to drug use or a similar behavioral habit after an attempt to stop, is a common part of addiction recovery. Though they vary by drug, relapse rates for substance use disorder mirror those for other chronic medical illnesses, according to research cited by the National Institute on Drug Abuse. For example, 40% to 60% of patients with a substance use disorder will relapse, while 50% to 70% of people treated for high blood pressure or asthma may relapse if they stop following their medical treatment plan.
Mindfulness-based addiction treatment trains people to pause and be in the present, acknowledging their cravings while restructuring their “natural reward pathways”, says Eric Garland, director of the University of Utah’s Center on Mindfulness and Integrative Health Intervention Development.
“What I think therapeutically happens is, in order to recover from addiction, a person has to relearn what is and is not important in life … because that’s the thing that gets broken in addiction – the person gives up the things that once were meaningful in their life for the drug,” Garland says.
In teaching people mindfulness skills, Garland says they may “strengthen their self-control and their self-awareness, so that then they can become more sensitive to natural pleasure to cultivate a sense of joy and to reclaim a sense of meaning in life.”
Though it varies by treatment center, mindfulness treatment plans tend to offer weekly group meetings led by a trained instructor, a framework for daily individual practice and, in some cases, recordings or apps to help guide patients through meditation. Mindfulness may be offered either as a primary or supplementary treatment, depending on the person receiving care, Bowen says.
“It’s designed to help people be their own experts,” Bowen says. “So rather than having someone tell patients, ‘This is what’s wrong with you, this is what you need to do,’ the approach is much more collaborative in helping people observe for themselves what’s happening, to learn how to observe their own processes,” from their behaviors to their thoughts and emotions.
The practice of mindfulness in the U.S. medical field dates to the late 1970s, with the development of mindfulness-based stress reduction, or MBSR, under Jon Kabat-Zinn at the University of Massachusetts Medical School. Initially, Kabat-Zinn tested the approach for pain, primary care and orthopedic patients, and researchers at the turn of the 21st century began investigating the ability of mindfulness-based programs to treat various addictions, such as alcohol use disorder and cigarette smoking.
In recent years, clinical trials of mindfulness in addiction treatment have connected the approach to reduced cravings; relapse prevention; decreased impulsivity; and reduced stress and substance use for patients.
“A hallmark of any person I’ve ever treated with addiction is that they’re very rarely in the Now. They’re either regretting the past and all their mistakes and really ruminating on that and dreading that, or they’re dreading the future, or just wanting a fix,” Witkiewitz says. “So what we’re doing is actually training them to be in the moment again, and to be OK with the stress.”
Still, there’s more work to be done to confirm mindfulness as an effective agent in addiction recovery. Dr. Petros Levounis, chair of the psychiatry department at Rutgers New Jersey Medical School, says while he sees mindfulness as an emerging “fourth wave” of addiction treatment, more research is needed, including into which mindfulness practices may be better for specific addictions.
“We have been burned in the past where, for example, with medications, we thought that bupropion – it is very much a dopamine agent and addiction is so much a dopamine process – that it would be good for all addictions. Turns out that bupropion is only good for tobacco cessation. Who knew?” Levounis says. “We don’t really know why it’s not good for cocaine and it’s not good for a number of other addictions, but it’s not.”
“I think what we need to do with mindfulness is identify what are really unique aspects of mindfulness-based interventions and then study them more specifically,” he says.
Sherry Benton, founder and chief science officer of online therapy provider TAO Connect, says she’s unsure whether the time is right for mindfulness as a primary form of addiction treatment, even though recent research has shown positive outcomes when it’s used in combination with medications like methadone.
“We need bigger studies, broader studies, a wider swath of the population. On the other hand, it’s not like you’re going to get side effects with mindfulness meditation. If it works, great. It isn’t going to hurt anybody,” Benton says. “It’s worth trying.”
Clinical trials so far have been perfect-case scenarios, Witkiewitz says, in which researchers have supervised the work in a more controlled environment but haven’t observed the efficacy of the practice in real-world situations, such as at a primary care physician’s office or other treatment centers. Witkiewitz says she and fellow researchers are in the process of testing a rolling group course in treatment centers and primary care settings, and would ideally offer mindfulness group sessions in hospitals, just like Alcoholics Anonymous groups.
“Generally, once you develop a new treatment, it takes years for it to actually get into every kind of treatment setting,” Witkiewitz says. “I think the clinical trials are converging to say this is an effective way to treat this. So now the next step is: How do we get it out into broader settings? And that just takes time.”
Bowen agrees.
“When we first started this work, we were very much on the frontier, we had to fight to get credibility and be careful about who we talked about our work to,” Bowen says. “People now are beginning to see this as a credible approach.”
Indeed, treatment centers like Centered Recovery have begun incorporating mindfulness into their offerings, as have providers like Dr. Judson Brewer, an addiction psychiatrist and director of research and innovation at Brown University’s Mindfulness Center.
“Awareness is a capacity that we all have, and reinforcement learning is a learning process that we all use. So where can we bring those two together?” Brewer says. “I think we are right at that inflection point where, you know, the mechanisms are being mapped out, they’re lining up with theory, people are starting to develop treatments that are efficacious, but also feasible.”
Garland, of the University of Utah, says he thinks there’s “about to be an explosion of growth in this area,” thanks in part to grants under the National Institutes of Health’s HEAL Initiative that have put funding behind a handful of mindfulness research projects.
“People have been going about providing mindfulness as a treatment for addiction in sort of loosey-goosey kind of ways, without a lot of rigorous, structured, research-proven approaches,” Garland says. “But that’s about to change.”
