Treating Addiction: The Case for Mindfulness

Addiction is a complex and misunderstood condition, though it affects many worldwide. Tragically, alcohol and illicit drug use account for over 5% of the world’s total burden of disease (Khanna & Greeson, 2013). In the U.S., the National Institutes of Health (2015) report that 10% of American adults have had a substance use disorder at some point in their life, but 75% of them received no form of treatment due to ineffective care, lack of resources, or the stigma surrounding addiction ("10 percent," 2015). When individuals do receive some specialty treatment, the rate of relapse is estimated to be over 60% within a year following treatment (Witkiewitz et al., 2014). It is evident that addiction is abundant, but treatment options available may be limited, inaccessible, or ineffective.

The Stages of Addiction

Addiction is a chronic disease of the brain that involves running through a three-stage cycle to maintain itself. First is the binge and intoxication stage, in which an individual consumes a substance and the brain feels rewarded; stimuli around the consumption environment are associated with reward, and the area of the brain responsible for habit formation is stimulated. This stage involves the basal ganglia where neurons enhance the rewarding effects of substance use (Administration (US) & General (US), 2016). Next is the withdrawal and negative affect stage, during which the individual experiences negative emotions and sometimes physical illness after not taking the substance. The extended amygdala is involved here where stress systems are activated (Administration (US) & General (US), 2016). Lastly is the preoccupation and anticipation stage, during which the individual experiences craving and begins seeking out the substance once again due to deficits in executive functioning (Administration (US) & General (US), 2016).

Figure 1: The phases of the addiction cycle and their associated brain regions (Administration (US) & General (US), 2016).

The Case for Mindfulness as Treatment

When determining an effective and a long-lasting intervention for addiction, it is important to keep these biological and behavioral stages in mind. It is also necessary that relapse prevention be emphasized in care in order for treatment to eradicate addictive behaviors and improve the quality of patients’ lives. Attempting to determine a treatment option that targets the phasic processes of addiction and the reciprocal interactions that contribute to substance use rather than independent risk factors, Witkiewitz et al. (2014)] argue that mindfulness, specifically mindfulness-based relapse prevention (MBRP), shows great promise for the treatment of substance use disorders (Witkiewitz et al., 2014). Mindfulness can help those struggling with addiction to decrease the chance of relapse by improving awareness of thoughts and flexibility in response to triggers (Witkiewitz et al., 2014).

Mindfulness, which comes from Buddhist tradition, is a practice that involves purposeful, focused, and non-judgmental attention to the present moment. It is a practice that is accessible to anyone and can be practiced within or outside of a religious context (Witkiewitz et al., 2014). In the Buddhist theory associated with mindfulness, craving is seen as a natural human occurrence and the cause of suffering - that is, craving for more pleasure and less pain rather than accepting what it is creates great dissatisfaction (Witkiewitz et al., 2014). When people suffering from addiction practice mindfulness, they can carefully examine their thoughts and emotions related to their triggers, cravings, and urges to use, which may help them reframe how they react to these cognitive stimuli (Witkiewitz et al., 2014). In this way, habitual cognitive patterns can become disrupted and addictive behavior may be reduced. Further, through a mindfulness-based stress management intervention, people with addiction have been shown to decrease stress, anxiety, and depression, as well as cravings (Iranshahri, B., & Jenaabadi, H. 2015).

Figure 2: Practicing mindfulness increases awareness of and distance from addictive patterns (Brewer, 2022).

Manualizing a Mindfulness-Based Treatment

Based on the potential for mindfulness to diminish the cycle of addiction, researchers set out to design a manualized mindfulness-based treatment that could be applied to a wide array of patients by different practitioners. Combining mindfulness-based practices with the development of cognitive-behavioral skills, the mindfulness-based relapse prevention (MBRP) program was developed (Witkiewitz et al., 2014). In this program, participants receive education on mindfulness and its relevance to relapse prevention, work on increasing awareness and tolerance of discomfort, and expand their reactive repertoires when faced with triggers by learning mindfulness-based practices (Witkiewitz et al., 2014). According to participants in the program across three studies, the most helpful mindfulness exercise was SOBER Breathing Space with a rating of 82% fairly or extremely helpful. SOBER is an acronym that stands for the steps of how to mindfully act in a triggering situation: stop or slow down, observe what is happening, bring attention to breathing, expand awareness to the whole body, and respond with awareness (Witkiewitz et al., 2014). Overall, MBRP was shown to be an effective intervention for addiction in clinical trials, with mindfulness practices being especially helpful in diminishing relapse episodes.

Conclusion

The space that mindfulness creates for awareness of habitual behavior, thoughts, and emotions may be enough to disrupt addictive cycles of behavior. High-risk situations for substance use involve a lack of awareness of the moment, acting on auto-pilot, and being judgmental, but mindfulness training helps individuals to act in the opposite manner, increasing awareness and self-compassion while decreasing auto-pilot behavior, judgment, and reactivity (Witkiewitz et al., 2014). The fact that mindfulness practices are simple to practice and easily accessible, coupled with the finding that mindfulness-based therapies produce successful results in clinical trials, offers potentially wide-ranging and effective interventions for substance use disorders that have historically been undertreated.

Bibliographical References

Iranshahri, B., & Jenaabadi, H. (2015). The Effectiveness of Mindfulness Therapy in Controlling under Treatment Addicts’ Drug Cravings. Open Journal of Medical Psychology, 4(3), Article 3. https://doi.org/10.4236/ojmp.2015.43009

Khanna, S., & Greeson, J. M. (2013). A narrative review of yoga and mindfulness as complementary therapies for addiction. Complementary Therapies in Medicine, 21(3), 244–252.https://doi.org/10.1016/j.ctim.2013.01.008

National Institute of Health (NIH). (2015, November 18). 10 percent of US adults have drug use disorder at some point in their lives. National Institutes of Health (NIH). https://www.nih.gov/news-events/news-releases/10-percent-us-adults-have-drug-use-disorder-some-point-their-lives Substance Abuse and Mental Health Services Administration (US), Office of the Surgeon General (US) (2016). The neurobiology of substance use, misuse, and addiction. In US Department of Health and Human Services (HHS), Facing addiction in America: The surgeon general’s report on alcohol, drugs, and health (pp. 2.1-31). HHS. https://www.ncbi.nlm.nih.gov/books/NBK424849/ Witkiewitz, K., Bowen, S., Harrop, E. N., Douglas, H., Enkema, M., & Sedgwick, C. (2014). Mindfulness-based treatment to prevent addictive behavior relapse: Theoretical models and hypothesized mechanisms of change. Substance Use & Misuse, 49(5), 513–524. https://doi.org/10.3109/10826084.2014.891845

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