Substance Abuse

Traditionally several modalities have been used either separately or in conjunction for treating chemical dependency and process addictions. These include 12 Step oriented interventions (which support the utilization of the 12 Step program as used by Alcoholics Anonymous and like fellowships, Cognitive Behavioral Therapy, and Motivational Enhancement Therapy.

More recently clinicians have been adding mindfulness practices to their repertoire of interventions. Several new mindfulness based interventions have gained popularity with professional clinicians, including Mindfulness Based Stress Reduction (MBSR), Mindfulness Based Cognitive Therapy (MBCT), Dialectical Behavioral Therapy (DBT), and Acceptance & Commitment Therapy (ACT). These approaches borrow from age old Buddhist based practices. While their origins lie in Buddhism, these practices have been deemed effective enough to utilize in clinical practices without there being a need to espouse a religious philosophy  making it all inclusive.

The idea behind mindfulness meditation is to observe the present moment by paying attention to the breath and body, as well as thoughts and emotions. People with challenges related to addiction tend to act out on addictive behaviors to avoid uncomfortable feelings and to bring pleasure. The basic text of Alcoholics Anonymous states, Men and women drink essentially because they like the affect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks-drinks which they see others taking with impunity (Https://silkworth.net/bb/doctorsopinion.html) So they attempt to escape the present moment because they feel restless, irritable, bored and unsatisfied. Mindfulness practices help the client to learn to face the present movement with all of its pleasant and unpleasant sensations, feelings and thoughts. It has been said that when we name the dragon, the dragon loses its power. By facing and observing these experiences in a more objective way. Mindfulness practices actually enhance other therapies like Cognitive Behavioral therapy, because it gives the client a chance to change their perceptions into something more objective and realistic, and improve emotional health as a result.

Mindfulness practices also aid 12 Step practices, which include taking inventory of one’s thoughts and actions, and spiritual practices such as meditation. We are then in much less danger of excitement, fear, anger, worry, self-pity, or foolish decisions. We become much more efficient. We do not tire so easily, for we are not burning up energy foolishly as we did when we were trying to arrange life to suit ourselves.  (Https://silkworth.net/bb/intoaction.html)

A lot of research has been done on the effectiveness of using these techniques in clinical settings. For more information on this subject, please refer to the bibliography listed below:

Alterman, A. I., Koppenhaver, J. M., Mulholland, E., Ladden, L. J., & Baime, M. J. (2004). Pilot trial of effectiveness of mindfulness meditation for substance abuse patients. Journal of Substance Use, 9(6), 259-268.

Amaro, H., Magno-Gatmaytan, C., Meléndez, M., Cortés, D. E., Arevalo, S., & Margolin, A. (2010). Addiction treatment intervention: An uncontrolled prospective pilot study of spiritual self-schema therapy with Latina women. Substance Abuse, 31(2), 117-125.

Brewer, J. A., Bowen, S., Smith, J. T., Marlatt, G. A., & Potenza, M. N. (2010). Mindfulness-Based treatments for co-occurring depression and substance use disorders: What can we learn from the brain? Addiction.

Brewer, J. A., Elwafi, H. M., & Davis, J. H. (2012). Craving to quit: Psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychology of Addictive Behaviors.

Britton, W. B., Bootzin, R. R., Cousins, J. C., Hasler, B. P., Peck, T., & Shapiro, S. L. (2010). The contribution of mindfulness practice to a multicomponent behavioral sleep intervention following substance abuse treatment in adolescents: A treatment-development study. Substance Abuse, 31(2), 86-97.

Eisenlohr-Moul, T. A., Walsh, E. C., Charnigo, R. J., Lynam, D. R., & Baer, R. A. (2012). The what and the how of dispositional mindfulness: Using interactions among subscales of the fiveNfacet mindfulness questionnaire to understand its relation to substance use. Assessment. Https://www.ncbi.nlm.nih.gov/pubmed/22589412

Garland, E. L., Gaylord, S. A., Boettiger, C. A., & Howard, M. O. (2010). Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: Results of a randomized controlled pilot trial. Journal of Psychoactive Drugs, 42(2).

Liehr, P., Marcus, M. T., Carroll, D., Granmayeh, L. K., Cron, S. G., & Pennebaker, J. W. (2010). Linguistic analysis to assess the effect of a mindfulness intervention on self-change for adults in substance use recovery. Substance Abuse, 31(2), 79-85. Marcus, M. T., Fine, M., Kouzekanani, K., Mindfulness-Based Meditation in a Therapeutic Community, Journal of Substance Use , 5, 305-311, 2001.

Marcus, M.T., Fine, M., Moeller, F. G., Khan, M.M., Pitt, K., Liehr, P., Changes in stress levels following mindfulness-based stress reduction in a therapeutic community, Addictive Disorders and Their Treatment, 2: 63-68. 2003.

Marlatt, G. A., Witkiewitz, K., Dillworth, T. M., Bowen, S. W., Parks, G. A., Macpherson, L. M., et al. (2004). Vipassana meditation as a treatment for alcohol and drug use disorders.

Smout, M. F., Longo, M., Harrison, S., Minniti, R., Wickes, W., & White, J. M. (2010). Psychosocial treatment for methamphetamine use disorders: A preliminary randomized controlled trial of cognitive behavior therapy and acceptance and commitment therapy. Substance Abuse, 31(2), 98-107.

Treloar, C., Laybutt, B., & Carruthers, S. (2010). Using mindfulness to develop health education strategies for blood borne virus prevention in injecting drug use. Drugs: Education, Prevention, and Policy, 11-18.

Zgierska, A. & Marcus, M. T. (2010). Mindfulness-Based therapies for substance use disorders: Part 2. Substance Abuse, 31(2), 77-78.

Zgierska, A., Rabago, D., Zuelsdroff, M., et al. (2008). Mindfulness meditation for alcohol relapse prevention: A feasibility pilot study. Journal of Addiction Medicine, 2(3), 165- 173.

This post was written by Eric Millman, LCPC