The practice of mindfulness is a powerful tool in addiction recovery. The following article explains how mindfulness plays a role in relapse prevention.
THE EFFECTS OF MINDFULNESS-BASED TECHNIQUES ON RELAPSE IN PATIENTS WITH ALCOHOL AND DRUG ADDICTIONS
By: Paige Tuck, MS, PLPC, RASAC-II
Everyday hundreds of men and women, boys and girls, of all ages enter rehabilitation treatment centers for drug and alcohol addiction. During their treatment stay, they abstain from substance use, gain knowledge on the facts, problems, and risks of drug and alcohol addiction, participate in group and individual counseling, all in learning and exploring underlying causes for addiction and how to live free of any substance use. An intricate part of rehabilitation is acquiring coping skills for relapse prevention. Over 60% of in-patient or outpatient rehabilitation centers are repeating treatment due a relapse occurrence (Drug and Alcohol Service Information System, DASIS, 2002). Although relapse can be included in the stages of change in one’s recovery process, it can as well become a repetitive cycle, having the client and their loved ones go through multiple emotional, financial, and strenuous times, that can sometimes lead to irreversible consequences.
Relapse can occur due to numerous factors, but the most common causes include negative affect (depression), craving or urges, interpersonal stress, lack of motivation, and insufficient coping skills (Conners, Maisto, & Zywiak, 1996: Witkiewitz & Marlett, 2004). The relapse chain, according Lewis et al. (2011), begins with a buildup or onset of stress caused by negative or positive occurrences. Overly negative or positive thoughts, moods, and feelings are activated such as confusion, irritability, depression, elation, and bewilderment. Overreaction or failing to take action occurs escalating the problem. The problem will snowball and cause new ones to be created that put the client at a point of no return and feeling incapable of handling it. Thoughts about “the good times” when they were using (drugs or alcohol) will increase and the client will think about or engage in self-sabotaging behaviors. The client will have added stress, feel out-of-control, and will often isolate and alienate from their support system.
With mindfulness-based techniques, one can practice awareness and acceptance, to recognize and be present with uncomfortable or unwanted feelings rather than trying to get distracted from and suppress them (Witkiewitz & Villarroel, 2009). Mindfulness-based practice can create a shift in the locus of control from external environmental circumstances to an internal or personal locus of control. It has been shown, through work by neurologists using fMRI (functional magnetic resonance imagery), that practicing mindfulness techniques after an 8-week session, can impact functioning of the brain where it no longer responds (a previously conditioned response) to cravings by automatically wanting to use drugs or alcohol to cover or escape an unpleasant state (Brewer et al., 2013).
The most common way to practice mindfulness is through meditation and guided imagery. The practice of mindfulness usually focuses on the body, breath, and thoughts through a guided meditation with a trained facilitator. Several different methods are available to practitioners to include into the treatment program. Nilsson (2014) introduced a four-dimensional model of mindfulness being physical, mental, social, and existential. The physical dimension focuses on the body’s state of being and experiencing more bodily awareness in activities routinely done throughout the day. This is achieved with mindfulness yoga, body scanning, sitting and walking meditation, and provides a heightened sense of sensory presence and attention rather than just being on “autopilot”.
The mental dimension trains the conscious mind to resist the constant flow of thoughts, feelings, and desires with body-conscious breathing. These thoughts are related to restlessness, irritability, anxiety, unpleasant memories. The social dimension focuses on the cultivation of empathy and compassion between members of the group. Lastly, an existential dimension encourages the search for meaning in life.
Another mindfulness-based relapse prevention exercise used in helping clients focus on the awareness and acceptance of uncomfortable states, and not to escape them or act in an automatic way, is the SOBER space exercise, which stands for “Stop”, “Observe”, “Breathe”, “Expand Awareness”, and “Respond Mindfully”.
Research has consistently shown the mindfulness-based practices can help alleviate stress and depression (Carmody & Baer, 2008) and significantly reduce relapse in drug and alcohol addictions (Witkiewitz et al. 2013). Ultimately, incorporating this approach with the traditional approaches such as the 12-step model, motivational interviewing, reality therapy, and cognitive behavior therapy (CBT), allows for expansion of coping skills for greater insight, growth and permanent change to occur. In conclusion, the addition of mindfulness-based practices through meditation can have an impact on one’s recovery, providing a better life to those suffering from addiction, a peace of mind for their families, a reduction in the amount of money spent for treatment, and other health problems related to addiction.
Brewer, J.A., Elwafi, H.M. & Davis, J.H. (2013). Craving to quit: psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychology of addictive behaviors, 27(2), 366-379.
Carmody, J. & Baer, R.A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical, and psychological symptoms and well being in a mindfulness-based stressed reduction program. Journal of Behavior Medicine, 31, 22-33.
Conners, G. J., Maisto, S. A., & Zywiak, W. H. (1996). Understanding relapse in the broader context of post-treatment functioning. Addiction, 91(Suppl.1), 173-189.
Drug and Alcohol Services Information System: The DASIS report. (2002). New and repeat admission to substance abuse treatment. Retrieved from: http://www.samhsa.gov/data/2k2/RepeatTX/RepeatTX.pdf
Lewis, J.A. and Dana, R.Q., & Blevins, G.A, (2011). Substance Abuse Counseling, (4th ed) (213-229) United States: Brooks/Cole, Cengage learning.
Nilsson, H. (2014). A four-dimensional model of mindfulness and its implications for health. Psychology of religion and spirituality, 6(2), 162-174.
Witkiewitz, K. & Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of consulting and clinical psychology, 78(3), 362-374.
Witkiewitz, K., Bowen, S. & Lustyk, K.B. (2013). Retraining the addicted brain: a review of hypothesized neurobiological mechanisms of mindfulness-based relapse prevention. Psychology of addictive behaviors, 27(2), 351-365.
Witkiewitz, K. & Marlatt, G.A. (2004). Relapse prevention for alcohol and drug problems, that was zen, this is tao. American Psychologist, 59(4), 224-235.
Witkiewitz, K. & Villarroel, N. (2009). Dynamic association between negative affect and alcohol lapses following alcohol treatment. Journal of Consulting and Clinical Psychology, 77, 633-644.