Addiction Recovery, Key 5: Mindfulness
[excerpted from, 9 Keys to Addiction Recovery: Health Psychology ?2023]
And now: your mind therapy. Mindfulness is our 5th key.
This is one of the most powerful tools you can have in your recovery. I can say this with confidence (I’ve practiced mindfulness for nearly 40 years) – and a good deal of research to back me up.
While many people think of mindfulness as meditation, and this is a core practice, it’s much more than that. Also, if you think you can’t meditate, think again: meditation is actually very simple, yet its effects are profound – especially in addiction recovery.
I like to think of mindfulness as, focus and notice. But also, don’t attach. (Hear me out.)
One of the core aspects of mindfulness, which is a trait or aspect of personality, a state or mental condition, and a practice with exercises we can engage in, is attention.
Now, you may be one of the many with ADD or ADHD, and thinking, this isn’t for me – attention is exactly my problem! This simply means, mindfulness is even more for you, and will help you enormously.
In mindfulness, we pay attention to our lives. In recovery, this means we begin to notice all the tiny joys throughout our day – the sunbeams coming in through the window and dancing on the floor, the stranger who said good morning to us, the cool air on the face, the way we feel. We begin to be rich in time – time affluent – as we actually notice the many moments of beauty throughout each day. We also begin to cherish ourselves, our life, our world. The smallest thing can be a source of joy. In all of this, you’re healing and retraining your brain’s pleasure or reward centers, which have been vastly overstimulated by active addiction – whether behavioral or substance – and now depleted so that nothing gives you pleasure. Mindfulness can help.
Mindfulness allows us to live deliberately, to be more in charge of ourselves and our lives, to pay attention. In fact, it’s an exercise to improve attention, much like any physical exercise will strengthen muscle. More than that: emotional regulation. We notice our thoughts and feelings as they arise…and then we let them drift away again like a puff of air, with no need to latch on or let it define us. Thoughts and emotions are story, part of our story, but we don’t need to be defined by story. We don’t need to ruminate on that thought all day, or let that emotion consume us; we begin to be more emotionally intelligent, and to regulate our emotions in a healthy way.
A 10-minute daily practice of mindfulness meditation is enough to supercharge your health, both physical and mental. Just 10 minutes! (Lots of research on this.) This can be as simple as sitting quietly, distractions minimized and eyes closed, focused on your slow and deep breathing; when you notice your focus has drifted (and it will; it’s normal), just gently refocus on your breathing; meanwhile, as thoughts or emotions come, just notice and greet them, then send them on their way again. And that’s it. Ten powerful, peaceful minutes every day. (There are many other mindfulness practices, and you’ll find more in the exercises section below.)
Trait mindfulness or self-regulation has been associated with lower risk of addiction, whether behavioral or substance, in a German study of 4,001 adolescents (Arnaud et al., 2023); related risk factors, such as psychological symptoms or distress or impulsivity, were also inversely related to trait mindfulness – indication of mindfulness as a protective factor.
The alteration in interoception, or processing of the body’s sensate signaling, that was addressed in our previous key seems to be reversed by mindfulness interventions, as shown on brain studies (May et al., 2022). Whereas substance use disorders in particular decrease interoceptive awareness and overstimulate other brain functions, mindfulness does precisely the opposite for improved addiction treatment outcomes. In a review of 30 studies of mindfulness-based intervention for substance use disorder, Korecki et al. (2020) found evidence for efficacy comparable to other types of treatment in terms of harm reduction, craving, abstinence, and related problems.
Comparable efficacy – and, mindfulness can be performed as self-treatment, at home, daily, and at zero cost. (Plus, it has a host of other physical and mental/emotional benefits.)
Naturally, mindfulness programs specific to addiction recovery have been developed. One such is Mindfulness-Oriented Recovery Enhancement [MORE] (Garland, 2016), which is not only the cognitive control and emotional regulation of all mindfulness practice, as well as the savoring of daily experience, our physical body, and the natural world; it also integrates strategies of positive reappraisal in order to disrupt the progress of addiction. This further generates interoception, to engage and potentially restructure the brain’s reward centers and to generally ‘reboot’ the brain affected by addiction (Garland, 2021).
In a review of 16 studies regarding MORE, Parisi et al. (2022) identified evidence of this mindfulness program’s efficacy not only for addiction but also chronic pain and psychological symptoms. Hu (2023), in a comparison of MORE to another such treatment program, Mindfulness-Based Relapse Prevention [MBRP], demonstrated evidence for their comparability in coping skills for craving management. She identified a distinction between them in that MORE cultivates skills of reappraisal with an aim toward decoupling triggers from pleasure, while MBRP focuses on relapse prevention in those who are abstinent, by applying the mindfulness principle of nonattachment to cravings in viewing them as transient states to be dissipated rather than acted upon.
A new mindfulness treatment approach recently piloted, specific to opioid use disorder [OUD], is the Mindful Recovery OUD Care Continuum [M-ROCC] (Schuman-Olivier et al., 2023). This 24-week training is specifically trauma-informed and conducted alongside medical treatment. The pilot study evidenced increased interoception and self-compassion, decreased experiential avoidance, and self-reported use for management of stress, anxiety, pain catastrophizing, and rumination.
Finally, and perhaps most fitting: Recovery Dharma [RD], a Buddhist-based, mindfulness-oriented, peer support program for addiction treatment. An online survey study was conducted by LaBelle et al. (2023), with 209 participants, average age 47 and an average of 7 years in recovery. Analysis demonstrated that mindfulness practice, meditation, and perceived support from the community significantly predicted measures of recovery capital while the duration of both meditation and recovery did not. Researchers concluded that consistent mindfulness meditation, rather than infrequent but more prolonged sessions, can enhance recovery capital.
So, how can we enhance our mindfulness?
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领英推荐
Exercises:
Without any doubt: follow the basic form of mindfulness meditation as already described above, and do it for 10 minutes every day. Just 10 minutes. But: every day, without fail. It seems so small, but it’s truly powerful.
Develop a mantram. Choose a word or short phrase that’s meaningful to you – “I’m worthy” or “I’m healthy” or “I’m capable” – or other, and say it in your mind many times throughout every day. Again: simple, but surprisingly effective. Choose just one and keep it the same; if you’re getting bored of it this may mean that it’s fairly integrated into your psyche and time to change to another. Reinforcement is key.
Engage in mindful walking. As an indoor activity, try walking as slowly as possible, focused completely on the walking itself. When walking outdoors, even in a crowd, just time your breathing and pace to one another; a normal (but steady, mindful) pace would be 3-4 steps per inhalation, then the same for exhalation, and so on. By paying attention to it, you’ll be walking mindfully.
Have a mindful meal. Put all the entertainment away; focus only on your meal itself – the food in its taste, color, texture, temperature, how you feel, when you feel full, the act of feeding yourself, the pleasure of eating, the nourishment that the food brings to your body, and any other details.
Take a walk in nature – and notice everything. Look at tiny details, feel how your body is functioning, listen for sounds, taste the air, feel the sun on your face. Absorb as much of this experience as you can.
Throughout your day, notice its details. Pay attention. Look for beauty, for meaning, for humor, for interchanges with other people, for moments to appreciate. Live the day fully, noticing everything and missing nothing. Sense the richness in an ordinary day.
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References:
Arnaud N, Wartberg L, Simon-Kutscher K et al. (2023). Prevalence of substance use disorders and associations with mindfulness, impulsive personality traits and psychopathological symptoms in a representative sample of adolescents in Germany. European Child and Adolescent Psychiatry. https://doi.org/10.1007/s00787-023-02173-0
Garland EL (2016). Restructuring reward processing with Mindfulness-Oriented Recovery Enhancement: Novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain. Annals of the New York Academy of Sciences 1373; 25-37. https://doi.org/10.1111/nyas.13034
Garland EL (2021). Mindful positive emotion regulation as a treatment for addiction: From hedonic pleasure to self-transcendent meaning. Current Opinion in Behavioral Sciences 39, 168-177. https://doi.org/10.1016/j.cobeha.2021.03.019
Hu J (2023). Neuropsychological Mechanisms and Evidence of Mindfulness-Based Interventions for Addiction. Journal of Education, Humanities and Social Sciences 8, 904-908. https://doi.org/10.54097/ehss.v8i.4379
Korecki JR, Schwebel FJ, Votaw VR et al. (2020). Mindfulness-based programs for substance use disorders: A systematic review of manualized treatments. Substance Abuse Treatment, Prevention, and Policy 15:51. https://doi.org/10.1186/s13011-020-00293-3
LaBelle O, Hastings M, Vest N et al. (2023). The role of mindfulness, meditation, and peer support in recovery capital among Recovery Dharma members. Journal of Substance Use and Addiction Treatment 208939. https://doi.org/10.1016/j.josat.2022.208939
May AC, Davis C, Kirlic N et al. (2022). Mindfulness-Based Interventions for the Treatment of Aberrant Interoceptive Processing in Substance Use Disorders. Brain Sciences 12:2, 279. https://doi.org/10.3390/brainsci12020279
Parisi A, Roberts RL, Hanley AW et al. (2022). Mindfulness-Oriented Recovery Enhancement for Addictive Behavior, Psychiatric Distress, and Chronic Pain: A Multilevel Meta-Analysis of Randomized Controlled Trials. Mindfulness 13, 2396-2412. https://doi.org/10.1007/s12671-022-01964-x
Schuman-Olivier Z, Fatkin T, Creedon TB et al. (2023). Effects of a trauma-informed mindful recovery program on comorbid pain, anxiety, and substance use during primary care buprenorphine treatment: A proof-of-concept study. American Journal on Addictions 32, 244-253. https://doi.org/10.1111/ajad.13364