Mindfulness for Treating Addiction: A Clinician’s Guide

Mindfulness for Treating Addiction: A Clinician’s Guide

Psychotherapy 1

An aspect of our scientific work relating to mindfulness involves investigating its applications for treating addiction. In this respect, we have a longstanding collaboration with Dr. Mark Griffiths who is Professor of Behavioural Addiction at Nottingham Trent University (UK) and is internationally recognised for his work in this field of study. Today’s post draws upon findings from our research using Meditation Awareness Training and provides ten recommendations on the psychotherapeutic use of mindfulness in addiction treatment contexts. These recommendations are primarily intended for mental health professionals, but individuals with addiction problems may also find them of interest. Although we have principally based our recommendations on insights gained from using mindfulness and meditation for treating behavioural addictions (e.g., gambling disorder, workaholism, sex addiction), we have also consulted the literature concerning the use of mindfulness for treating chemical addictions (e.g., substance- and alcohol-use disorders). Therefore, whilst we acknowledge that there are important differences between behavioural and chemical addictions (e.g., the physical signs of drug addiction are typically absent in behavioural addiction), we envisage that the following recommendations will be applicable to both addiction categories.

  1. Undertake a Thorough Assessment: Careful evaluation of the client’s history (e.g., clinical history, social history, education history, religious history, employment history, etc.) and presenting problems will come high on the list of any competent mental health clinician. However, we have chosen to include ‘thorough assessment’ as one of our specific recommendations because there appears to be a belief amongst a minority of mental health professionals that mindfulness is a one-stop cure for all mental health issues. As discussed in one of our peer-reviewed papers that was recently published in the British Medical Journal, the only psychopathologies for which the empirical evidence is robust enough to support the wide scale utilisation of mindfulness are specific forms of depression and anxiety. In other words, mindfulness is not a suitable treatment for every individual presenting for treatment. For example, we recommend that clinicians exercise additional caution (including taking into account their own experience with using mindfulness) before introducing mindfulness to clients whose addiction problem occurs in conjunction with psychotic features.
  2. Build Strong Meditative Foundations: Mindfulness is a practice to develop throughout one’s lifetime. It is a marathon and not a sprint. If an individual is to derive lasting benefit from mindfulness, it is essential that they establish strong meditative foundations. If we want to become aware of the subtle aspects of mind, we first need to become aware of the gross aspects of mind. And before we can do that, we need a method of calming, collecting and focussing the mind. This is why breath awareness is a vital feature of meditative development. Using the breath as a concentration anchor provides the client with a reference point – a place of safety to which they can return whenever their mind starts to run away with itself. The mental cravings that underlie addiction can be powerful and consuming, and without strong meditative foundations, it is unlikely that the client will be able to regulate these cravings as well as the withdrawal symptoms that they are likely to encounter during later treatment phases. Another important foundation of mindfulness is awareness of the body. At the early stages of treatment, clients should be taught how to sit with awareness, eat with awareness, walk with awareness and talk with awareness. Clients should be encouraged to adopt mindfulness as a way of life and not just a technique to apply when they are feeling low or susceptible to addiction-related urges.
  3. Make use of Psycho-education: In addiction treatment contexts, we suggest that psycho-education should be utilised at the early stages of treatment and should focus on two key areas: (i) educating clients in the science concerning the aetiology and symptom course of their particular addiction, and (ii) explaining the principles of mindfulness and a meditation-based recovery model. For a comprehensive and insightful academic resource that clinicians can draw upon in this respect, we recommend the chapter on mindfulness and addiction by Dr. Sean Dae Houlihan and Dr. Judson Brewer that features in our recent edited Springer volume on Mindfulness and Buddhist-Derived Approaches in Mental Health and Addiction (see further reading list below).
  4. Teach ‘Urge Surfing’: The term ‘urge surfing’ has been used in the scientific literature to refer to the process of mindfully observing the mental urges associated with addiction. The idea is that the client, having established themselves in awareness of breathing, takes craving as the object of meditation. They follow their breath and observe how craving dominates their cognitive-affective processes. The process of observing mental craving helps to objectify it and creates ‘mental space’ whereby instead of feeding the craving (i.e., by emotionally and conceptually adding to it), craving is allowed to exist ‘as it is’. It may appear as though urge surfing is concerned with controlling craving, but that’s not the case. Rather, the technique involves allowing craving to come and go such that it can progress through its natural cycle of birth, life and dissolution. When we teach this technique, we inform clients that if craving is manifest in the mind, that’s OK. We also inform them that if craving is not manifest, that’s OK too.
  5. Make use of Bliss Substitution: Substitution techniques are sometimes used in the treatment of both behavioural and chemical addictions. For example, studies have shown that some individuals with gambling disorder respond well to gradually substituting their gambling activity for recreational activities such as singing, learning computer skills, communication workshops, dance and music. Our own studies have shown that the substitution principle can also work well in the case of addiction treatments following a meditation-based recovery model. One of the key drivers of addiction is the mood modification (e.g., ‘feeling high’) that results from engaging with a particular substance or behaviour. Meditation may be particularly suitable as an addiction substitution technique because specific forms of meditation can induce blissful feelings. Effectively, the client learns to replace the ‘buzz’ or ‘high’ associated with a ‘negative addiction’ with the bliss and peace of meditation (i.e., a positive form of addiction). Eventually, clients should be encouraged to relinquish any dependency on meditation, but in the early stages of treating addiction, it can be a useful therapeutic technique.
  6. Employ Meditation Exposure Therapy: Exposure therapy is a method employed by various modalities of psychotherapy, and it can also be used as part of mindfulness therapy for individuals suffering from addiction. It is all very well teaching the client how to practise mindfulness from the safety of the psychotherapist’s consulting room, but at some point it is probable that they will encounter the stimuli that have previously caused strong mental urges to arise. Consequently, we encourage the psychotherapist to accompany (i.e., where it is safe and realistic to do so) the client in ‘real-world settings’ that are likely to induce relapse. For example, if the client is addicted to off-line gambling, consider accompanying them to a casino in order to demonstrate that it is possible for them to remain meditatively composed whilst surrounded by the object of their addiction. Meditation exposure therapy isn’t suitable for every client (or indeed for every mental health clinician), but where applicable, we generally recommend that it is used towards the end of the treatment course.
  7. Undermine the Value of the Addictive Object: This technique involves guiding the client to think about the ‘true nature’ of the object of their addiction. More specifically, it involves introducing the client – albeit at an elementary level – to the concepts of impermanence, interconnectedness and emptiness. Again, the clinician will have to assess on a case-by-case basis whether this technique is appropriate, but we have personally found it to be effective in addiction treatment contexts. By fostering meditative awareness of impermanence and the empty nature of all phenomena, the client can gradually begin to question and then undermine the intrinsic value that they have assigned to the object of their addition. For example, an individual suffering from sex addiction can use specific meditative techniques in order to better understand that (i) the individual components that comprise the human body are not particularly desirable in and of themselves (e.g., nails, hair, mucus, faeces, urine, pus, vomit, blood, sinew, skin, bone, teeth, flesh, sweat, etc.), (ii) the inevitable destiny of the body is that of ageing, illness and decay, and (iii) the body exists as a composite entity but does not exist intrinsically. If the client looks deeply using meditation, they can learn to see that in beauty and life, there is foulness and decay (and vice-versa). They can also learn to see that there is ‘other’ in ‘self’ and ‘self’ in ‘other’, and that when they practice kindness and respect towards themselves, they practise kindness and respect towards the entire world.
  8. Schedule Follow-up Sessions: Most of the available treatments that use mindfulness generally adhere to an eight-week treatment course. However, in the traditional Buddhist setting, a person would normally be required to engage in day-to-day mindfulness practice over a period of many years before being deemed to have gained a reasonable grounding in the practice. Consequently, it is important to schedule booster sessions and to meet with the client at regular (e.g., monthly) intervals following the initial programme of treatment. Ideally, clients should also be encouraged to make contact with mindfulness groups that are facilitated by competent teachers.
  9. Lead by Example: As discussed in a previous post where we offered guidelines on the general use of mindfulness in psychotherapy (i.e., not specific to treating addiction), it is important that the mental health clinician emanates a presence of meditative calm and awareness. This has to be natural and as indicated above, it can only arise after consistent daily practice over a period of many years. If the clinician merely ‘acts’ at being mindful, the client is likely (whether consciously or subconsciously) to pick up on this and it will inevitably act as an obstacle to recovery.
  10. Be Inspired: Mindfulness has been practised by spiritual traditions for thousands of years. When a clinician engages with the practice in a sincere manner, and when they wholeheartedly wish to help the client overcome their suffering, that clinician is bestowed with the blessings and wisdom of this ancient spiritual lineage. They become what is known in Buddhism as a Bodhisattva – a rare and beautiful being that conduct acts of kindness in order to alleviate the suffering of others. Skilled mental health professionals perform an invaluable role to society. They are inspired individuals who in turn help to inspire the clients they work with.

Ven Dr Edo Shonin and Ven William Van Gordon

 

Further Reading

Alavi, S. S., Ferdosi, M., Jannatifard, F., et al. (2012). Behavioral addiction versus substance addiction: Correspondence of psychiatric and psychological views. International Journal of Preventative Medicine, 3, 290-294.

Appel, J., & Kim-Appel, D. (2009). Mindfulness: Implications for substance abuse and addiction. International Journal of Mental Health Addiction, 7, 506-512.

Griffiths, M. D., (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M. D., Shonin, E., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, 1, 1-6.

Houlihan, S. D., & Brewer, J. A. (2015). The emerging science of mindfulness as a treatment for addiction. In: E. Y. Shonin, W. Van Gordon and M. D. Griffiths (eds.), Mindfulness and other Buddhist-derived approaches in mental health and addiction (pp. 191-210). New York: Springer.

Iskender, M., & Akin, A. (2011). Compassion and internet addiction. Turkish Online Journal of Educational Technology, 10, 215-221.

Jackson, A. C., Francis, K. L., Byrne, G., et al. (2013). Leisure substitution and problem gambling: report of a proof of concept group intervention. International Journal of Mental Health and Addiction, 11, 64–74.

Rosenberg, K. P., Carnes, P. J., & O’Connor, S. (2014). Evaluation and treatment of sex addiction. Journal of Sex and Marital Therapy, 40, 77-91.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014). The treatment of workaholism with Meditation Awareness Training: A Case Study. Explore: The Journal of Science and Healing, 10, 193-195.

Shonn, E., Van Gordon, W., & Griffiths, M. D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.

Shonin, E., Van Gordon W., & Griffiths, M. D. (2014). Mindfulness as a treatment for behavioral addiction. Journal of Addiction Research and Therapy, 5, e122. DOI: 10.4172/2155-6105.1000e122.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014). Mindfulness and the social media. Journal of Mass Communication and Journalism, 2014, 4: 5, DOI: 10.4172/2165-7912.1000194.

Shonin, E., Van Gordon W., & Griffiths, M. D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioural Addictions, 2, 63-71.

Shonin, E., Van Gordon W., & Griffiths, M. D. (2013). Meditation for the treatment of addictive behaviours: Sending out an SOS. Addiction Today, March, 18-19.

Shonin, E., Van Gordon, W. & Griffiths, M. D. (2013). Mindfulness-based interventions for the treatment of problem gambling. Journal of the National Council on Problem Gambling, 16, 17-18

Sussman, S., Lisha, N. & Griffiths, M. D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Witkiewitz, K, Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy, 19, 211-228.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

Before Time Goes By

Before Time Goes By

time 1

Clicca qui per l’Italiano

Growing and play

Adventure each day

The joys of childhood

But time goes by

Education and training

Ignorance waning

The value of knowledge

But time goes by

Courtship and romance

Love’s heart-warming dance

 The beauty of youth

But time goes by

A family to raise

Hungry mouths that gaze

The duty of parenthood

But time goes by

Making a living

No time for giving

The demands of work

But time goes by

Beliefs to fight for

Ideas to deplore

The folly of the pious

But time goes by

Growing reputation

Seeking acclamation

The lure of power

But time goes by

Wealth amassing

Owning and outclassing

The pleasure of possessing

But time goes by

Winning on Sunday

Losing on Monday

The uncertainty of life

But time goes by

Pain and sickness

Loss of mental quickness

The loneliness of old age

But time goes by

Fear of dying

Lament and crying

The inevitability of death

But time goes by

Oh when will you sever

Your pointless endeavour

And relinquish your plans

Before time goes by

Oh when will you pacify

Your clinging to ‘I’

And embrace compassion

Before time goes by

Oh when will you console

Your restless soul

And know lasting peace

Before time goes by

Oh when will you heed

Your teacher’s plead

And enter the Way

Before time goes by

Oh when will you find

Your innermost mind

And dwell in emptiness

Before time goes by

Oh when will you be bestowed

Your rightful deathless abode

And return to home

Before time goes by

Ven Edo Shonin and Ven William Van Gordon

Prima che il tempo passa

time 1

Crescere e giocherellare

Le avventure giornaliere

Le gioie dell’infanzia

Ma il tempo passa

Educazione e allenamento

L’ignoranza in declino

Il valore della sapienza

Ma il tempo passa

Il corteggiamento e la passione

La danza di amore che scalda il cuore

 La bellezza della gioventù

Ma il tempo passa

Una famiglia da allevare

Bocche affamate che non fanno altro che guardare

Il dovere della paternità

Ma il tempo passa

La necessità di fare soldi

Non c’è tempo per essere generosi

Le esigenze del lavoro

Ma il tempo passa

Lottare per le cradenze morale

Idee da deplorare

La follia delle persone pie

Ma il tempo passa

Una crescente reputazione

Alla ricerca di acclamazione

Il richiamo di potere

Ma il tempo passa

Ammassare benessere

A padroneggiare e il desiderio di surclassare

Il piacere di possedere

Ma il tempo passa

Vincere la Domenica

Perdere il Lunedi

L’incertezza della vita

Ma il tempo passa

Il dolore e la malattia

Perdita della prontezza mentale

La solitudine della vecchiaia

Ma il tempo passa

La paura di morire

I lamenti e il piangere

L’inevitabilità della morte

Ma il tempo passa

Oh quando reciderete

Il vostro sforzo pleonastico

E rinunciare ai vostri piani

Prima che il tempo passa

Oh quando riuscirete a pacificare

il vostro attaccamento a un ‘sé’

E abbracciare la compassione

Prima che il tempo passa

Oh quando vi consolate

Il vostro anima inquieta

E conoscete una pace duratura

Prima che il tempo passa

Oh quando farete attenzione

all’appello del vostro insegnante

E intraprendere la Via Giusta

Prima che il tempo passa

Oh quando troverete

La vostra mente più profonda

E dimorate nel vuoto

Prima che il tempo passa

Oh quando si sarà elargito

La vostra dimora immortale legittimo

E tornate a casa

Prima che il tempo passa

Ven Edo Shonin and Ven William Van Gordon

 

 

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