If there’s a bigger challenge than making a person quit drinking, then it’s certainly preventing a relapse. The data from the 80s used to show a grim image: the early studies of generic inpatient programs found that 80 to 90% of alcoholics relapsed in the first year after treatment when relapse was defined as a single drink[1]. The same pattern and figures apply to other types of addiction, such as opiate and nicotine addiction. The figures explain why we probably all know a lot of people who are on and off alcohol and opiates for many years, if not for their whole adult life.
Since the 80s, therapists have started to get creative in an attempt to curb those dramatically high relapse numbers. For example, Cognitive Behavioral Therapy in treating addiction had come a long way. Although relapse rates have dropped a bit since the end of the 20th century, they’re still worryingly high. Relapse still is every recovered addict’s biggest nightmare.
At the very beginning of 21st century, an unlikely ally to relapse prevention and general treatment of addiction appeared out of the blue. Well, not really, since some minor research has been done priorly, but the idea wasn’t taken seriously until the 00s. The idea in question is to use the practice of mindfulness meditation for treating addiction. And it turns out, it yields excellent results.
What Is Mindfulness?
When we say “meditation”, the first thing that comes to an average person’s mind is “relaxation”. And indeed, the relaxation meditation techniques are intended to relax your body, and empty your mind of unproductive thoughts. Remember how yesterday’s worries feel better after a good night’s sleep? Well, the relaxation meditation is a state similar to “dreaming awake”. It works by focusing your attention on an object or a sound, which helps you in controlling (pushing away) all other thoughts.
Different relaxation meditation techniques have shown limited efficacy in treating addiction and relapse. Though they would initially help recovering addicts to feel better and stay on track, the studies say that in long-term they haven’t shown any valuable effect, that relapse rates are almost equally common, and many people abandon their meditation practice after a few months.
Mindfulness meditation is different. While with relaxation meditation you’re to trying to push all your thoughts away, in mindfulness meditation you’re being mindful – paying careful attention to the thoughts, ideas, and feelings that fill your mind and body during a simple breathing exercise. At the same time, you’re distancing yourself from your thoughts. You acknowledge them, and feel them in an uncontrolled, unjudging manner.
Mindfulness practice’s goal is to bring suppressed thoughts to the light of day, thereby helping you to discover and integrate underlying causes of your addiction. And uncovering your issues doesn’t always feel nice. Unlike relaxation meditation, mindfulness is not meant to always be a pleasant ride, and a bumpy road is to be expected when dealing with addictions. The idea of letting your hidden emotions surface has very interesting implications for addiction issues since we usually drink or abuse other substances to escape the emotions we perceive as unpleasant.
And the repulsive emotions can be powerful. Often described as “a void” or a “big black hole”, people are usually afraid to face them for the fear of being completely consumed by the darkness within. But mindfulness practice has a remedy for that. The main focus of your attention during the meditation is your own breath. It is your anchor in reality and your tool for keeping the troubling feelings at a safe distance.
Through this mixture of focusing, acknowledging and accepting the thoughts and feelings, but gently returning the attention to your breath when needed, “one learns not to take emotions and thoughts literally as facts, but simply as mental events; in other words, mindfulness meditation can change how one relates to dysfunctional thoughts and negative effect rather than changing or eliminating the states themselves“1.
This technique has been referred to as taking a “decentered perspective” or “cognitive distancing”, and it’s believed to be an exceptional way to prevent dysfunctional thoughts and emotional avoidance.
Another great feature of using mindfulness in treating addictions is that it can be seamlessly blended with other forms of therapy, such as different techniques of cognitive-behavioral therapy.
Empirical Studies on Mindfulness in Treating Addiction
Although empirical research on the integration of mindfulness into “regular” forms of therapy is still in its early days, there are serious, quality studies confirming its effectiveness.
For example, a study from 2010 called “Depression, Craving and Substance Use Following a Randomized Trial of Mindfulness-Based Relapse Prevention“[2] has shown that Mindfulness-Based Relapse Prevention (MBRP) is effective for reduction of substance abuse. It works by helping patients to reduce emotional discomfort and lessen the craving for the substance felt during depressive or aggravated episodes.
Michael Waupoose, the programme manager for Gateway Recovery, a University of Wisconsin-Madison Health addiction treatment center, takes the explanation further: “If a patient has a very bad argument with his spouse or children, his anxiety will increase; he may get frustrated and angry; and, commonly, he will automatically leave that situation and go out for a drink to relieve stress and tension. Obviously, this is an example of unhealthy coping with discomfort. Mindfulness meditation would teach that person how to be present in that situation, how to be conscious of what’s happening to their body, and how to deal with it without reacting to it automatically. It teaches people how to be conscious of their feelings or thoughts without having to follow them all the way through.“[3]
How can you incorporate mindfulness into your own recovery?
There are several mindfulness-inclusive or mindfulness-based therapy techniques, including but not limited to Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT – which was originally designed for treating borderline personality disorder), Mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). You can read more about them here1.
If you believe you might benefit from the mindfulness-based approach, the first thing you can do is talk to your therapist about this approach since all of these techniques are used under a guidance by a professional.
If your drinking problem is still not out of control, or if you’ve recovered but still you get occasionally bothered by thoughts of having that “just one drink”, you may benefit from do-it-yourself mindfulness practice. There are many resources (and even phone apps) to help you out with starting the practice.
In the next part of this mindfulness series, we’re going to examine one such self-help approach called “The Presence Process”.
[1] Breslin C.F, Zack M, McMain S (2002). An Information-Processing Analysis of Mindfulness: Implications for Relapse Prevention in the Treatment of Substance Abuse. Centre for Addiction and Mental Health
[2] 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.
https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC3280693/
[3] UW Health Mindfulness (2010). Meditation in the Treatment of Alcoholism. University of Wisconsin-Madison
http://www.uwhealth.org/news/mindfulness-meditation-in-the-treatment-of-alcoholism/26457