Addiction

Quit Smoking Mindfully

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“Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.” – Mark Twain

 

“Tobacco use remains the single largest preventable cause of death and disease in the United States. Cigarette smoking kills more than 480,000 Americans each year, with more than 41,000 of these deaths from exposure to secondhand smoke. In addition, smoking-related illness in the United States costs more than $300 billion a year. In 2013, an estimated 17.8% (42.1 million) U.S. adults were current cigarette smokers.”  (Centers for Disease Control and Prevention).

 

Nicotine is one of the most addictive substances known. But, its addictiveness is not just due to its pharmacological properties. Addiction to smoking also involves learned or conditioned factors, genetics, and social and environmental factors. This makes it easy to become addicted and very difficult to stop. To some extent this is why there still are high rates of smoking even though mostly everyone understands that it has very negative effects on health and longevity.

 

There are a wide variety of methods and strategies to quit smoking which are to some extent effective. According to the National Institutes of Health, about 40% of smokers who want to quit make a serious attempt to do so each year, but fewer than 5% actually succeed. Most people require three or four failed attempts before being successful. One problem is that after quitting if a single cigarette is smoked, going back to regular smoking is almost assured. As John Polito wrote “nicotine dependency recovery is one of the few challenges in life where being 99% successful all but assures 100% defeat.”

 

So, better methods to quit which can not only promote quitting but also prevent relapse are badly needed. In today’s Research News article “Randomized trial comparing mindfulness training for smokers to a matched control”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1124440280913230/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121076/

Davis and colleagues compared the efficacy of a mindfulness training for smokers (MTS) program to the American Lung Association’s Freedom from Smoking (FFS) program. The MTS program included meditation, group support, and instruction on mindful management of smoking triggers, urges, addictive thoughts and emotions. They applied these programs to quitting smoking with low socioeconomic status smokers, a very difficult segment of the population to treat. Both groups used nicotine patches for the first two weeks of treatment.

 

They found that at four weeks after the end of treatment 35% of the mindfulness training group and 34% of the FFS group were smoking abstinent. But at 24 weeks 25% of the mindfulness group were still abstinent compared to 18% for the FFS group. This suggests that mindfulness may be helpful in maintaining abstinence after successful quitting of smoking. The mindfulness training group not surprisingly had higher mindfulness scores. Importantly, they showed lower urges to smoke after quitting. In addition, the mindfulness training group showed a lower tendency to avoid experiences. It is important to note that mindfulness training had these effects in a low socioeconomic status group which have traditionally been found to be difficult to treat.

 

These are exciting results and suggest that mindfulness training may be an important addition to programs for smoking cessation. It appears that mindfulness may be effective by reducing urges to smoke. Mindfulness training increases focus of an acceptance of the present moment. After the physiological symptoms of smoking withdrawal are over the most difficult issues that tend to produce relapse are learned environmental and social triggers to smoke. It is possible that mindfulness training allows the individual to be better at understanding and accepting these triggers and not avoid experiences but confront them. This may then decrease the urge to smoke and improve abstinence.

 

Regardless of the mechanism, mindfulness training appears to be a beneficial addition to smoking cessation programs. Of course, further research is needed.

 

So, quit smoking mindfully.

 

“Smoking sucks! The one thing I would say to my kid is, ‘It’s not just that it’s bad for you. Do you want to spend the rest of your life fighting a stupid addiction to a stupid thing that doesn’t even really give you a good buzz?’” – Katherine Heigl

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Decrease Suicidality with Mindfulness

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“Killing yourself is a major commitment, it takes a kind of courage. Most people just lead lives of cowardly desperation. It’s kinda half suicide where you just dull yourself with substances.” – Robert Crumb

 

Suicide is the 10th leading cause of death in the US for all ages. It is much more prevalent with males who account for 79% of suicides. Every day, approximately 105 Americans die by suicide. Worldwide over 800,000 people die by suicide every year. (Suicide Awareness Voices of Education). Yet compared with other life threatening conditions there has been scant research on how to identify potential suicide attempters and reduce suicidality.

 

Depression and other mood disorders are the number-one risk factor for suicide, but alcohol and drug abuse – even without depression – are a close second. In fact, research has shown that the strongest predictor of suicide is alcoholism, not a psychiatric diagnosis. People with substance use disorders are about six times more likely to commit suicide than the general population. To make matter worse people with substance abuse are often incarcerated. In prison suicidality is even higher than outside. It is not the primary effects of the substances that promote suicide as the likelihood of suicide does not decline after complete withdrawal from the drugs or alcohol.

 

So there is a great need to study suicidality especially in conjunction with substance use disorders to identify predictors and potential methods to prevent actual suicide attempts. In today’s Research News article “Trait Mindfulness, Reasons for Living and General Symptom Severity as Predictors of Suicide Probability in Males with Substance Abuse or Dependence”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1123964037627521/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434430/

Mohammadkhani and colleagues studied incarcerated and outpatient substance abusers and measured mindfulness, psychiatric symptoms, reasons for living, and suicide probability. These groups were indeed high risk as 36% of the outpatients and 42% of the incarcerated participants had attempted suicide. They found that the strongest single predictor of suicide probability was the severity of the individuals’ psychiatric symptoms and the second was fear of social disapproval. Importantly, they found that the higher the level of mindfulness, the lower the probability of suicide.

 

These findings are interesting and suggest that mindfulness training might be an effective intervention to lower suicidality and the risk of attempting suicide in the high risk population of substance abusers. Of course, a randomized clinical trial is needed to establish effectiveness.

 

The findings also raise interesting questions as to why mindfulness might be an antidote to suicidality. There are a number of known effects of mindfulness that might account for its negative association with suicidality. Mindfulness has been shown to decrease psychiatric symptoms and depression, the leading causes of suicide attempts. Indeed, they found that high mindfulness was associated with lower levels of psychiatric symptoms. Mindfulness also improves emotion regulation allowing the individual to respond more adaptively to sometimes overwhelming emotions. In addition, it is known to reduce physiological and psychological responses to stress which might lower stress’ ability to prompt a suicide attempt. In addition, suicide is often associated with hopelessness about the future. Mindfulness by increasing focus on the present moment lowers worry and rumination about the future and may thereby reduce the likelihood of a suicide attempt. Finally, mindfulness is known to help prevent relapse after successful withdrawal from addiction and this may make the individual more hopeful about the future.

 

Regardless of the reasons, mindfulness appears to be able to buffer the individual against the forces that can promote and prompt suicide.

 

“Suicide is a serious thing. And if you know anyone who is suicidal, you need to get them help. No one should be in pain. Everyone should love themselves.” – Gerard Way

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Staying on the Wagon with Mindfulness

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“It’s Easy to Quit Smoking. I’ve Done It a Thousand Times” – Mark Twain

 

“…there is a saying used in twelve-step programs and in most treatment centers that “Relapse is part of recovery.” It’s another dangerous slogan that is based on a myth, and it only gives people permission to relapse because they think that when they do, they are on the road to recovery.”  ― Chris Prentiss

 

Drug and alcohol addictions are very difficult to kick and if successful about half the time the individual will relapse. “The chronic nature of the disease means that relapsing to drug abuse at some point is not only possible, but likely.” – National Institute on Drug Abuse. Relapse does not mean treatment has failed. Rather, lapsing back to drug use indicates that treatment needs to be reinstated or adjusted or that another treatment tried. Successful drug abuse treatment requires changing deeply imbedded behaviors particularly in response to emotions and stress. Hence, treatment must include therapy to replace maladaptive behaviors with adaptive ones and build mechanisms to effectively regulate emotions and responses to stress.

 

Mindfulness-Based Relapse Prevention (MBRP) has been developed specifically to prevent relapse after successful recovery from substance abuse. It has been shown to be superior to 12-step programs in preventing addiction relapse (see http://contemplative-studies.org/wp/index.php/2015/08/28/kick-the-drug-habit-with-mindfulness/). MBRP combines meditation with a cognitive therapy based relapse prevention program. The program prepares the individual to deal with high risk situations, contexts and people that have been associated with drug use in the past. So, when they encounter these people or situations in the future they will be better able to refrain from repeating their drug use behaviors. The program also works to develop self-efficacy, helping the individual understand that they have the ability to control their urges and cravings. The addition of meditation appears to strengthen emotion regulation and responses to stress resulting in improved effectiveness and duration of relapse prevention.

 

In today’s Research News article “Mindfulness-Based Relapse Prevention: History, Mechanisms of Action, and Effects”

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Penberthy and colleagues review the published research on MBRP effectiveness in relapse prevention and conclude that MBRP is effective in preventing substance abuse relapse. They point out, however, that there is a lack of long-term follow-up (over 6 months) to establish whether the program works over the long haul.

 

An important aspect of mindfulness training in relapse prevention is the improvement in emotion regulation that the training produces (see http://contemplative-studies.org/wp/index.php/2015/09/10/take-command-and-control-of-your-emotions/). The individual is better able to sense, feel, and understand the emotions they’re experiencing, the intensity of the emotions are maintained at manageable levels, and the individual can respond more adaptively. Intense emotions are often triggers for relapse. So, the mindfulness training provides the individual the means to understand and cope with the emotions in other ways than substance use.

 

The improved emotion regulation assists the individual in dealing with what is called the “violation effect.” This occurs when a brief lapse in recovery is followed by powerful negative emotions that amplify the lapse into a full relapse. The development of emotion regulation skills and non-judgmental awareness of emotions is essential to withstanding the negative consequences of a lapse thereby preventing it from escalating.

 

Meditation training is also been shown to improve the psychological and physiological responses to stress (see http://contemplative-studies.org/wp/index.php/2015/07/17/destress-with-mindfulness/). Substance use is often triggered by highly stressful situations and the individual uses the drugs to help cope with the stress. By developing a different means of dealing effectively with stress meditation training helps the individual to continue abstinence in the face of difficult and stressful situations.

 

So, although more research is needed especially investigating long-term effectiveness, Mindfulness Based Relapse Prevention appears to be an effective treatment program for assisting the recovered drug or alcohol abuser from relapsing.

 

“Recovery is a process. It’s decision by decision, step by step, gain by gain, day by day, month by month, and year after year. Trudge Forward!” – DBT-CBT Workbook

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Add Spirituality to substance Abuse Treatment to Amplify its Benefits

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“What fascinates me about addiction and obsessive behavior is that people would choose an altered state of consciousness that’s toxic and ostensibly destroys most aspects of your normal life, because for a brief moment you feel okay.” – Moby

 

Substance abuse and addiction is a large and difficult problem for all groups. But, it is especially a problem for Native American and Alaska Native populations. The rates of binge alcohol use and illicit drug use are higher among American Indian or Alaska Native adults than the national averages (30.6 vs. 24.5 percent and 11.2 vs. 7.9 percent, respectively) and  the  need for treatment is higher than the national average for adults (18.0 vs. 9.6 percent). But only one in eight (12.6 percent) in need of treatment received treatment.

 

There is a great need for effective treatments for substance abuse overall, but particularly for the Native American and Alaska Native populations. Mindfulness based treatments have shown promise. The mindfulness based therapeutic technique Dialectical Behavior Therapy (DBT) has been demonstrated to be effective for the treatment of substance abuse. Similarly, spirituality has also been shown to be beneficial in recovery from addictions and alcoholism (see links below).

 

In the treatment of Native American and Alaska Native populations there has been a glaring lack of incorporation their spiritual beliefs into the therapeutic process. This is a problem as these spiritual beliefs are critical and central to their cultures and integration of them into therapy is critical in working with this population.

 

In today’s Research News article “Dialectical behavior therapy with American Indian/Alaska Native adolescents diagnosed with substance use disorders: Combining an evidence based treatment with cultural, traditional, and spiritual beliefs.”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1091066804250578/?type=1&theater

Beckstead and colleagues integrate Native American and Alaska Native spiritual beliefs into the evidence based treatment Dialectical Behavior Therapy (DBT) and applied it to treating substance abuse and addiction in Native American and Alaska Native adolescents. Remarkably they found that 90% of the 229 patients treated showed clinically significant improvement and 6% more showed improvement. No patients demonstrated deterioration.

 

These results are remarkable as reflected in the very large calculated effect size for the integrated treatment. This suggests that integrating culturally appropriate spiritual beliefs into treatment greatly amplifies the effectiveness of the treatment. As we discussed previously (see links below) spirituality has a number of positive characteristics that make it effective in recovery from addiction. So, its integration into secularly based treatments appears to have an amplifying effect, making these treatments even more effective.

 

So fight substance abuse with spiritually appropriate treatment.

 

“All the suffering, stress, and addiction comes from not realizing you already are what you are looking for.” – Jon Kabat-Zinn
CMCS – Center for Mindfulness and Contemplative Studies

 

LINKS

Spirituality improves recovery from addictions

http://contemplative-studies.org/wp/index.php/2015/07/17/spirituality-improves-recovery-from-addiction/

Spirituality improves recovery from alcoholism

http://contemplative-studies.org/wp/index.php/2015/07/17/spirituality-and-alcoholism-treatment/

 

 

Kick the Drug Habit with Mindfulness

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Substance abuse is a major health and social problem. There are estimated 22.2 million people in the U.S. with substance dependence. It is estimated that worldwide there are nearly ¼ million deaths yearly as a result of illicit drug use which includes unintentional overdoses, suicides, HIV and AIDS, and trauma. In the U.S. about 17 million people abuse alcohol. Drunk driving fatalities accounted for over 10,000 death annually and including all causes alcohol abuse accounts for around 90,000 deaths each year, making it the third leading preventable cause of death in the United States.

Obviously there is a need to find effective methods to prevent and treat substance abuse. There are a number of programs that are successful at stopping the drug abuse, including the classic 12-step program emblematic of Alcoholics Anonymous. Unfortunately the majority of drug and/or alcohol abusers relapse and return to substance abuse. Hence, it is important to find an effective method to prevent these relapses.

In today’s Research News article “Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders: A Randomized Clinical Trial”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1078832758807316/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489711/

Bowen and colleagues examine the ability of a 12-step program, a Relapse Prevention (RP) program, and Mindfulness-Based Relapse Prevention (MBRP) in preventing relapse over a one-year period.

The Relapse Prevention (RP) program attempts to prevent relapse by helping the abuser to identify situations that tend to precipitate relapse and teach cognitive (thinking) and behavioral skills to navigate through these situations. Mindfulness-Based Relapse Prevention (MBRP) employs some components of relapse prevention and adds mindfulness based components to increase awareness and behavioral flexibility in daily life.

They found at three month follow-up that all three programs were effective in preventing relapse. But at 6 months both the RP and MBRP programs were superior to the 12-step program in preventing relapse. The participants in these programs had significantly higher abstinence from drug use and refraining from heavy drinking. The superiority of the Mindfulness-Based Relapse Prevention (MBRP) program was evidenced at the one-year follow-up, reporting 31% fewer drug use days and a significantly higher probability of refraining from heavy drinking. So, all programs were effective over the short term, but over the long-term the mindfulness based program worked the best.

How can mindfulness help an addict to refrain from indulging over the long-term? Mindfulness training stresses present moment awareness of both internal and external stimuli. It puts the individual in better touch with their own feeling and thoughts in real time. The cognitive therapy components of the program help the individual properly interpret what their feeling and to change the way they think about themselves and others. This improves the addict’s ability to recognize and tolerate the discomfort associated with craving, interpret it correctly, not see it as a personal failure, and effectively employ an alternative technique to deal with craving.

In addition mindfulness is known to improve emotion regulation. The individual becomes better at recognizing and responding effectively to their own emotions. Thus the addict can better recognize emotions, particularly negative  ones, and feel them thoroughly but respond to not with drugs or alcohol, but with responses more appropriate for the current situation.

Regardless of the mechanism the fact that mindfulness training can extend the effectiveness of relapse prevention is very significant. The longer the addict remains drug or alcohol free, the greater the likelihood of developing more adaptive behaviors which can, in turn, spawn the kind of success experiences that can help to maintain the drug free existence.

So, practice mindfulness and kick the habit.

CMCS – Center for Mindfulness and Contemplative Studies

Spirituality Improves Recovery from Addiction

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In a previous post we described the relationship between spirituality and recovery from alcoholism. https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1032110166812909/?type=1&theater

This is great, but, what about other addictions? Is spirituality helpful with these also?

Substance abuse and addiction is a terrible problem. It isn’t just illicit drugs but includes many prescriptions drugs especially opioid pain relievers. It is estimated that there are approximately 17,000 deaths from illicit drug overdoses. Prescription drugs, however, exceed this total with overdoses of prescription pain killers producing over 22,000 deaths per year and over 500,000 visits per year to the emergency room.

These statistics, although startling are only the tip of the iceberg. Drug use is associated with suicide, homicide, motor-vehicle injury, HIV infection, pneumonia, violence, mental illness, and hepatitis. It can renders the individual ineffective at work, it tears apart families, it makes the individual dangerous both driving and not, It also degrades the person’s life expectancy, which is about 15-20 years from the moment of addiction.

An effective treatment for addiction has been elusive. Most programs and therapies to treat addictions have poor success rates. Recent research is indicating that mindfulness and also spirituality can be quite helpful for kicking the habit. In today’s Research News article, “NIDA-Drug Addiction Treatment Outcome Study (DATOS) Relapse as a Function of Spirituality/Religiosity”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1042790469078212/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455957/

it was found that high levels of spirituality/religiosity are associated with much lower relapse rates for drug additions. This was the case for cocaine, heroin, alcohol, and marijuana relapse. Unfortunately, prescription drugs were not investigated.

 Why is spirituality/religiosity associated with better outcomes? In today’s study it was found that the strongest association between remission and spirituality involved attending religious services weekly. Hence, it would appear that it is important to participate in religious/spiritual groups. These groups tend to be populated with non-addicts and abusers. So, engagement with these groups provides a social network of people likely to provide support rather than temptation. It is very difficult to prevent relapse when those around you are using drugs themselves and especially when they encourage you to join them. So religious/spiritual groups should help to make it easier to abstain as a substitute for a drug culture.

It has also the case that spirituality/religiosity is associated with negative beliefs about drug abuse. Buddhism teaches that intoxication is an impediment to spiritual development. Other religions completely prohibit drugs while many decry the behaviors that occur under their influence.  This provides what psychologists call cognitive dissonance; an uncomfortable feeling when there is an incompatibility between drug abuse and spirituality/religiosity. The recognition that drug use is not an OK thing to do might provide the extra motivation to help withstand the cravings.

In addition, spirituality/religiosity provides a source of comfort as the individual faces the challenges of refraining from drugs. The challenges provided in everyday life can be a source of motivation to use drugs. An addict often uses drugs to escape from the pressures, stresses, and emotional upheavals that occur during ordinary life. Spirituality/religiosity may provide another way to cope with the individual’s problems. The individual can take solace in the religion instead of drugs when upheavals occur.

It is not known whether the same pattern of results would occur for prescription drug addicts. But, it would seem that the same logic would apply. Hopefully further research will test whether spirituality/religiosity is predictive of improved outcomes with prescription drug addiction.

Regardless the association is clear that spirituality/religiosity is associated with more positive outcomes in relapse prevention with drugs of abuse.

CMCS

Spirituality and Alcoholism Treatment

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Alcoholism is a terrible disease. It renders the individual ineffective at work. It tears apart families, with one in every four families having alcohol related problems. It makes the individual dangerous both driving and not, with over 33 thousand deaths attributed to drunk driving in the US per year. It is associated with a quarter of all homicides worldwide. It also degrades the person’s health, reducing life expectancy by about 10-12 years.

An effective treatment for this addiction has been elusive. Alcoholics Anonymous has been as effective as any other treatment devised. Why is it somewhat effective, when many other programs fail? Why is it effective for some, but not all? One reason could be the emphasis on spirituality present in AA.

In today’s Research News article, “Spiritual Awakening Predicts Improved Drinking Outcomes in a Polish Treatment Sample”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1032107776813148/?type=1&theater

it was found that undergoing spiritual awakening while in AA was associated with much better outcomes, including increased abstinence or a higher likelihood of absence of heavy drinking.

Why is spiritual awakening associated with better outcomes? One possible reason is that spirituality provides a source of comfort as the individual faces the challenges of stopping drinking. The challenges provided in everyday life can be a source of motivation to drink. An alcoholic uses alcohol as an escape from the pressures, stresses, and emotional upheavals that occur during ordinary life. But the alcoholism tends to produce its own set of stresses that create a vicious cycle where the escape creates the problems to be escaped. Spirituality may provide another way to cope with the individual’s problems. The individual can take solace in the devine instead of alcohol when upheavals occur. This can help to break the vicious cycle, making it possible to deal with the alcoholism.

Spirituality can provide the recognition that they need help, that they can’t go it alone. It helps the individual recognize that they can’t control the drinking without outside assistance. The alcoholic then can allow fellow alcoholics, people close to them, or therapists to provide needed assistance when the urge to drink begins to overwhelm the individual’s will to stop drinking. The recognition that there are greater powers than themselves makes it easier to ask for and accept assistance.

It has also the case that spirituality is associated with negative beliefs about alcohol. Buddhism teaches that intoxication is an impediment to spiritual development. Other religions completely prohibit alcohol while many decry the behaviors that occur during alcoholic stupor.  This provides a cognitive incompatibility between drinking and spirituality. The recognition that drinking is not an OK thing to do might provide the extra motivation to help withstand the cravings.

In addition, spiritual groups tend to be populated with non-alcoholics. So, increased spirituality also tends to shift the individual’s social network away from drinking buddies to people less inclined to provide temptation. It is very difficult to stop drinking when those around you are not only drinking themselves but encouraging you to drink. So shifting social groups to people who either abstain or demonstrate controlled drinking can help tremendously.

Regardless of the explanation the association is clear. Spiritual awakening is associated with more positive outcomes for AA participants.

CMCS