Drugs

Decrease Suicidality with Mindfulness

psyjdc 1 Comment

 

“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

 

The Made-up “Real”

psyjdc Leave a comment

 

“Reality is merely an illusion, albeit a very persistent one.” ~ Albert Einstein

 

“The light of memory, or rather the light that memory lends to things, is the palest light of all. I am not quite sure whether I am dreaming or remembering, whether I have lived my life or dreamed it. Just as dreams do, memory makes me profoundly aware of the unreality, the evanescence of the world, a fleeting image in the moving water.” – Eugene Ionesco
Dreams are purported to be not real. They are thought to be constructions of our nervous system that occur during an altered state of consciousness termed sleep. But, they appear and feel very real. While the dream is in progress we experience it as completely real. Things happen mostly in real time. We visualize people, places, and things in great detail and hear sounds and voices. We even feel emotions. What’s different about a dream in comparison to what we call reality?

 

In actuality, much of what we experience during so called “reality” is not real, but a construction produced by our nervous systems. We experience color in our visual world, but in fact there is nothing in the physical world that has color. Our eyes take in different wavelengths of light, electromagnetic radiation with different distances between peaks. That is all. There is nothing colored here. But our eyes have three different receptors that respond to different ranges of wavelengths. Our brain then interprets the activity of these receptors as different colors. In fact it is a complete illusion. What we think we see and experience is in fact not there.

 

Our everyday thoughts, day dreams, and fantasies we recognize as not a reflection of reality. But nevertheless they constitute a constructed experience. Our brain is completely capable of constructing experiences that are similar to those that we label as “reality.” Could it be that this labelled “reality” is in fact just another constructed experience?

 

The great physiologist and philosopher, Johannes Müller, pointed out that we are not directly aware of the natural world, but rather what we are aware of is the state of our nervous system. In other words, our awareness is simply of what is going on in our nervous system. It is constructed by brain processes. Is this any more real than the dream?

 

It is clear that we can make up experiences and perceive them vividly. The great question then becomes how much is “real” and how much and which ones are mental constructs. This question has had a range of answers from the materialist who suggests that there is objective reality to the Zen master who suggests that there is no reality other than pure being.

 

If all that we are aware of is the state of our nervous system is that, at least, an objective reality? Dreams are produced by internal brain activity that lacks an external referent. These are apparently very “real’ to the dreamer, but most would agree that they are not “real.” Drugs can produce very “real” experiences but most agree that they are not “real.” But are these experiences not just a construct of altered brain activity produced by sleep systems or altered chemistry, respectively? If our sleep systems or altered brain chemistry can produce an untrue “reality” what does this imply about the “reality” produced by our usual brain chemistry? Does it not imply that the nervous system is at best an unstable platform for the expression of “reality” or that our awareness itself does not present to us the “real?”

 

The only thing that we conclusively know to be real is our personal awareness of the immediate moment. Everything else is just a memory or a fantasy. That experienced moment is ever changing, mutating, arising and falling away. It cannot be held onto. So, the only thing that we know to be real is ephemeral, a puff of smoke blown in the wind. But, is this phantasm real or is it created in our awareness? Is it a reflection of an objective reality or a compelling hallucination? Does it have substance beyond experience?

 

We have arrived at the point of concluding that the only “reality” that we can know to be real is an ephemeral experience of a present moment and that even this is perhaps only a continuing experience of the ever changing state of our nervous system that we know is not an accurate depiction of any external physical state of environmental energies. To be sure, this is a very tenuous grasp at something “real.”

 

Doesn’t it make more sense to admit that awareness is the only “reality?” What enters awareness is simply what we experience regardless of its origin. Does it really matter if it is reflective of an external “reality” or simply all made up? It is simply our “reality” and it may not need to be anything more. Seeing it this way, the question becomes irrelevant.

 

 “I’m more convinced each day of the complete unreality of the material world and the supreme vitality of the invisible world of spirit.”- Paul Russo

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Psychedelic Drugs and Spirituality

psyjdc 18 Comments

“In history, psychedelic plants were used by priests and shamans with a desire to discover the interior.” – Alejandro Jodorowsky

 

Psychedelic substances have been used almost since the beginning of recorded history to alter consciousness and produce spiritually meaningful experiences. Psychedelics produce effects that are similar to those that are reported in spiritual awakenings. They report a loss of the personal self. They experience what they used to refer to as the self as just a part of an integrated whole. They report feeling interconnected with everything else in a sense of oneness with all things. They experience a feeling of timelessness where time seems to stop and everything is taking place in a single present moment. They experience ineffability, being unable to express in words what they are experiencing and as a result sometimes producing paradoxical statements. And they experience a positive mood, with renewed energy and enthusiasm.

 

It is easy to see why people find these experiences so pleasant and eye opening. They often report that the experiences changed them forever. Even though the effects of psychedelic substances have been experienced and reported on for centuries, only very recently have these effects come under rigorous scientific scrutiny. One deterrent to the research is the legal prohibitions for the possession and use of these substances. One way around this problem is to take advantage of natural groupings of individuals who regularly use psychedelic substances.

 

In today’s Research News article “Long-term use of psychedelic drugs is associated with differences in brain structure and personality in humans.”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1110584015632190/?type=3&theater

Bouso and colleagues took advantage of the fact that a substantial number of Brazilian religious groups ingest the natural psychedelic substance ayahuasca on a regular basis for ritual purposes. These groups, like many users of psychedelic substances, employ them to develop spirituality and self-transcendence. The investigators used neuroimaging to investigate the differences in brain structure between long-term (at least 50 uses) users of ayahuasca and matched control participants.

 

Bouso and colleagues found that the ayahuasca users had a thinning of a number of midline structures of the brain especially the posterior cingulate cortex.in addition, the amount of this thinning was positively related to the length of time that the individual had been using ayahuasca. The thinning suggests that there is a eduction in the use and importance of the structures. Importantly, the ayahuasca users did not differ from controls in the incidence of psychological problems or neuropsychological function. This suggests that the use of ayahuasca does not produce psychological or cognitive harm.

 

One of the most interesting findings was a significant increase in self-transcendence in the ayahuasca users. This included and increase in self-forgetfulness, which represents a decrease in self-conscious experience, transpersonal identification, which is seeing oneself as not isolated but merely a part of an integrated whole, and spiritual acceptance, which is an increase in viewing life as beyond the physical. Hence this self-transcendence is an indicator of increased spirituality and loss of the personal ego.

 

It is interesting that the midline structures including posterior cingulate cortex that are thinned with ayahuasca use are considered key elements of what’s termed the default mode network. This is an interconnected set of neural structures that becomes most active when the individual is lost in thought, day dreaming, and involved in self-referential thinking. In other words this system becomes active when the individual has lost touch with the present moment and his/her thoughts are referenced to a separate self.

 

So, the anatomical findings correlate nicely with the psychological findings for the ayahuasca users and suggest that the use of this psychedelic appears to be psychologically relatively harmless and appear to accentuate experiences that are virtually identical to those occurring in spiritual awakenings. This may suggest that spiritual awakening and psychedelic substance effects work through the same neural mechanisms.

 

“Through all of history mankind has ingested psychedelic substances. Those substances exist to put you in touch with spirits beyond yourself, with the creator, with the creative impulse of the planet.” – Ray Manzarek
CMCS – Center for Mindfulness and Contemplative Studies

Lower Substance Use with Mindfulness  

psyjdc 1 Comment

“Research has demonstrated that the age when adolescents first start using alcohol, tobacco, and other illicit drugs is a predictor of later alcohol and drug problems. More than 40% of youth who start drinking at age 14 or younger develop alcohol dependence, compared with 10% of youth who begin drinking at age 20 or older.” – Erik Laursen and Paul Brasler

 

Adolescence is often a time of rebellion and experimentation and drug use is often the result. In a recent survey it was found that 9% of 8th graders, 23.5% of 10th graders, and 37.4% of 12th graders used alcohol in the past month and 19.4% of seniors engaged in binge drinking. These findings are particularly troubling as nearly one in four adolescents has ridden in a car with a driver who had been drinking and car accidents are the leading cause of death for adolescents. Fortunately, alcohol use by adolescents has been decreasing over the last several years.

 

Unlike the decline in alcohol use, marijuana use in adolescents has remained steady. Marijuana use in the preceding month was reported by 6.5% of 8th graders, 16.6% of 10th graders, and 21.2% of 12th graders with around 6% percent of 12th graders reporting daily use of marijuana.  Marijuana was reported as easy to obtain by 81% of 12th graders.

 

These statistics are troubling and methods to reduce the use of alcohol and marijuana among adolescents are needed. Mindfulness has been shown to help with recovery from alcohol abuse (see http://contemplative-studies.org/wp/index.php/2015/08/28/kick-the-drug-habit-with-mindfulness/). This raises the question as to whether mindfulness might be useful in combating adolescent alcohol and marijuana use.

 

In today’s Research News article “When you see it, let it be: Urgency, mindfulness and adolescent substance use”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1108628525827739/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567253/

Robinson and colleagues studied male and female youths in the 9th through 12th grades and measured mindfulness and alcohol, substance use patterns, impulsivity, and urgency, the impulsive tendency toward rash action. They found that mindfulness was associated with lower urgency, impulsivity, and alcohol and marijuana use. They also found that urgency and impulsivity were associated with greater alcohol and marijuana use.

 

These results suggest that mindfulness may be useful for restraining alcohol and marijuana use in adolescents. The findings, however, are correlational and thus do not allow the conclusion that mindfulness is the cause of lower use. It could be that lack of drug use makes them more mindful or some third factor, such as attention problems is responsible for both. A study training students in mindfulness and looking at subsequent alcohol and marijuana use is needed. But, these results are an encouraging first step.

 

The fact that mindfulness was associated with lower urgency and impulsivity is very interesting as these traits have been previously shown to be associated with the initiation of alcohol and marijuana use in adolescents. It also may indicate that mindfulness lowers alcohol and marijuana use by lowering urgency and impulsivity which in turn results in a lowering of use. It is known that mindfulness improves emotion regulation in general (see http://contemplative-studies.org/wp/index.php/2015/09/10/take-command-and-control-of-your-emotions/ and http://contemplative-studies.org/wp/index.php/2015/08/20/regulate-emotions-with-mindfulness/) and the finding for urgency and impulsivity may be another instance. Further research is needed to clarify these ideas.

 

So, lower substance use with mindfulness.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Kick the Drug Habit with Mindfulness

psyjdc 2 Comments

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

psyjdc 1 Comment

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