How Mindfulness Can Prevent RelapseAnna Ciulla
Mindfulness, as defined by the Greater Good Science Center at the University of California, Berkeley, is a “moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment,” which various mindfulness exercises can help to develop. These originally Buddhist-inspired, now largely secularized techniques for achieving greater self-acceptance and self-awareness have gained a mainstream following in Western medicine through experts like Jon Kabat-Zinn. The University of Massachusetts’ School of Medicine professor developed “Mindfulness-Based Stress Reduction” (MBSR) in the late 1970s as a way to improve patients’ quality of life, and today MBSR is a widely recognized adjunct treatment for a range of physical and mental disorders, including drug and alcohol addiction.
Recent research into mindfulness meditation and substance abuse has found that mindfulness can prevent relapse by reducing cravings and other painful thoughts and emotions that are common triggers for drugs and alcohol. This article reviews some of the outstanding scientific literature that suggests how mindfulness can be an effective form of relapse prevention, as embodied in interventions like MBRP, and as a part of a comprehensive approach to treating substance use disorders (SUDs).
Mindfulness for Drug and Alcohol Cravings
The prevalence of relapse in early recovery has sparked research into mindfulness’ potential for lowering these risks of relapse, and over a decade of investigation has turned up some promising findings. One of these is the discovery that mindfulness exercises reduce the pain and discomfort of drug and alcohol cravings, which can be a significant predictor of relapse. A study in 2015, the results of which appeared in the journal Addictive Behaviors, reported that a home mindfulness practice led to better recovery outcomes—in particular, significantly less cravings and drug and alcohol use during post-treatment follow-up at the two-month and four-month marks. Moreover, the longer the time spent in meditation at home, the better these recovery outcomes became. Also significant was the fact that these beneficial results faded when home meditation was discontinued.
Mindfulness for Preventing Relapse
Reduced drug and alcohol cravings are one reason that mindfulness for preventing relapse is the object of emerging research. Another study, published by the American Medical Association, compared a mindfulness-based relapse prevention plan to two others, one that included a standard relapse prevention component and another with no such component. The mindfulness-based plan yielded the best long-term recovery outcomes, with “significantly lower risk of relapse to drug use and heavy drinking” evidenced among the study participants.
Mindfulness-Based Relapse Prevention (MBRP)
Mindfulness-based therapies for various mental and physical disorders also now include a particular approach to addiction relapse known as Mindfulness-Based Relapse Prevention (MBRP), similar elements of which inform drug and alcohol treatments at Beach House Center for Recovery. In addition to its evidenced effectiveness in the studies mentioned above, MBRP has proven beneficial for reducing relapse in research elsewhere.
MBRP combines evidence-based mindfulness techniques with cognitive-behavioral therapies and group-based psychosocial interventions, with the goal of increasing awareness of addiction triggers and their physical, emotional and cognitive effects, so that over time clients can manage these relapse cues more effectively. At its heart, MBRP takes an accepting and compassionate approach to addictive thoughts and behaviors. Those trained in MBRP learn to recognize early warning signs for relapse, including internal (thoughts and emotions) and external (environmental) cues for drug or alcohol use, by observing what is happening in any given moment from the perspective of a detached but closely attentive onlooker.
In 2014 findings published in the journal Psychology of Addictive Behaviors, MBRP increased clients’ tolerance for uncomfortable states and challenging situations typically associated with greater vulnerability to relapse. In such circumstances, the application of MBRP meant no increase in cravings was reported. Instead, clients receiving MBRP reportedly demonstrated significantly lower rates of substance abuse and greater decreases in craving when compared with a control group.
Moreover, using neuroimaging technology, the researchers were able to hypothesize how mindfulness achieved these positive results. They theorized that mindfulness positively affected multiple parts of the brain, by actually correcting neurological imbalances caused by addiction.
In another pilot efficacy trial of MBRP, clients who received the mindfulness-based intervention exhibited greater decreases in cravings and lower rates of substance abuse—and, connected with these outcomes, greater acceptance and awareness of their condition.
Mindfulness for Co-Occurring Disorders
Mindfulness interventions for co-occurring disorders (CODs), or dual diagnoses like depression or anxiety—a common correlation of SUDs—have also shown promise in reducing the risks of drug and alcohol relapse. For example, mindfulness training has reportedly helped clients with a SUD and a coexisting diagnosis of major depression tolerate unpleasant emotional states and “unlearn maladaptive behaviors” like obsessive rumination (both of which can be relapse triggers).
The following positive outcomes of mindfulness for CODs like depression and anxiety are also significant factors in the effective prevention of drug and alcohol relapse:
- A decrease in stress-related, ruminative patterns of thinking that are a known trigger of substance abuse
- Decreased “avoidance” behaviors (which can contribute to relapse as an escape mechanism), such as the suppression of distressing thoughts, the acknowledgement and acceptance of which seem to be more effective at preventing relapse
- An increase in the ability to “let go” of negative thought patterns that can often feed relapse—and, relatedly, a decrease in the very presence of these negative thought patterns
- A reduction in self-reported stress and anxiety levels, the experience and perception of which can also lead to relapse