Thursday, October 29, 2020

Mind-body medicine in addiction recovery

As someone who struggled with a miserable opiate addiction for 10 years, and who has treated hundreds of people for various addictions, I am increasingly impressed with the ways in which mind-body medicine can be a critical component of recovery from addiction. Mind-body medicine is the use of behavioral and lifestyle interventions, such as meditation, relaxation, yoga, acupuncture, and mindfulness, to holistically address medical problems. Mind-body treatments can be integrated with traditional medical treatments, or used as standalone treatments for certain conditions. Mind-body medicine is now being studied by the National Institutes of Health and effectively used in the treatment of addiction, and it will likely play a role in addiction recovery programs in the future.

Mind-body principles are not new to the recovery movement

Mind-body principles have been around since the start of the recovery movement in 1937, and they are a big part of Alcoholics Anonymous. The 12 Steps of AA feature concepts such as surrender, meditation, gratitude, and letting go — all critical components of mind-body medicine. Most 12-step meetings end with the Serenity Prayer: “God, grand me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Mutual help groups play a role in recovery for many people, and the principles of mindfulness that are part of these programs — in addition to the social support — shouldn’t be overlooked.

My experience with mind-body therapies for addiction

When I was sent to rehab for 90 days by the medical board due to my addiction, we participated in a lot of activities that seemed to be meant to approximate mind-body medicine, but they were haphazard and not particularly scientific, and I don’t believe they had the intended effect or were at all therapeutic. For example, we did shrubbery mazes (I’d get lost); we sat meditatively in silence (everyone around me chain-smoked, triggering my asthma); we had repeated lectures about “letting go and letting God” (I still have no idea what this means); we’d spend 30 minutes staring at a red square projected onto a screen (this gave me a migraine); and we went to a local acupuncture place where they hooked up extra electric current to the needles to give us extra “chi” (I felt like I was being cooked for dinner). Given that rehab is a $50 billion industry, I felt this was a lost opportunity to utilize mind-body medicine in a way that wasn’t superficial or trivial.

Formal mind-body therapies for addiction are being rigorously studied

Fortunately, there are now several scientifically-based mind-body medicine options for people in recovery. Mindfulness-Based Relapse Prevention (MBRP) is a technique that uses meditation as well as cognitive approaches to prevent relapse. It aims to cultivate awareness of cues and triggers so that one doesn’t instinctively turn to using drugs. It also helps people get comfortable sitting with unpleasant emotions and thoughts —their distress tolerance, a person’s ability to tolerate emotional discomfort — without automatically escaping by taking a drug. Improving distress tolerance is a common theme to many, if not all, approaches to addiction recovery, as a large part of the appeal of drug use is replacing a bad emotion with a good emotion — for example, by using a drug.

Mindfulness-Oriented Recovery Enhancement (MORE) is another technique to address addiction in recovery. MORE attempts to use both mindfulness and positive psychology to address the underlying distress that caused the addiction in the first place. There are three main pillars of MORE: it has been proven to help with distress tolerance; cue reactivity (the way people with addiction respond to cues, such as seeing a bottle of prescription drugs, which often trigger cravings); and attentional bias (the way an addicted brain will pay extra, selective attention to certain things, such as a pack of cigarettes when one is quitting smoking).

Mindfulness-Based Addiction Therapy (MBAT) is a technique that uses mindfulness to teach clients how to notice current emotions and sensations, and how to detach themselves from the urge to use drugs. This is called “urge surfing,” and we practiced it extensively in rehab. The aim is to break the automatic link between feeling uncomfortable, craving drugs, and, without thought or reflection, taking a drug to alleviate that discomfort.

Is there good evidence for mind-body medicine approaches to recovery?

While there is promising research that mind-body treatments for addiction are effective, some of the research is contradictory. According to a meta-analysis in the Journal of Substance Abuse Treatment, mindfulness is a positive intervention for substance use disorders, it has a significant but small effect on reducing substance misuse, a substantial effect on reducing cravings, and, importantly, it is a treatment that has a large effect on reducing levels of stress.

However, not all studies of mind-body medicine for addiction have shown overwhelmingly positive results. Some studies showed that the treatment gains diminish over time. Some randomized controlled trials did not show that mind-body medicine was better than cognitive behavioral therapy in decreasing alcohol and cocaine use, or in abstaining from cigarette use.

The National Center for Complementary and Integrative Health did a thorough review of much of the current literature surrounding mind-body medicine as it applies to addiction treatment, and summarized the impact of certain mind-body treatments as follows:

  • Acupuncture is generally safe, and may help with withdrawal, cravings, and anxiety, but there is little evidence that it directly impacts actual substance use.
  • There was some evidence that hypnotherapy my improve smoking cessation.
  • Mindfulness-based interventions can reduce the use of substances including alcohol, cocaine, marijuana, cigarettes, opiates, and amphetamines greater than control therapies do, and are also associated with a reduction in cravings and risk of relapse. But the data in several studies are not strong.

At this time, we need more and better evidence, and more definitive conclusions, about how helpful, ultimately, mind-body medicine will be in helping to treat addiction in different treatment settings. But a takeaway message is that mindfulness-based treatments are certainly quite effective as adjunct treatments for addiction, in that they can help people with their anxiety, distress tolerance, and cravings, and quite plausibly will turn out to help people put down the drink or the drug, and to avoid relapsing, once they have managed to get themselves into recovery.

Mind-body interventions to prevent addiction

If mind-body medicine can significantly reduce stress, then one must ask if it can also help us prevent addiction by helping our society deal with the chronic, overwhelming stress that it is facing. Addiction is in large part considered to be a “disease of despair.” Important contributors to addiction are untreated anxiety and depression, unresolved childhood trauma, social isolation, and poor distress tolerance. If all of us can learn, or be trained, to be more mindful, grateful, present, and connected, perhaps the need, and eventually the habit, of fulfilling our most basic needs with the false promise of a chemical that merely wears off — and leaves us worse off — will become less of a problem in our society.

The post Mind-body medicine in addiction recovery appeared first on Harvard Health Blog.

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