The Evidence for Mindfulness in Addiction Treatment

Not long ago, the use of mindfulness activities in the treatment of alcohol and substance use disorders was considered a novelty. While many mental health professionals had positive anecdotal evidence for the use of techniques like meditation, yoga, and guided relaxation in treatment – and many people in recovery found the approaches helpful – mindfulness did not have a sufficient base of evidence and data to warrant its inclusion in licensed and accredited treatment programs.

No matter how many people attested to their effectiveness, the research was not there. Therefore, well-respected treatment centers offered mindfulness activities as complementary supports, rather than primary treatment modalities.

In 2012, the National Center for Complementary and Integrative Health (NCCIH) took the following stance on the use of mindfulness in addiction treatment:

“Available data suggest that mindfulness-based interventions may help significantly reduce the consumption of several substances including alcohol, cigarettes, opiates, and others compared to control groups; however, many studies have had small sample sizes, methodological problems, and a lack of consistently replicated findings.”

Since then, studies with larger sample sizes and sound methodologies have replicated the promising findings presented by earlier research. Here’s a brief summary of three mindfulness approaches in current use, and the research that supports them.

Mindfulness in Addiction Treatment: What the Research Says

  1. Mindfulness-based Relapse Prevention (MBRP). In a randomized clinical trial that compared the effectiveness of MBRP with Cognitive Behavioral Therapy Relapse Prevention (CBTRP) and Treatment As Usual (TAU), results showed that MBRP participants showed significantly fewer days of drug use and heavy drinking at 12-month follow-up. In the words of the researchers: 

Targeted mindfulness practices may support long-term outcomes by strengthening the ability to monitor and skillfully cope with the discomfort associated with craving or negative effect, thus supporting long-term outcomes.”

  1. Mindfulness-Based Interventions (MBIs). In a review of the literature on the effectiveness of mindfulness in recovery, researchers analyzed the results of 24 studies published between 2011 and 2014. Here’s what they concluded:

“Current evidence suggests that MBIs can reduce the consumption of several substances including alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates to a significantly greater extent than waitlist controls, non-specific educational support groups, and some specific control groups.”

  1. Mindfulness Oriented Recovery Enhancement (MORE). The principal investigator behind MORE, Eric Garland, Ph.D., has published over 20 studies on the role of mindfulness in recovery and has received over 50 million dollars in grants to support his research. To date, the MORE technique represents the most comprehensive and organized integration of mindfulness into the treatment of substance use disorders in the U.S. Research on MORE has examined its effectiveness in smoking cessation, alcohol use disorders, chronic pain/opioid use disorders, and cancer treatment. In a study that compared MORE to CBT and TAU, Garland concluded:

Study findings indicated that from pre-to post-treatment, MORE was associated with modest yet significantly greater improvements in substance craving, post-traumatic stress, and negative affect than CBT, and greater improvements in post-traumatic stress and positive affect than TAU.”

In 2018, in response to this increase in evidence and the results of the 2017 National Health Interview Survey (NHIS), the NCCIH amended their stance:

“Mind and body approaches, such as mindfulness-based interventions, have shown some success when used along with the treatment of substance abuse and addiction…Mind and body approaches can be part of a comprehensive addiction treatment plan that includes behavioral modifications, and may include pharmaceuticals to decrease cravings, group therapy, or counseling.”

The evidence shows that mindfulness can work as an effective component of an integrated treatment plan, and some studies indicate that mindfulness may equally as effective as some traditional therapeutic supports such as Cognitive Behavioral Therapy (CBT).

Mindfulness is effective – the new data makes that clear.

But how does mindfulness work?

The Neurological Basis for Mindfulness

Addiction changes the brain.

Research shows the areas of the brain responsible for attention, emotion, and behavioral regulation become dysfunctional in individuals diagnosed with a substance use disorder. Both the form and function of these critical brain regions are compromised. An individual with a substance use disorder reacts to environmental cues related to substance use, attaches emotions to those cues, and makes behavioral judgments related to those cues and emotions in ways that are different than people who do not have a substance use disorder. They develop patterns of reacting, processing, and behaving that reinforce drug use over virtually all other methods of coping with stress and managing emotions. Over time, these patterns become automatic and unconscious. For the person locked in them, they become difficult to recognize. In some cases, they’re nearly impossible to break.

That’s where mindfulness comes in.

Mindfulness practices, in general, focus on three primary things: awareness, disengagement, and perception. First, mindfulness trains an individual to develop a heightened awareness of everything that’s happening in their present moment: thoughts, emotions, physical sensations – everything. That’s awareness. Next, mindfulness trains an individual to detach from the thoughts, emotions, and sensations they experience. That’s disengagement. Finally, mindfulness trains an individual to experience the world as it is, rather than colored by thoughts, feelings, and physical sensations that may or may not be habitual. That’s perception. When the three elements of mindfulness combine, an individual gains the ability to control their reactions, manage their emotions, and make decisions based on reason rather than impulse.

How Mindfulness Helps

Mindfulness practices, in the context of substance use disorder treatment, transpose those three skills directly to recovery. First, they train individuals to recognize when they’re reacting to drug-related environmental cues in habitual patterns. Next, they train them to disengage from the emotional states attached to those patterns – positive or negative – that drive them to seek drugs. Finally, they train them to make rational decisions about behavioral choices based on what they want to accomplish in recovery. For people struggling with substance use disorders, what they want to accomplish most often is sobriety.

Mindfulness – in conjunction with traditional treatment – gives them another tool to accomplish that goal. Research shows the three elements of mindfulness – awareness, disengagement, and perception – directly involve the areas of the brain that control attention, emotion, and behavioral regulation. These are the parts of the brain that become dysfunctional in the addicted brain. It follows, therefore, that mindfulness can help people in recovery: mindfulness works to restore balance to that which has become imbalanced.

The Future of Mindfulness in Addiction Treatment

Thanks to the tireless work of clinicians and researchers – and the solid evidentiary base they’ve developed over the past decade – more people living with alcohol and substance use disorders participate in mindfulness activities during treatment than ever before.

The wait has been both warranted and worthwhile. It takes years to develop best practices and to determine an appropriate standard of care for any disease or illness, and alcohol and substance use disorders are no different. A treatment modality that clears these significant hurdles – meaning the evidence and data in support of its use have been dissected by the best and brightest minds in the world – and receives the endorsement of the mental health community can be trusted by any patient seeking help.

That does not mean the treatment will work for everyone. Mindfulness does not work for every person who tries it. What it means is that the modality – mindfulness, in this case – will increase the likelihood of overall treatment success. The latest data says that mindfulness, when used in conjunction with behavioral modification and pharmaceutical support (if necessary), can help individuals living with an alcohol or substance use disorder manage cravings, process emotions, and handle the stress and anxiety that contribute to relapse.

Fully Integrated Treatment Model

The future of mindfulness in addiction treatment lies in integrating mindfulness practices such as meditation, yoga, and relaxation into traditional approaches to treatment such as Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Group Therapy, and Family Therapy. Some of this work has already happened: DBT itself includes elements of mindfulness, and therapists around the country regularly use basic mindfulness exercises as part of counseling sessions. The next step is to formalize these techniques so they’re repeatable and distributable: it will take time for mindfulness practices to reach everyone who can benefit from them, but that day is coming soon. When it does, people living with addiction will have one more tool at their disposal to live a life free from alcohol and drugs.