Mindfulness, Women, and Treatment for Substance Use Disorder
For women recovering from substance use disorders (SUDs), promising research shows mindfulness-based interventions (MBIs) are a good complementary treatment option. A systematic review of 54 studies from the last decade establishes that MBIs can successfully decrease rates of relapse as well as diminish cravings. Researchers looking into sex-differences in SUDs find that inability to regulate difficult emotions distinguish SUDs in women compared to men. The good news is that engaging in MBIs teaches women effective strategies for regulating emotions that can lead to substance abuse.
Women and SUDs
In the last three decades, specific focus on gender differences in SUDs reveals the following:
- Higher incidence of co-occurring mood disorders in women, most commonly anxiety and depression. Women diagnosed with major depression, which is the most commonly diagnosed disorder, are 6 times more likely to develop a SUD than men.
- Higher reports of intimate partner violence, with a greater likelihood to develop into posttraumatic stress disorder (PTSD). 30-59% of women diagnosed with PTSD are also diagnosed with a SUD.
- Women with eating disorders are 4 times more likely to develop an SUD and vice versa.
- Women are more likely to telescope, namely, progress more rapidly from beginning use to abuse. Addiction researchers explain this phenomenon both in terms of biological differences (body fat percentages, hormonal changes related to menstruation, distinct processes in metabolizing substances) as well as patterns of use (e.g., coping with stress).
- Vulnerability to problems related to health, interpersonal/family dynamics, and psychiatric consequences (onset of PTSD) are more significant in women than men.
These gender-specific features point to a need to develop effective treatments for women that simultaneously address co-occurring psychiatric disorders (anxiety, depression, eating disorders, and PTSD) to avoid relapse and diminish cravings when confronting stressful situations.
Because addressing SUDs in women typically requires addressing past traumas, anxiety, depression, PTSD symptoms, and greater sensitivity to stress, researchers have begun to study the effectiveness of MBIs insofar as they enhance emotional regulation, that is, strategies individuals use to monitor, modify, and manage emotional responses to situations related to important goals.
Researchers find that ability to skillfully regulate one’s emotions, such as learning to accept rather than avoid negative emotions, can help diminish negative emotions and enhance positive ones. Women who have not yet developed useful strategies for regulating their negative emotions are more likely to develop maladaptive coping strategies, such as SUDs and/or eating disorders.
MBIs as a Promising Treatment for Women
A crucial aspect of MBIs is learning to accept difficult emotions, hence the suitability of these specific forms of treatment for women contending with SUDs and co-occurring psychiatric disorders. Nearly four decades ago, Dr. Jon Kabat-Zinn introduced mindfulness-based stress reduction (MBSR), designed to treat chronic pain. Therapists later developed mindfulness-based cognitive therapy (MBCT) to prevent the relapse of Major Depression Disorder (MDD). Given the demonstrated efficacy of both MBSR and MBCT, the development of newer MBIs have flourished, each dedicated to a specific psychiatric and/or medical focus. Among these new MBI treatments are those that address SUDs, such as mindfulness-based relapse prevention (MBRP) and mind-body bridging.
A common technique is a type of controlled breathing that stimulates our parasympathetic nervous system – the system responsible for lowering heart rate and relaxing our muscles. In learning how to put the body into a relaxed state, one becomes better able to bring attention to the present moment and thus away from ruminating over past or future events that trigger anxiety or distress. MBIs also help individuals cultivate a non-judgmental attitude to the present moment. They learn to cultivate acceptance of their current situation and alter reactions to emotions elicited by it. In other words, MBIs teach individuals to reintegrate their bodies and minds. They learn that by using techniques that act directly on the nervous system, they can break the habitual thought patterns associated with addiction.
Studies focused on the efficacy of MBIs for treating women with SUDs suggest they are an effective complement to traditional therapies, a.k.a Treatment as Usual (TAU). MBIs differ from TAUs in their emphasis on techniques that teach patients to examine their thoughts related to cravings. In MBRP, for example, women learn to recognize the presence of cravings in a non-judgmental way to help them disconnect the feelings of cravings from acting on those feelings.
While many studies are still underway to further examine the efficacy and mechanisms of MBIs in women patients, the preliminary findings are hopeful. For example, in a study of a 10 week mind-body bridging session aimed at women in a treatment facility, researchers found decreased craving, decreased the negative impact of past trauma, and improved sleep compared to women in TAU. Another study found that MBRP may be more efficacious for lower-income, racial, and ethnic minority women compared to TAU. Researchers observed significantly reduced craving and increased days without drug use 15 weeks after discharge from a treatment facility.
Treatment, Aftercare, and Beyond
One important take-away from this research is that integrating MBIs into aftercare programs and long-term sobriety plans is a smart choice – especially for women – because they help in precisely the areas evidence shows women need more support than men. And adding in mindfulness practices does not require women to change or radically alter their current treatment plans, since they require no special equipment, clothing, or location: once an individual learns a mindfulness technique, it’s theirs to apply anytime, anywhere, in any situation.