Mindfulness helps people with substance use disorders

Cravings are funny things. If you’ve ever tried to abstain from chocolate, fizzy drinks, or burgers you’ll know that it’s not a simple matter of not doing it. As I explain here, the brain is designed for an age when sugar and fat were scarce. Check out the guy below, climbing up a 40 metre tree and getting stung by bees just to get some honey. If that’s the length we’ll go to get sugar when it’s scarce, it’s easy to see why people binge when it’s just a few pennies and a short walk away.

That craving multiplied several times is what people addicted to drugs must contend with. Addictive drugs hack into this very system that gives us cravings, and sends it into overdrive while people are taking the drugs. This creates a strong urge to return to this behaviour – just like the junk food, the brain thinks it’s very important.

That’s the point of cravings, in a sense. In a world without junk food and drugs, they are generally useful things, helping you to survive and pass your genes on. But we don’t live in that world; we live in one where the playing field is uneven, where it’s hard to identify a craving as something that should not be acted upon – doing so goes against our nature.

Yet we also possess our coveted higher cognitive functions – the ability to observe and reflect on the way our mind works, and override the brain’s suggested course of action. Thus anything that helps in this process should also help us deal with cravings, be they for chocolate or for drugs.

Mindfulness meditation is one of those things. The process of meditation can involve the observation of thought – watching thoughts as they arise, and noticing how the thought is separate from the observer. If the thought and observer are separate, identification with the content of the thought weakens, and with it, potentially, the control that compulsive thoughts have over the individual.

North Rehabilitation Facility is a low-security jail in Seattle. In 2006, a paper by Sarah Bowen and colleagues reports an interesting test conducted here – mindfulness meditation (a 10 day Vipassana course) versus ‘treatment as usual’ (substance abuse education, among other things). The Vipassana course involves complete silence, no outside contact and intense 10+ hour schedules of meditation training each day.

Swapping bud for Buddha – Mindfulness meditation for substance abuse is being tested in various drug rehab centers. (Credit: zendotstudio)

Substance use was recorded from the participants in both groups, at baseline and at a three-month follow-up. At the three month point, all participants had been released. Comparing Vipassana to treatment as usual, the authors report reduced alcohol, marijuana and crack cocaine use in the meditation group! There were also decreases in various negative psychiatric symptoms, and increases in some positive psychosocial outcomes. These latter results are consistent with previous studies.

While the results here are quite encouraging, but note that we’re relying on self-report, and that group selection was not random. So it’s possible, even if unlikely, that participants more prone to lie would self-select for the meditation program. However, the substance use reports at baseline were not significantly different between groups, so it seems it was the program that produced the changes at follow up.

So the question becomes, what about the program had this effect? I’ve already noted that it’s difficult to separate the effects of the actual meditation with other things that go along with it – in this case, the authors note that perhaps separation, vegetarian meals, silence, relaxation, or lack of tobacco might have played a role. My money’s on the meditation itself, but these results don’t separate that from the confounding factors.

Although these results are consistent with the explanation I gave above, then, it’s hard to say whether the increased detachment of self from thoughts specifically caused the effects. Future studies will have to investigate this — but these results are definitely promising.


Even brief meditation improves cognitive function – Mindfulness vs. The Hobbit

In a previous post, I explained how meditation practice is associated with increased cortical thickness. As interesting as that is, it does leave a couple of questions open:

  • These were experienced meditators (7 years practice on average). What about beginners? How long does it take to make a difference?
  • OK, so the brain changes. Good, great, but what does this equate to? What difference does it make in what the brain can do?

This is where Zeidan et al come in. A group of people with no prior experience in meditation were split into two groups. One would get four sessions of mindfulness training, the other would get four sets of listening to The Hobbit on audiobook.

Buddha vs. Gandalf

What happened? Well, in terms of self-reported mood, both groups showed improvements – reduced negative moods, reduced symptoms of depression, reduced anxiety when comparing before and after measurements. However, there were no differences between groups. So, either mindfulness training and The Hobbit are equally effective in this regard, or some other factor was effecting both groups equally (participants were all students, so that’s not too implausible).

This is similar to another study, which compared mindfulness to relaxation and found no difference between them in terms of their effect on mood. Also echoing that study, Zeidan and colleagues report that the mindfulness group had the upper hand in things other than mood – this time it was performance on the following cognitive tasks:

  • The Digit Modalities Test – A test of visual tracking and working memory
  • Verbal fluency – A word association test asking people to think of as many words beginning with F, A, and S, or, C, F and L within one minute.
  • The n-back test – A test of processing speed, working memory and attention.

So although there were no mood benefits over the control group, meditating for four days, for just 20 minutes per day, can increase cognitive function in these areas!  So get your tush on the cush, as Jon Kabat-Zinn would say.


Meditation is associated with changes in the physical structure of the brain

In this post, I mentioned some interesting studies where neuroscientists put Buddhist monks into brain scanners, trying to find out what effect meditation has on the brain. They found some interesting results in terms of brain activity. If you throw neuroplasticity into the mix too, you’d expect some structural differences too. A study led by Sara Lazar looked into just that.

I’ve mentioned my thoughts on neuroscience and positive psychology previously. My key point is that, since neuroplasticity is a given these days, it’s not all that impressive to demonstrate changes in the brain as a result of consistent practice of a given activity. But that doesn’t mean it’s not an important study to do. The key questions are: what changes, how much, and does this fit in with other results and theory?

Twenty experienced meditators (had been one at least one retreat, practice 4 hours a week on average), were compared to a matched control group (by age, sex, race, and years of education). So note here that we don’t have random assignment, but we’ve got the next best thing if we want to study experienced meditators right now.

What happened?

Cortical thickness was compared between the two groups. Over the whole brain, there was no difference, meaning the changes were limited to a specific area. The areas were related to somatosensory, auditory, and interoceptive processing. If you want the specific brain regions, here they are:

  • A region of the right anterior insula
  • The right middle and superior frontal sulci (Brodmann areas 9 and 10, roughly)
  • The left superior temporal gyrus (auditory cortex)
  • A small region in the central sulcus

Also, normal age-related decreases in Brodmann areas 9/10 were seen in the control group but not the meditation group. In other words, meditation potentially helps prevent age-related deterioration in the brain!

Of course, this is a correlation study, and when two things are measured at the same time, it’s impossible to say what is the cause and what is the effect. Maybe people with enhanced cortical thickness tend to be drawn to meditation, rather than the other way around? It’s certainly possible, but as the authors note, if that were true you might expect greater cortical thickness overall, which wasn’t found here.

Meditation gives a double-whammy when it comes to making structural changes in the brain. Firstly, there is the control of attention during a consistent practice schedule. Secondly, the relaxed state of the body appears to facilitate cortical plasticity, at least in the auditory areas according to one study. This is comparable to the idea that sleep aids learning, study breaks aid recall, and so on.

That the structural changes were consistent with the brain areas associated with the techniques being practised, and that these changes may stave off age-related cortical decline, is encouraging. Presumably, different types of mental exercise would have effects on the brain areas related to them, and you could devise a routine aimed at the faculties you expect you’ll most need in your old age.


Lazar SW, Kerr C, Wasserman RH, Gray JR, Greve D, Treadway MT, McGarvey M, Quinn BT, Dusek JA, Benson H, Rauch SL, Moore CI, Fischl B. Meditation experience is associated with increased cortical thickness. NeuroReport, 2005; 16: 1893-1897.

Meditation versus relaxation

I have previously mentioned a study comparing meditation with relaxation. I have managed to dig it up and have a closer look at it.

The issue is where the benefits of meditation come from. Is it the practice of meditation itself? Or is it simply the fact that you’re sitting down, relaxing, forgetting your worldly concerns for a few precious moments?

It’s a tough question, because the two go together so closely. The way to answer it is to compare two groups of people, each doing one or the other, and try to keep the conditions of the test as similar as you can between groups. You’d measure things like mood and distress, and you could also throw a control group in too.

This is what the study did.

The participants were medical students, 81 in total, who were randomly split into the groups – meditation, relaxation, and no-treatment control group.

The meditators had four 1.5 hour sessions, spread over four weeks. The exercises included:

“…body scan meditation,in which the practitioner focuses attention on each part of the body to notice sensations that arise; sittingmeditation,where the practice is focusing non-judgmental awareness on whatever arises moment by moment; Hatha yoga, where one practices gentle stretching while maintaining attention on subtle movements in the body; walking meditation, where one practices walking slowly, with awareness; and loving-kindness meditation, where one focuses attention on feelings of caring and love for one’s self and others to cultivate compassionate awareness and action in everyday life.”

The relaxation exercises…:

“[integrate] techniques of autogenic relaxation using the six autogenic phrases used by Schultz, progressive muscle relaxation (using tension and release of muscles throughout the body to relax), simple breathing techniques (such as simple diaphragmatic breathing and breathing with counting), and guided imagery to give a comprehensive course on stress reduction via a focus on bodily relaxation.”

To keep conditions similar, the participants rated the warmth of the room and the abilities of the instructor, and the results came out even.

So which group did best?

Well, in terms of reducing distress and increasing positive mood states, the results were more or less even. Both relaxation and meditation were better than nothing, and meditation was slightly – but not significantly – more effective than the somatic relaxation exercises.

However, meditation did have an edge in one area – reducing distractive and ruminative thoughts. This is as you’d expect, given the concentration-building nature of mindfulness meditation. Statistical modelling indicated that part of the benefits of reduced distress in the mindfulness group were caused by this decreased rumination.

One other thing is worth mentioning – the results were recorded 7 to 14 days after the end of the test, AND they were taken just before the students had their finals! So the take home from this is, both of these techniques are effective, even in times of high stress, and also, don’t worry if you miss a day!

Do you get back from meditation what you expect?

According to Deane Shapiro, a lot of meditation research deliberately avoids the spiritual aspect to the practice, for which it has always been intended.  Even if you leave aside whether these things, which sit outside scientific models of reality, are true, this might be a mistake. Even if it’s all dead wrong, people are still approaching the practice of meditation from one place rather than another. It says things about them; it’s interesting.

On top of that, it might influence the effects (or perceived effects) that people get from their meditation practice.

Do you meditate for increased mental clarity and concentration? To learn more about your self? Or are you seeking something beyond yourself? To Shapiro, these things represent a continuum on which meditators goals fit: self-regulation, self-exploration, and self-liberation. Learning to control stress is a self-regulation goal, learning how your mind works is and exploration goal, and attempting to experience the unity of the universe is an example of a liberation goal.

Twenty-seven meditators were interviewed about their hopes, expectations and goals for meditation, as well as the positive results they felt they had received from it. For two-thirds, the results were congruent with their expectation – that is, a self-regulation expectation produced self-regulation benefits, and so on. The same group were interviewed after going on a retreat, and the benefits of the intense retreat were also comparable to their intentions.

Another interesting thing about this group, is that their goals fit along this continuum based on the amount of time they had been practising. That is, novices were more likely to have self-regulation goals, while experienced practitioners were more likely to have liberation goals.

Although this study has some flaws (low sample size, reliance on self-report), they are consistent with the idea that you get back from meditation what you expect. Another interesting test of this would be comparing people who have beliefs in supernatural entities and forces, with those who are hard materialists. Maybe the former group would have more of those ‘strange’ experiences you hear about sometimes.


Shapiro, D.H. (1992). A preliminary study of long term meditators: Goals, effects, religious orientation, cognitions. Journal of Transpersonal Psychology, 24 (1), 23–39.