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 prisons. (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.


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