mindfulness for treating addiction_psychotherapists guide

7/25/2019 Mindfulness for Treating Addiction_Psychotherapists Guide

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Mindfulness for Treating Addiction: A Clinicians Guide

An aspect of our scientic work relating to mindfulness

involves investigating its applications for treating addiction. In

this respect, we have a longstanding collaboration with Dr.

Mark Griiths who is rofessor of !ehavioural Addiction at

"ottingham #rent $niversit% &$'( and is internationall%

recognised for his work in this eld of stud%. #oda%)s post

draws upon ndings from our research using Meditation

Awareness #raining and provides ten recommendations on the

ps%chotherapeutic use of mindfulness in addiction treatment

conte*ts. #hese recommendations are primaril% intended for

mental health professionals, but individuals with addiction

problems ma% also nd them of interest. Although we have

principall% based our recommendations on insights gained

from using mindfulness and meditation for treating

behavioural addictions &e.g., gambling disorder, workaholism,se* addiction(, we have also consulted the literature

concerning the use of mindfulness for treating chemical

addictions &e.g., substance+ and alcohol+use disorders(.

#herefore, whilst we acknowledge that there are important

dierences between behavioural and chemical addictions &e.g.,

the ph%sical signs of drug addiction are t%picall% absent in


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behavioural addiction(, we envisage that the following

recommendations will be applicable to both addiction

categories.

. Undertake a Thorough Assessment- areful evaluation of

the client)s histor% &e.g., clinical histor%, social histor%,

education histor%, religious histor%, emplo%ment histor%,

etc.( and presenting problems will come high on the list of

an% competent mental health clinician. /owever, we have

chosen to include 0thorough assessment) as one of our

specic recommendations because there appears to be a

belief amongst a minorit% of mental health professionals

that mindfulness is a one+stop cure for all mental health

issues. As discussed in one of our peer+reviewed papers

that was recentl% published in the !ritish Medical 1ournal,

the onl% ps%chopathologies for which the empirical

evidence is robust enough to support the wide scale

utilisation of mindfulness are specic forms of depression

and an*iet%. In other words, mindfulness is not a suitable

treatment for ever% individual presenting for treatment. 2or

e*ample, we recommend that clinicians e*ercise additional

caution &including taking into account their own e*perience

with using mindfulness( before introducing mindfulness to

clients whose addiction problem occurs in con3unction with

ps%chotic features.4.Build Strong Meditative Foundations- Mindfulness is a

practice to develop throughout one)s lifetime. It is a

marathon and not a sprint. If an individual is to derive

lasting benet from mindfulness, it is essential that the%


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establish strong meditative foundations. If we want to

become aware of the subtle aspects of mind, we rst need

to become aware of the gross aspects of mind. And before

we can do that, we need a method of calming, collecting

and focussing the mind. #his is wh% breath awareness is a

vital feature of meditative development. $sing the breath as

a concentration anchor provides the client with a reference

point 5 a place of safet% to which the% can return whenever

their mind starts to run awa% with itself. #he mental

cravings that underlie addiction can be powerful and

consuming, and without strong meditative foundations, it is

unlikel% that the client will be able to regulate these

cravings as well as withdrawal s%mptoms that the% are

likel% to encounter during later treatment phases. Another

important foundation of mindfulness is awareness of the

bod%. At the earl% stages of treatment, clients should be

taught how to sit with awareness, eat with awareness, walk

with awareness and talk with awareness. lients should be

encouraged to adopt mindfulness as a wa% of life and not

3ust a techni6ue to appl% when the% are feeling low or

susceptible to addiction+related urges.7.Make use of Psycho-education: In addiction treatment

conte*ts, we suggest that ps%cho+education should be

utilised at the earl% stages of treatment and should focus on

two ke% areas- &i( educating clients in the science

concerning the aetiolog% and s%mptom course of their

particular addiction, and &ii( e*plaining the principles of

mindfulness and a meditation+based recover% model. 2or a

comprehensive and insightful academic resource that


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clinicians can draw upon in this respect, we recommend the

chapter on mindfulness and addiction b% Dr. 8ean Dae

/oulihan and Dr. 1udson !rewer that features in our recent

edited 8pringer volume on 0Mindfulness and Buddhist-

Derived Aroaches in Mental !ealth and Addiction) &see

further reading list below(.9. Teach "Urge Sur#ng$: #he term 0urge surng) has been used

in the scientic literature to refer to the process of

mindfull% observing the mental urges associated with

addiction. #he idea is that the client, having establishedthemselves in awareness of breathing, takes craving as the

ob3ect of meditation. #he% follow their breath and observe

how craving dominates their cognitive+aective processes.

#he process of observing mental craving helps to ob3ectif%

it and creates 0mental space) whereb% instead of feeding the

craving &i.e., b% emotionall% and conceptuall% adding to it(,craving is allowed to e*ist 0as it is). It ma% appear as though

urge surng is concerned with controlling craving, but

that)s not the case. :ather, the techni6ue involves allowing

craving to come and go such that it can progress through

its natural c%cle of birth, life and dissolution. ;hen we

teach this techni6ue, we inform clients that if craving is

manifest in the mind, that)s


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recreational activities such as singing, learning computer

skills, communication workshops, dance and music. ventuall%, clients should

be encouraged to relin6uish an% dependenc% on meditation,

but in the earl% stages of treating addiction, it can be a

useful therapeutic techni6ue.@.&mloy Meditation &'osure Theray- >*posure therap% is

a method emplo%ed b% various modalities of ps%chotherap%,

and it can also be used as part of mindfulness therap% for

individuals suering from addiction. It is all ver% well

teaching the client how to practise mindfulness from the

safet% of ps%chotherapist)s consulting room, but at some

point it is probable that the% will encounter the stimuli that

have previousl% caused strong mental urges to arise.

onse6uentl%, we encourage the ps%chotherapist to

accompan% &i.e., where it is safe and realistic to do so( the

client in 0real+world settings) that are likel% to induce

relapse. 2or e*ample, if the client is addicted to o+line

gambling, consider accompan%ing them to a casino in order


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to demonstrate that it is possible for them to remain

meditativel% composed whilst surrounded b% the ob3ect of

their addiction. Meditation e*posure therap% isn)t suitable

for ever% client &or indeed for ever% mental health

clinician(, but where applicable, we generall% recommend

that it is used towards the end of the treatment course.. Undermine the (alue of the Addictive )%*ect:#his

techni6ue involves guiding the client to think about the

0true nature) of the ob3ect of their addiction. More

specicall%, it involves introducing the client 5 albeit at anelementar% level 5 to the concepts of impermanence,

interconnectedness and emptiness. Again, the clinician will

have to assess on a case+b%+case basis whether this

techni6ue is appropriate, but we have personall% found it to

be eective in addiction treatment conte*ts. !% fostering

meditative awareness of impermanence and the empt%nature of all phenomena, the client can graduall% begin to

6uestion and then undermine the intrinsic value that the%

have assigned to the ob3ect of their addition. 2or e*ample,

an individual suering from se* addiction can use specic

meditative techni6ues in order to better understand that &i(

the individual components that comprise the human bod%

are not particularl% desirable in and of themselves &e.g.,

nails, hair, mucus, faeces, urine, pus, vomit, blood, sinew,

skin, bone, teeth, Besh, sweat, etc.(, &ii( the inevitable

destin% of the bod% is that of ageing, illness and deca%, and

&iii( the bod% e*ists as a composite entit% but does not e*ist

intrinsicall%. If the client looks deepl% using meditation, the%

can learn to see that in beaut% and life, there is foulness


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and deca% &and vice+versa(. #he% can also learn to see that

there is 0other) in 0self) and 0self) in 0other), and that when

the% practice kindness and respect towards themselves,

the% practise kindness and respect towards the entire

world.C. Schedule Follo+-u Sessions- Most of the available

treatments that use mindfulness generall% adhere to an

eight+week treatment course. /owever, in the traditional

!uddhist setting, a person would normall% be re6uired to

engage in da%+to+da% mindfulness practice over a period ofman% %ears before being deemed to have gained a

reasonable grounding in the practice. onse6uentl%, it is

important to schedule booster sessions and to meet with the

client at regular &e.g., monthl%( intervals following the

initial programme of treatment. Ideall%, clients should also

be encouraged to make contact with mindfulness groupsthat are facilitated b% competent teachers.

.,ead %y &'amle- As discussed in a previous post where we

oered guidelines on the general use of mindfulness in

ps%chotherap% &i.e., not specic to treating addiction(, it is

important that the mental health clinician emanates a

presence of meditative calm and awareness. #his has to be

natural and as indicated above, it can onl% arise after

consistent dail% practice over a period of man% %ears. If the

clinician merel% 0acts) at being mindful, the client is likel%

&whether consciousl% or subconsciousl%( to pick up on this

and it will inevitabl% act as an obstacle to recover%.E. Be nsired- Mindfulness has been practised b% spiritual

traditions for thousands of %ears. ;hen a clinician engages


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with the practice in a sincere manner, and when the%

wholeheartedl% wish to help the client overcome their

suering, that clinician is bestowed with the blessings and

wisdom of this ancient spiritual lineage. #he% become what

is known in !uddhism as a !odhisattva 5 a rare and

beautiful being that conduct acts of kindness in order to

alleviate the suering of others. 8killed mental health

professionals perform an invaluable role to societ%. #he% are

inspired individuals who in turn help to inspire the clients

the% work with.

Ven Dr Edo Shonin and Ven William Van Gordon

Further Reading

Alavi, 8. 8., 2erdosi, M., 1annatifard, 2., et al. &4E4(.

!ehavioral addiction versus substance addiction-

orrespondence of ps%chiatric and ps%chological views.

nternational .ournal of Preventative Medicine/ 0/4E+49.

Appel, 1., F 'im+Appel, D. &4EE(. Mindfulness- Implications for

substance abuse and addiction.nternational .ournal of

Mental !ealth Addiction/ 1, =E@+=4.

Griiths, M. D., &4EE=(. A 0components) model of addiction

within a biops%chosocial framework..ournal of Su%stance

Use/ 23/ +.

Griiths, M. D., 8honin, >., F an Gordon, ;. &4E=(.

Mindfulness as a treatment for gambling disorder..ournal

of 4am%ling and 5ommercial 4aming 6esearch, 2, +@.


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/oulihan, 8. D., F !rewer, 1. A. &4E=(. #he emerging science

of mindfulness as a treatment for addiction. In- >. H.

8honin, ;. an Gordon and M. D. Griiths &eds.(,

Mindfulness and other Buddhist-derived aroaches in

mental health and addiction &pp. +4E(. "ew Hork-

8pringer.

Iskender, M., F Akin, A. &4E(. ompassion and internet

addiction. Turkish )nline .ournal of &ducational

Technology/ 23, 4=+44.

1ackson, A. ., 2rancis, '. ., !%rne, G., et al. &4E7(. eisure

substitution and problem gambling- report of a proof of

concept group intervention.nternational .ournal of

Mental !ealth and Addiction/ 22/ @959.

:osenberg, '. ., arnes, . 1., F valuation and treatment of se* addiction..ournal of Se'

and Marital Theray,73, +.

8honin, >!an Gordon, ;., F Griiths, M. D. &4E9(. #he

treatment of workaholism with Meditation Awareness

#raining- A ase 8tud%.&'lore: The .ournal of Science and

!ealing/ 23, 7+=.

8honn, >., an Gordon, ;., F Griiths, M. D. &4E9(. ognitive

!ehavioral #herap% &!#( and Meditation Awareness

#raining &MA#( for the treatment of co+occurring

schi?ophrenia with pathological gambling- A case stud%.

nternational .ournal of Mental !ealth and Addiction, 28,

C+@.


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8honin, >., an Gordon ;., F Griiths, M. D. &4E9(. Mindfulness

as a treatment for behavioral addiction..ournal of Addiction

6esearch and Theray, 9, e44. D., an Gordon, ;., F Griiths, M. D. &4E9(.

Mindfulness and the social media..ournal of Mass

5ommunication and .ournalism,8327/ 7: 9, D., an Gordon ;., F Griiths, M. D. &4E7(. !uddhist

philosoph% for the treatment of problem gambling..ournal

of Behavioural Addictions/ 8/@7+.

8honin, >., an Gordon ;., F Griiths, M. D. &4E7(.

Meditation for the treatment of addictive behaviours-

8ending out an 8., an Gordon, ;. F Griiths, M. D. &4E7(.

Mindfulness+based interventions for the treatment of

problem gambling..ournal of the ational 5ouncil on

Pro%lem 4am%ling/ 2;/+C

8ussman, 8., isha, ". F Griiths, M. D. &4E(. revalence of

the addictions- A problem of the ma3orit% or the minorit%K

&valuation and the !ealth Professions, 07, 7+=@.

;itkiewit?, ', Marlatt, G. A., F ;alker, D. &4EE=(. Mindfulness+

based relapse prevention for alcohol and substance use

disorders..ournal of 5ognitive Psychotheray/ 2

mindfulness for treating addiction_psychotherapists guide

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