Mindfulness-Based Therapies for Substance Use Disorders: Part 1

The link between stress and addiction is well-known. Stress increases the likelihood of alcohol and drug use, and can precipitate relapses following treatment (1). Clinicians and researchers recognize the critical need to incorporate stress management techniques into inpatient and outpatient treatment. The goal is to assist clients to replace substance use with healthy coping skills when confronted with the inevitable stressors that threaten sobriety. Improved treatment retention and relapse prevention are desired outcomes of the challenging search for evidencedbased programs for recovering addicts. This thematic issue of Substance Abuse is devoted to an emerging, promising area of research, mindfulness meditation as a therapy for addictive disorders. Conceptual framework and findings from a pilot-level research combined with an anecdotal evidence from clinical practice support the use of this innovative therapy for a broad spectrum of substance use disorders and mental health problems in general. If effective, mindfulness meditation based interventions could help improve treatment outcomes in addictive disorders. Mindfulness meditation, originally derived from Buddhist Vipassana meditation, is the cornerstone of the Mindfulness-Based Stress Reduction (MBSR) program developed by KabatZinn in 1979 to teach patients with chronic physical and mental health problems how to improve their lives. MBSR is now used as an adjunctive treatment for a wide range of disorders and is increasingly finding its way into the treatment of addiction. Kabat-Zinn defines mindfulness as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (2). Mindfulness encourages awareness and acceptance of thoughts, feelings and bodily sensations as they arise, and recognition of their impermanence. Mindfulness practitioners are taught to acknowledge and accept their experiences rather than to modify or suppress them. This change in one’s relationship to present-moment experience has been described as “reperceiving” (3) or “attentional control” (4), and may facilitate more mindful behavioral choices. The set of skills associated with mindfulness can be taught independent of religious or cultural background, and in a variety of forms of interventions (5). In addition to MBSR, mindfulness-based interventions, used in a context of addictive disorders, include Mindfulness-Based Cognitive Therapy (MBCT) (6), Dialectical Behavior Therapy (DBT) (7), and Acceptance and Commitment Therapy (ACT) (8). Recent modifications of these approaches, developed specifically for substance abusing populations, include MindfulnessBased Relapse Prevention (MBRP) (9) and Mindfulness-Based Therapeutic Community (MBTC) treatment (10).