Is Mindfulness an Emerging Treatment for Addiction?

Rehab Helps Thousands of Addicts Quit. It Can Help You, Too.

Why do young mothers buy a daily pack of cigarettes instead of spending this money on nutritious food for their children? Why are treatments that help roughly 33 percent of people overcome their substance use and have a 70 perfect relapse rate hailed as “gold standard” by the National Institute of Drug Abuse (NIDA)? In other words, why are addictions so hard to overcome?

Our brains are set up to learn. From an evolutionary perspective, when we come upon a good source of food or water, it is helpful to remember where it is. When we discover something dangerous, that memory is helpful too. And this reward-based learning system, that is conserved all the way back to the most primitive of nervous systems (the sea slug with roughly 20,000 neurons), in its most basic form has three elements: trigger, behavior, reward. We see berries, we eat them, and if they taste good, we lay down a memory to come back.

Fast forward to modern day. Food is plentiful and our environment is relatively safe, yet our brains have the same reward-based learning system. Under the names of operant conditioning, associative learning and positive and negative reinforcement, a lot more is known about how it works. This is the good news.

The bad news is that over time, humans have stumbled upon substances that literally hijack this reward-based learning system.-Judson Brewer

The bad news is that over time, humans have stumbled upon substances that literally hijack this reward-based learning system. In fact, every substance of abuse from tobacco to crack cocaine affects the same brain pathways – the mesolimbic pathway which mainly acts through the neurotransmitter dopamine. And each time we do a line of cocaine and feel the high or smoke a cigarette when we are stressed out and feel better afterwards, we reinforce the “habit loop.” This combination of tapping into the dopamine system and behavioral repetition is deadly. For example, smoking is the leading cause of preventable morbidity and mortality in the US.

The Habit Loop

Treatments such as cognitive behavioral therapy are thought to act through the prefrontal cortex – involved in reasoning, planning and “top down” cognitive control in general. When we know we shouldn’t eat that second helping of cake or smoke a cigarette, this is the part of the brain that helps us control that urge. Unfortunately, like the rest of the body, the prefrontal cortex is subject to fatigue, described by some as “ego depletion.” As the HALT acronym predicts, when we are Hungry, Angry, Lonely, or Tired, we are more susceptible to smoking or using drugs. This may be because, as the youngest part of the brain from an evolutionary standpoint, this is also the first cortical region to go “offline” when we are stressed or otherwise depleted.

If we can’t rely on our prefrontal cortex, are there other ways to change our behaviors?

Based in ancient Buddhist psychology, mindfulness helps individuals pay careful attention to their cravings, such that they can see what they are made up of – thoughts and body sensations.-Judson Brewer

Interestingly, mindfulness training seems to be emerging as a possible solution. Based in ancient Buddhist psychology, mindfulness helps individuals pay careful attention to their cravings, such that they can see what they are made up of – thoughts and body sensations. Importantly, with this awareness, they can notice cravings as they arise, see how they change from moment to moment (instead of lasting “forever” as some of my patients have described), and as a result, stay with them and ride them out instead of acting on them. Also, paying attention helps individuals see clearly what they are getting from their behavior in that moment.

For example, a person in our smoking program commented, “Mindful smoking: smells like stinky cheese and tastes like chemicals. YUCK!” She noticed that smoking wasn’t as great as she might have convinced herself previously. And this is the beginning of the end – we start to get disenchanted with what we were doing – just by paying careful attention. This dual purpose of mindfulness – disenchantment and being able to be with ourselves instead of reacting automatically – may be a winning combination.

We have found that mindfulness training helps individuals with a range of addictions from alcohol to cocaine to nicotine dependence. In fact, in one randomized clinical trial, we found that it was twice as good as gold standard treatment (American Lung Association’s Freedom From Smoking) in helping people quit and stay quit. Why would it work so well? It turns out that it targets the core addictive loop – by helping people ride out their cravings instead of acting on them, it decouples the link between craving and smoking, effectively dismantling the loop. This is an important point, because these data pinpoint a mechanistic link that is being targeted by mindfulness, which is not always easy to find in behavioral treatments.

We have found that mindfulness training helps individuals with a range of addictions from alcohol to cocaine to nicotine dependence.-Judson Brewer

Mindfulness Treatment Programs

Though more research is needed, treatment programs such as Mindfulness-based Relapse Prevention (MBRP) show promise and are now manualized so that therapists can be trained to deliver them. Additionally, web and app-based delivery of mindfulness is being tested. For example, Craving to Quit delivers the manualized mindfulness training that we developed at Yale University described above via short daily videos, animations and in the moment exercises via a web and smartphone app, and is paired with an online community where individuals can get peer and expert support (e.g. forum moderated by an addiction psychiatrist). Craving to Quit is now being studied in clinical trials funded by the American Heart Association and the National Cancer Institute (e.g. this study at Yale is currently enrolling).

Figure 1: Addictive habit loop © 2014 Judson Brewer. Adapted from Brewer et al 2012.

Photo Source: pixabay

What Are Your Thoughts on this Topic?

  • By myself

    Great article minus the stereotyping of young mothers.

  • nanette donithan

    something needs to be tried…there is an epidemic of addiction of all sorts killing us…and especially our youth now…current 12 step programs fall way short

  • Chad Sewich

    The Kiloby Center for Recovery in Palm Springs, CA is one of (if not the only) exclusively mindfulness-based addiction recovery centers in the US.

  • Fran DiDomenicis

    FFAI’ve been using mindfulness based approaches with my clients for years and find it a most effective approach with a variety of complaints, including addictive urges. As stated in the article, clients can learn to stay aware through the entire sequence of reactions, from initial subtle reactions to pleasant and unpleasant stimuli into the funnel of thoughts, sensations, and emotions that lead to the automatic behaviors that usually follow. By putting all these sensory and mental movements under the microscope of mindfulness, one can see the fleeting, insubstantial nature of it all.

    This last point is important in helping people learn to “let go”, not believe everything they think or feel, and develop what Buddhists call equanimity. Eventually they can gain important spiritual insights and freedom. I recommend it!

  • stevea

    Have mindfulness interventions been tried with eating disorder urges, impulses, thoughts, behaviors, etc. and is there any statistical documentation or first person accounts of the results? ED is an epidemic and very dangerous but less visible in many cases.

  • Ilona Phillips

    Definitely an important piece of my work with addictions and compulsions at I appreciate this article breaking down the basics of addiction.

  • Mindful Life Weight Loss

    We use mindfulness practice to help people lose weight. Mindfulness is helpful to interrupt the emotional eating cycle. And even more, once people adopt a mindfulness practice they see positive effects ripple outward to their lives in general.

  • Brandon Burns

    I don’t see anyone asking the question: Why can’t the 12-step program and Mindfulness approaches be used in tandem with one another? Certainly interesting that readers are either for one thing or against the other. In a world of absolutes i.e. only going to 12-step programs or only going to Mindfulness programs, we all sell ourselves short. The goal is to get people better, not to say what program works “best”. If Mindfulness programs, on any occasion lead to relapse, then, it seems offaly dumb to say it is better! To rearrange the notion, it would be like saying, we fail less than the other guys! This cannot be right.

    In my experience, whether recognized out-loud or not, 12-step programs utilize Mindfulness practices. To say they don’t is entirely misleading, especially given the extraordinary amount of psychologists working within 12-step programs. In any case, I am for whatever it takes to get young adults well. Absolutely speaking, there is no way the Mindfulness approach will work every time. If that is the case, then it is not the answer, but simply a tool to be utilized as needed, we can look at the 12-step program in the same light. Just my two cents.

    • Flurry

      Brilliant Idea

  • Art Marr

    A different perspective on mindfulness and addiction

    A foundational approach to the treatment of addiction is to increase opioid levels in the brain through natural and non-invasive means, and thus reduce cravings. Below is a link to a little book that outlines simple cognitive procedures that can provide for the sustained elevation of opioids as well as dopamine in the brain. The procedures have some similarity to mindfulness, but differ in significant ways.

    My argument and the procedure that follows (pp. 28, 39-41), is novel, short, succinct, simple and easily testable, and was written in consultation with and with the endorsement of Dr. Kent Berridge of the University of Michigan, a leading authority on the neuro-psychology of addiction. The book is written in two parts, for a lay and professional audience, and perhaps it may be of interest.

    (a supplementary article by the author on this topic from the International Journal of Stress Management is also linked)

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