Mindfulness In Addiction Treatment

1
Mindfulness In Addiction Treatment

• Elizabeth Suti, M.F.T.
• Program Manager
• UCLA Substance Abuse Service
• November 13, 2005
• Western Conference on Addictions
• esuti_at_mednet.ucla.edu

2

• Alcoholism is the disease
• of living elsewhere.
• (William Alexander, 1997)

3
Mindfulness

• An intentional focused awarenessa way of paying
  attention on purpose in the present moment,
  non-judgmentally (Kabat-Zinn, 2005)
• Quality of openness, of present-moment awareness
  and acceptanceexperiencing this moment as the
  only one that exists (Bien,2002)
• Mindfulness meditation involves observation of
  constantly changing internal and external stimuli
  as they arise (Baer, 2003)

4
(No Transcript)
5
Mindfulness

• Core teachings of the Buddha were the Four Nobel
  Truths
• 1. Suffering is inherent in life due to the
  impermanence of everything
• 2. The cause of suffering is clinging/craving of
  pleasurable experiences and an aversion to
  unpleasant ones
• 3. It is possible to end suffering through
  non-clinging and acceptance
• 4. The means to ending suffering is the
  Eight-Fold Path (moral and ethical teachings)

6
MINDFULNESS-BASEDINTERVENTIONS

• Mindfulness-Based Stress Reduction Program
  (MBSR) founded by Jon Kabat-Zinn, Ph.D. for
  medical illnesses and psychiatric disorders in
  1979

7
Mindfulness in CBT

• Mindfulness-Based Cognitive Therapy (MBCT)
  Teasdale, Segal Williams,1995). Skills of
  attentional control taught in mindfulness
  meditation could be used to prevent relapse to
  major depressive episodes.
• Acceptance and Commitment Therapy (ACT) Clients
  are taught to recognize an observing
  selfthoughts are not facts and I am not my
  thoughts (R. Baer,2003)
• Dialectical Behavioral Therapy (DBT) founded by
  Marsha Linehan, Ph.D., for Borderline Personality

8
Mindfulness in Addiction Treatment

• Relapse Prevention for addictive disorders using
  mindfulness skills (meditation) for coping with
  urges to use (urge surfing) Alan Marlatt, Ph.D.
• Addiction is a mindless state characterized by
  an inability to accept impermanence. The addict
  desires to fix impermanence by clinging or
  grasping on to the high (Alan Marlatt, Ph.D.)

9
Empirically Based Benefits of Mindfulness
Approaches

• Exposure and desensitization experiencing
  physical pain or emotional distress without
  excessive emotional reactivity which tends to
  make symptoms worse
• Cognitive Change non-judgmental observation can
  lead to understanding that thoughts, sensations,
  and emotions do not necessitate escape or
  avoidance behaviors (R. Baer, 2003)
• Self-Management Improved self-observation may
  promote use of a range of coping skills (cues and
  urges are noted without giving in to them)

10
Why Use a Mind-Body Approach?

• Recovery is best viewed as a holistic process
• M-B approaches recognize a persons innate
  healing abilities
• Illness provides some people with an opportunity
  for personal growth and transformation (a
  spiritual process for some)

11
DEFINITIONS

• Mind-Body Medicine minds capacity to affect
  health
• Complementary used together with conventional
  medicine
• Alternative used in place of conventional
  medicine
• Integrative combines mainstream medicine with
  evidence-based CAM

12
Mind-Body Practices

• Traditional Chinese Medicine (TCM)
• Meditation
• Yoga
• Acupuncture
• Tai chi and Qi gong
• Biofeedback
• Dietary/Herbal supplements
• Prayer

13
(No Transcript)
14
Is a Mind-Body Approach Scientific?

• NIH has a National Center for Complementary and
  Alternative Medicine (NCCAM,1998)
• Center for Addiction and Alternative Medicine
  Research at the U Michigan part of NCCAM
• Many major Universities have Integrative Medicine
  Departments
• Managed Care and Insurance Company are
  investigating Mind-Body Approaches
• MBSR Programs (over 200 in US)

15
Research Activities

• NIDA and NIAAA providing research grants for
  developing alternative therapies for addiction
  tx.
• Grants submitted to NIH on mindfulness daily
• Current research studies
• Immune Function
• Chronic Pain
• Anxiety and Panic
• Prostate Cancer
• Chronic fatigue/Fibromyalgia/IBS (10 yr. Study by
  Cigna)

16
Leading Integrative Medicine Programs

• Mind-Body Medical Institute at Harvard founded by
  Herbert Benson, MD
• UCLA Collaborative Centers for Integrative
  Medicine
• Mindfulness-Based Stress Reduction (MBSR) Program
  at the University of Massachusetts

17
(No Transcript)
18
Mind and Life Institute

• The Dalai Lama and Western Scientists
  (neuroscientist Francisco Varela) co-founded the
  Institute in 1987 for research collaboration
  between science and Buddhism for the purpose of
  understanding the nature of reality and
  investigating the mind http//www.mindandlife.org
  
• Ongoing research at MIT, and other academic
  institutions One study involves brain imaging of
  Buddhist monks during meditative states (EEG,
  MEG, fMRI)
• Public dialogues began in Sept. 2003 at MIT
• This years conference, Nov. 8-10, in Washington,
  D.C. will be on the Science and Clinical
  Applications of Meditation

19
(No Transcript)
20
Mindfulness Based Stress Reduction Program

• Jon Kabat-Zinn, Ph.D. founded program at Univ of
  Mass Med Center in 1979
• Healing power of mindfulness within a medical
  context
• While remaining firmly anchored in the worlds of
  science and medicine, integrating mindfulness
  into the larger cloth of our society is what is
  now required. This is what the world is longing
  for This is our crossover. (Kabat-Zinn,2004)

21
MBSR Clinical Program

• --Over 4,000 physicians have referred patients to
  the 8 week program
• --More than 16,000 patients have completed the
  program in past 25 years
• --There are currently over 200 MBSR clinics in
  academic medical centers, hospitals and free
  standing clinics
• --Medical problems addressed cancer, heart
  disease, back pain, AIDS, and other chronic
  illnesses

22
Mindfulness Meditation Methods

• Body Scan Meditation slow scan of entire body
  (greyhound bus tour)
• Gentle Hatha Yoga practiced with mindful
  awareness of the body
• Sitting Meditation mindfulness of breath, body,
  feelings, thoughts, and emotions
• Walking Meditation
• Home assignments 45 min. sitting meditation and
  15 minutes of informal practice

23
Professional Education

• 7-Day intensive residential training program in
  MBSR for health care professionals
• Teacher certification program in MBSR for health
  care professionals (3 part program)
• Supervision for MBSR instructors
• International Assoc. for MBSR practitioners
• Annual meeting of MBSR practitioners and
  researchers

24
MBSR Outreach

• Inner City Clinic
• Prison Project Norfolk Prison
• Elementary School Education
• CEOs, judges, attorneys, priests, health
  professionals
• Athletes George Mumford worked with the Lakers
  and the Bulls
• Media Bill Moyers PBS Documentary, Oprah,
  Dateline, Newsweek

25
Current Status of MBSR

• The Center for Mindfulness in Medicine, Health
  care and Society (CFM) www.umassmed.edu/cfm
• Located at the University of Massachusetts
  Medical School
• Mission is to integrate mindfulness in lives of
  individuals, institutions, and in society through
  clinical, research, education, and outreach
  initiatives
• The Stress Reduction Program is the clinical
  component of CFM
• Saki Santorelli, Ph.D., is current director.

26
(No Transcript)
27
Benefits of MindfulnessApproaches

• Decreases stress
• Decreases depression and anxiety
• Decreases blood pressure and heart rate
• Slows or controls chronic diseases
• Increases immune functioning
• Increases focus, attention and awareness
• 10 million American meditate regularly

28
Defining Stress

• Non specific response of the organism to any
  pressure or demand (Hans Selye 1950s)
• How you see things and how you handle them makes
  the difference in how much stress you will
  experience (Kabat-Zinn, 1990)
• If we change the way we see we can change the way
  we respond (Kabat-Zinn, 1990)

29
Stress Response

• Fight or flight responses are the physiological
  changes we undergo when feeling threatened
• Hyper-arousal occurs when there is an excessive
  release of stress hormones and neurotransmitters
• Hyper-arousal can become a way of life being
  stuck in stress reactivity (Kabat-Zinn, 1990)
• Internalizing the stress reaction doesnt bring
  the resolution of fighting or fleeing and can
  lead to illness

30
Hypothalamic-Pituitary-Adrenal (HPA) Axis

• Part of the neuroendochrine system
• Controls stress related hormones
• Responsible for controlling hormones, nervous
  system, energy expenditure, and modulates the
  immune system
• Physical and mental symptoms associated with
  suppression of HPA axis
• Denial and maladaptive coping can develop

31
Relaxation Response

• Relaxation Response published in 1975 by Herbert
  Benson, MD, Founder of Harvards Mind/Body
  Medical Institute
• Offered a biological explanation for how stress
  makes people ill, and how relaxation techniques
  decrease stress and help people heal--techniques
  used for thousands of years
• Responding vs. reacting to stress (addictive
  behavior) through awareness and mindfulness

32
STRESS AND RELAPSE

• Stress is a major relapse indicator (Gorski,
  Marlatt, Koob)
• Person with addictive disorders develops changes
  in functioning of the HPA axis (due to substance
  use and/or compromised ability to modulate
  stress secondary to trauma/abuse)
• Medications being developed to target the HPA
  process (Koob presented at 2004 CSAM)

33
Mindfulness and Addiction

• Mindfulness in this sense is learning to let go
  of the desired outcome, to practice non-doing as
  an alternative to the addictive fix (Marlatt)
• Where mindfulness is, addiction is not.
  Cultivation of one leaves lees room for the
  other (Bien, 2002)
• Calm awareness is an antidote for an addicted
  state of mind (Bien, 2002)

34
Mindfulness and Addiction

• Marlatts Relapse Prevention Model clients are
  taught to recognize triggers and cravings
  (desire) and the urge (intention)
• Mindfulness is characterized by a freedom from
  rigid attitudes, cognitions and behaviors
• Practice non-doing as an alternative to the
  next fix
• Addiction is a means of trying to control the
  nature of reality by maintaining the highs and
  avoiding the lows.
• Nature of present experience is one of constant
  change or flux. Thoughts come and go, physical
  sensations rise and fall like the breathe.
  Everything is impermanent.

35
Mindfulness and Addiction

• Addiction is a means of trying to control the
  nature of reality by maintaining the highs and
  avoiding the lows.
• Nature of present experience is one of constant
  change or flux. Thoughts come and go, physical
  sensations rise and fall like the breath.
• No need to fix what happens next. Addicts are
  devoted to the next fix because of the great
  difficulty in accepting the present moment.
  (Marlatt)

36
Mindfulness and Relapse Prevention

• Chemicals are used to change our mind-body state
  when we dont like how were feeling
• Addictive behaviors are maladaptive attempts at
  suppressing symptoms of disregulation--physical
  and mental (Kabat-Zinn, 1990)

37
Relapse Prevention

• Intervening in addictive, classically conditioned
  responses
• Recognizing triggers, cravings, and the urge
  (intent) to use (Matrix Institute, Marlatt)
• Identify above and teach clients they can accept
  cravings and urges without automatically engaging
  in the addictive behavior

38
Relapse Prevention Cont.

• Urge Surfingmindfully riding the urge. The
  urge is portrayed as an ocean wave. Like a wave,
  an urge begins slowly and gradually, grows in
  size until it crests, and then gently subsides.
  (Marlatt)
• Compatible with thought Stopping techniques for
  interrupting the craving process (Matrix Model)
• Rather than giving in, letting go

39
The Therapeutic Relationship

• The therapist is the most powerful tool for
  change (Marlatt)
• Person-Centered (Rogerian approach)
• Qualities of authenticity, unconditional
  acceptance, empathy humor, present moment
  experience, teacher and student both experiencing
  the process, and each being changed as a result
  of it (Santorelli)
• Clinician must practice mindfulness if she/he is
  teaching it to clients

40
Clinical Applications

• Its not just a set of techniquesits about
  paying attention, moment by moment
• One day at a time in the present we have
  choices, including sobriety
• Honoring ones experience, just as it is, even
  when theres guilt and shame present
• Bringing compassionate awareness to whatever is
  going on (cravings, regrets, etc.)
• Awareness helps diminish self destructive
  impulses first arise, before the behavior begins

41
Clinical Applications

• Balance is the antidote to craving. In the
  absence of balance, we take away one thing, only
  to replace it with another--cross-addiction
  (Griffin, 2004)
• Stress is decreased, change is a process and
  happens more effectively when the mind is calm
• Increased self awareness and self efficacy
• Compatibility with 12-Steps (Kevin Griffin, 2004)
• Acceptance of relapses vs. abstinence violation
  effect

42
Treatment and Research

• Marlatt conducted studies on Meditation and
  Alcohol Use and Recidivism (Univ. of Wash)
• M. Marcus study using MBSR in therapeutic
  community
• MBSR currently being used with clients at Summit
  Centers, Malibu
• Center for Studies of Addiction at U Penn Medical
  School has used MBSR in addicted adults
• Center for Motivation and Change Treatment
  Program in New York has started using MBSR

43
MINDFULNESS AT UCLA

• UCLA PHP program has began a mindfulness stress
  management group this fall
• UCLA Dept. of Psychology conducting a study on
  Mindfulness meditation with patients with HIV
• UCLA-NPI has a Mindful Awareness Research Center
  under direction of Susan Smalley, Ph.D. (ADHD)
• UCLA Integrative Medicine and UCLA Pediatric Pain
  Program started MBSR program with Trudy Goodman,
  M.F.T.

44
UCLA Partial Hospitalization ProgramMindfulness
Stress Management Group

• Definition of stress and stress inventory
• Mindfulness approaches as tools for reducing
  stress
• Mindful eating
• Sensory awareness
• Vipassana sitting meditation
• Walking meditation
• Writing and poetry

45

• Live Your Life as if
• it Really Mattered
• (J. Kabat-Zinn, 2005)