Addiction relapse prevention approaches have traditionally focused on challenging the thoughts that contribute to and exacerbate addictive behaviors as well as helping those in recovery develop healthier coping strategies in challenging situations.
These approaches, which are rooted in the cognitive behavioral tradition, have rarely co-existed with Buddhist or third wave approaches in relapse prevention protocols.
But during the last several years, an integrative mindfulness-based relapse prevention (MBRP) program has emerged. This approach, which is based largely on the research of addiction expert Alan Marlatt, Ph.D, combines mindfulness meditation and the cognitive behavioral-oriented relapse prevention therapy. It has been developed by Sarah Bowen, Ph.D, Neha Chawla, Ph.D, Joel Grow, Ph.D, and Katie Witkiewitz, Ph.D.
The following principles, which are adapted from the edited volume, Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions, provide the foundation for understanding a mindfulness-based approach to addiction.
From a traditional mindfulness perspective, the unchecked urge to grasp for what we don’t have or to escape from situations that we don’t want is at the heart of addictive behaviors.
“Addiction might thus be viewed as a non willingness or perceived inability to accept what exists in the present moment. There is a grasping for something that we think will deliver the experience we yearn for instead of the one we currently have,” write Bowen, Chawla, and Witkiewitz.
The practice of mindfulness meditation provides a way out of this trap. When we practice noticing the way our thoughts, emotions and physical sensations constantly change, we begin to transform our relationship to the activity of our minds.
With time and sustained practice, we become privy to the fickle nature of our internal experiences and therefore less likely to allow them to dictate our behavior.
Even when our internal experiences are not the way we’d prefer them to be, certain kinds of mindfulness meditation can help us relate to such unwanted experiences with a sense of curiosity and compassion. This allows us to behave in more flexible ways, even in the presence of challenges.
Let’s face it, when the primary goal is to escape unpleasant thoughts and feelings, substance use is, in fact, highly effective. It is temporary, and it most often always makes things worse, but it works for instant, fast-acting relief.
Research shows that the urge to escape or avoid unpleasant emotional states is the most common trigger for relapse, and addiction as traditionally been viewed as a way of self-medicating, meant to treat emotional discomfort.
When difficult thoughts or feelings are dulled, numbed or soothed through substance use, the addictive behavior is reinforced as a useful method. But of course, in the long-term, this is a dangerous trap.
Relying on substances to treat distressing thoughts or feelings may provide immediate relief, but the cost of that relief is typically more distressing thoughts like shame, depression and stress, which will also beg to be numbed. Because substances do provide temporary relief, it is easy to fall into the trap of continuing to rely on them as a coping tool.
Simply building awareness around these behavioral patterns is useful for those struggling with addiction. Understanding why the temptation to use substances is so strong, particularly in moments of stress or other emotional discomfort, is an important part of recovery and relapse prevention.
Understanding the relationship between substance use and the very human desire to avoid difficult feelings has the potential to short circuit the automatic urge to use when things become challenging.
Of course, addiction is not always motivated by the urge to escape discomfort. For some, addiction is about chasing pleasant feelings or things like excitement, intensity and other appetitive experiences. From a mindfulness perspective, this is another case of nonacceptance or wanting things to be other than what they are in the present moment.
Once again, mindfulness can help.
“Mindfulness practice may help clients find the naturally reinforcing or nourishing aspects of day-to-day life that are often deemed trivial and thus unworthy of attention of presence. By bringing purposeful attention to what gives us pleasure, not only is contact with natural positive reinforces increased, but we may also notice pleasure where previously we had missed it,” write Bowen, Chawla, and Witkiewitz.
The present moment can be a surprising source of pleasure for people who are used to going through their days on autopilot. Feeling the warm water run over your hands when you’re washing dishes on a chilly fall day, for example, can feel great.
Or being aware of a cool breeze blowing through the office window on a hot summer day, can be a source of pleasure. These moments certainly don’t guarantee euphoria, but they can also help ease or regulate otherwise stressful times that may otherwise challenge sobriety.
If you’d like to learn more about mindfulness-based relapse prevention and other mindfulness- and acceptance-based approaches to treating substance abuse, check out the book Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addiction
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