Addiction and Recovery: How Mindfulness May Help

An itchy sensation develops on your neck. Your first instinct is to scratch. But instead of reaching for the area, you wait for a second, studying the sensation. Is there another way to manage what you’re feeling?

This is the premise behind using mindfulness to treat urges related to substance use, explained Nicholas Barr in an article for the USC Suzanne Dworak-Peck School of Social Work website. 

“So much of the internal narrative around cravings is not being able to handle it,” Barr said. “What you get from mindfulness is the realization that you can deal with this; you can tolerate this.”

Barr, a postdoctoral scholar at USC, is head clinician for a new study being conducted by a team of experts at USC that will explore the effectiveness of using mindfulness to treat substance misuse and PTSD. A group of young adults in the study will receive mindfulness training on meditation, self-compassion and sitting with uncomfortable thoughts to assess the effects on recovery in comparison to a group who will not receive the training. The trainings are meant to work in conjunction with traditional recovery strategies such as cognitive behavioral therapy.    

“What you get from mindfulness is the realization that you can deal with this; you can tolerate this.”

This study will add to the growing body of research aimed at determining whether applying mindfulness to addiction recovery may help reduce drug cravings and create a healthier response to triggers. Using this meditative tool may enable people struggling with addiction to sit with their discomfort and avoid turning to substance use.

“We always think we don’t have enough time to sit with ourselves,” said Murali Nair, an expert in mindfulness and professor of social work at USC Suzanne Dworak-Peck School of Social Work. “But we do. Mindfulness is about living with a purpose all of the time.”

In his book, Coming to Our Senses: Healing Ourselves and the World Through Mindfulness, author and expert Jon Kabat-Zinn describes mindfulness as “moment-to-moment, non-judgmental awareness, cultivated by paying attention in a specific way, that is, in the present moment, and as non-reactively, as nonjudgmentally, and as openheartedly as possible.”

“Our minds work very fast, so mindfulness helps us slow down and essentially program ourselves.”

More plainly put, mindfulness helps people focus on their thoughts and feelings without negative judgment or attachment, Nair explained. It’s meant to be incorporated in daily life through practicing awareness, which fuels relaxation and calmness.

“Our minds work very fast, so mindfulness helps us slow down and essentially program ourselves,” he said. It can also help people develop more of an optimistic outlook and improve self-esteem holistically.

According to the American Psychological Association, training oneself to be more attentive and aware can enable an individual to have more control over their thinking, disengage with emotional reactions and more effectively self-regulate. Other benefits of mindfulness include:

“The mindfulness approach is good for all of us to practice,” Nair said.

He pointed out that although Western scientists have only recently begun using this approach to treat ailments like addiction, Far Eastern and Native American cultures have been practicing mindfulness for thousands of years.

According to the National Institute on Drug Abuse, addiction is characterized by uncontrollable drug seeking and use that leads to brain changes. While substance misuse often starts as voluntary, it can become compulsive over time and can affect parts of the brain dealing with reward and motivation, learning and memory, and behavior control.

Mindfulness can play a key role in mitigating addiction relapse by bringing attention and awareness to the present moment, explained Katie Witkiewitz, an expert in addictive behavior relapse and addiction treatment. In her view, it allows for people to sit with distress and discomfort that comes with drug cravings, slowing down their automatic response to turn to substance use.

“There are people who really don’t want to use substances, but they’ll say in that moment they felt that they had no choice,” Witkiewitz said. “And so what mindfulness does is basically pause that whole process and helps a person not be on autopilot when triggers happen.”

“Mindfulness can play a key role in mitigating addiction relapse by bringing attention and awareness to the present moment.”

Alongside her colleagues, Witkiewitz was one of the first psychologists to help develop mindfulness-based relapse prevention (MBRP). The group-based, eight-week treatment teaches people how to respond to triggers or cravings more healthily and trains them to notice the craving and allow it to subside and eventually pass — sometimes called “urge surfing.” According to a study on mindfulness-based treatment of addiction published in Addiction Science & Clinical Practice, being cognizant of one’s individual moment-to-moment experience enables people to deconstruct urges as a sensory component separate from themselves. The nonjudgmental approach also helps to prevent people from feeling shameful about experiencing a drug craving.

The goal is that with regular practice in daily life, mindfulness becomes more habitual when triggering moments hit.

“It’s not about teaching explicit ways of reappraising thoughts or teaching people to avoid people, places or things,” Witkiewitz said. “Mindfulness is more about changing how we live our lives.”

There are multiple mindfulness exercises people can engage in to gain more control over their thoughts. Some may be more focused specifically on helping people deal with triggers or cravings, while other exercises can be incorporated into everyday routines. 

MINDFUL BREATHING

Mindful breathing requires a person to observe their own breathing and pay attention to each inhale and exhale. Nair introduced several ways to practice mindful breathing.

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1. Count your breath. Take three deep breaths.
2. Holding your breath inside, count to six.
3. Exhale counting six, pause for three.
4. Repeat this three times. 

1. Open your mouth as much as possible as you inhale deeply.
2. As you exhale, make a very loud “ah” sound.
3. Repeat and release the breath.
4. Widen your mouth, showing the teeth.
5. Inhale and exhale the “ee” sound.
6. Open your mouth, but not as wide.
7. Inhale and exhale the “oh” sound.

1. Cross your hands and grip your opposite earlobes with your thumb and index fingers, applying a little pressure.
2. Breathe in and out.
3. Hold the breath and then bend down when letting out the breath.
4. Inhale and rise.
5. Exhale and come down.
6. Do this 11 times.

BODY SCAN

A body scan requires a person to bring attention and awareness to each part of the body in an upward motion from the feet to the head. Psychologist Shilagh Mirgain wrote a body scan script (PDF, 322 KB) for the Veterans Health Administration.

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1. Start by observing sensations in your feet. Wiggle your toes.
2. Continue observations to ankles, calves, knees and thighs.
3. Observe sensations throughout legs. Breathe into and out of the legs.
4. Focus on sensations in your lower back and pelvis. Soften any tension.
5. Move up toward your mid and upper back. Be mindful of the sensations in your muscles and temperature.
6. Exhale and let go of the tension.
7. Feel your heartbeat and observe how the chest rises and falls.
8. Continue up to neck, shoulder, throat and then scalp.
9. Let your breath expand to include the entire body as a whole.

SOBER SPACE

Witkiewitz played a significant role in helping to develop the SOBER space exercise, which centers on slowly coming into the moment, focusing on the body and observing breathing.

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1. Find an area to meditate in. This could be on a park bench, in a quiet room, on the bus with headphones on or anywhere you have an opportunity to sit with your thoughts.
2. S — Stop whatever action you’re about to do in a triggering moment.
3. O — Observe the breaths and body sensations; drop into the body.
4. B — Breathe, bring awareness to your breath, and pay attention as you inhale and exhale.
5. E — Expand awareness, recognizing you’re a body in this room, in this situation.
6. R — Respond mindfully. Come into the present moment and respond with some choice of how you want to respond in that situation.

Again, mindfulness exercises aren’t meant to be the sole means of treatment for people who experience cravings. And people who are experiencing signs of addiction or who are in recovery should consult with their physician who may refer them to the appropriate professional medical or psychological treatment.

But mindfulness can be one more tool in a person’s arsenal to overcome their struggles with substance misuse and improve their day-to-day functioning.  

“Mindfulness is about accepting and being proud of who you are,” Nair said. “You bring the change you want for your life.”

Citation for this content: The MSW@USC, the online Master of Social Work program at the University of Southern California: