Mindfulness, Meditation, and
Drug and Alcohol Use
MARCH 18, 2014
Mindfulness, Meditation and Drug and Alcohol
 What is mindfulness?
 Enhancement of mindfulness through meditation
Neurobiology of meditation and drug addiction
Mindfulness Based Relapse Prevention
Addiction and the criminal justice system:
mindfulness programs in jails and prisons
Research program at Chicago State University
Summary and conclusions
“Life is available only in the present moment.”
― Thích Nhất Hạnh
What is mindfulness?
 “Paying attention in a particular way; on purpose, in
the present moment, and non-judgmentally.”
Attention to thoughts, emotions and feelings in the present
Attitude of acceptance/non-reactivity and non-judgement
 A very old concept
 Sati in Sanskrit means “awareness”, also remembrance, an
important concept in Buddhism
 Came into Western languages in the 1970s through work of
Vietnamese monk Thich Nhat Hanh and others
What is mindfulness?
 Can be conceptualized as
 A mental state that varies from moment to moment in an
 A personality trait or disposition perduring over time that can
be measuring with personality inventories
 The goal of mindfulness practice
Five Facets Mindfulness Questionnaire (Baer et al
Dispositional Mindfulness
 Dispositional mindfulness is associated with
adaptive functioning (Baer et al 2006).
Anxiety levels and history of depression (Grossman et al 2004)
less severe gambling outcomes (Lakey et al 2007).
diabetes self-management (Gregg et al 2007).
Many other cross-sectional studies
 Difficulties with the construct of mindfulness as a
trait (Grossman 2011)
Self reports may not be accurate
Experienced meditators may be more aware of their own
limitations and rate themselves as less mindful
Dispositional Mindfulness and Drug/Alcohol Use
Among college age drinkers, relationship to alcohol use is
“paradoxical” (Eisenlohr-Moul et al 2012)
Higher levels of awareness
 Lower levels of non-reactivity
 Lower levels acting with awareness
Sample in drug treatment (Bowen and Enkema, 2014)
Mindfulness inversely related to severity of dependence
Cultivating Mindfulness
 Meditation
 Types of meditation
Concentration or focused meditation, including TM
 Insight or mindfulness meditation
 Certain types of Hatha Yoga
Insight Meditation
 Various eastern traditions including Zen, Vipassana
and Tibetan traditions can be grouped under
mindfulness meditation
 Often builds from awareness of the breath to
awareness of the whole field of phenomena at the
present moment
Can include sitting, walking meditation
 Short demonstration: Mindfulness Based Cognitive
Therapy (0:39:00)
 Several short term or medium term interventions but
for many, a lifetime practice
Neurobiology of meditation
 Types of studies:
 Measurement of brain state changes during meditation vs. rest
or other activities
 Cross sectional comparison between long term meditators,
short term participants in interventions, and/or nonmeditation control groups
Neural correlates of meditation/mindful states in these groups
 Or response to a stimulus such as pain stimulus, emotional
Longitudinal studies before and after meditation training
Comparisons to control group
Neurobiology of meditation
 Structural vs. functional studies
 Healthy samples vs. clinical samples (with symptoms
of depression, addiction etc)
 Evidence from EEG, PET, fMRI, and SPECT
Multiple brain structures affected
 Prefrontal cortex
 Somatosensory regions
 Dorsolateral PFC
 Hippocampus
 Insulae
 Amygdala
 Functional networks
 Eg insula plus somatosensory regions
 Cortex plus limbic system
Neurobiology of meditation
 Cross sectional comparison of long term meditator vs
non meditators show enhanced activity in the PFC,
right anterior insula and right hippocampus (Chiesa &
Seretti, 2010)
 Eight week meditation training increases grey matter
density in hippocampus, cerebellum compared to
controls (Hölzel et al 2010)
Specific or non-specific effect?
Mindfulness Meditation as a Behavioral Therapy
 “Third wave” of therapeutic interventions based on
acceptance of negative thoughts and emotions
rather than attempts to manage or control them.
Mindfulness-based Stress Reduction for chronic pain (KabatZinn 1980)
Acceptance and Commitment Therapy for depression and
anxiety (Hays et al 2006)
Mindfulness-based Cognitive Therapy for depression (Segal et
al 2002)
Dialectical Behavior Therapy for borderline personality
disorder (Hays et al 2004)
Possible mechanisms of clinical benefit
Strengthening connectivity between the cortex and
limbic system (Chiesa, 2013)
Dampen automatic amygdala activation
stress response,
 anxiety and other emotional states
 pain perception
 May be interpreted as an increased conscious control
 Increasing grey matter density in specific regions
(Hö lzel et al 2010)
Before meditation, high emotional
reactivity is observed. The amygdala easily
activates in response to negative stimuli
and the PFC is not able to inhibit the
amygdala. (Chiesa et al. 2010)
After meditation training, amygdala
activity is usually reduced. If amygdala
activates in response to negative stimuli,
PFC is engaged in order to dampen
automatic amygdala responses. (Chiesa et
al 2010)
Neurobiology of addiction
 Effect of drugs of abuse is related to the mesolimbic
reward system: ventral tegmental area, ventral
striatum, amygdala and medial PFC – the “reward
 Compulsive use also involves the dorsal striatum –
“habit circuit”
 Addiction also involves dysfunction in the cortex,
including dlPFC and activation of subgenual ACC
Effect of mindfulness meditation training
 Mindfulness training primarily targets the cortex; at
least initially, a “top down” process of improving
control over functioning
 Self referential thinking and rumination activate
midline PFC areas in both depression and addiction
(Brewer et al. 2009)
 Mindfulness practice may shift activation from
midline PCC to dlPCC – more objective awareness
 Lateralization of brain activation
Effect of a brief mindfulness meditation
 47 treatment-seeking smokers (12-h abstinent from
smoking) viewed images while undergoing fMRI
(Westbrook et al 2011).
Passively vs. trained to engage in mindful attention
 Mindful attention reduced neural activity in
subgenual anterior cingulate cortex (sgACC)
 Reduced connectivity with other craving related
regions including insula and ventral striatum
 Also reduced self-reported craving (Westbrook et al. 2011)
Effect of a brief mindfulness meditation
 47 treatment-seeking smokers (12-h abstinent from
smoking) viewed images while undergoing fMRI
(Westbrook et al 2011).
Passively vs. trained to engage in mindful attention
 Mindful attention reduced neural activity in
subgenual anterior cingulate cortex (sgACC)
 Reduced connectivity with other craving related
regions including insula and ventral striatum
 Also reduced self-reported craving (Westbrook et al. 2011)
Top-down or bottom-up process?
 Experienced meditators exhibit changes in limbic
system functioning during meditation that are
independent of cortical control.(Chiesa et al 2013)
 May depend on length of involvement in meditation
 May depend on type of sample: healthy vs. clinical
samples (eg smokers trying to quit)
Mindfulness Based Relapse Prevention (Chawla et al
 Based on Mindfulness Based Stress Reduction
 An eight week course including meditation, yoga,
and discussion of relapse, triggers, and relapse
 Designed for individuals coming out of drug
Mindfulness Based Relapse Prevention
 In a randomized controlled trial (RCT), significant
reductions in substance use and craving were
observed in the MBRP group compared to treatment
as usual (Bowen et al, 2009b)
 A second RCT compared mindfulness meditation to
cognitive behavioral therapy for substance use and
found reduced craving and physiological stress
indices in the treatment group (Zgierska et al 2010)
Mindfulness Based Relapse Prevention
 Might have particularly long-lasting effects on
reducing drug use (Zgierska et al 2009).
 However, strong evidence for effectiveness of
mindfulness-based treatment for substance use
disorders is still lacking. (Zgierska et al 2009)
Difficulties with MM in drug treatment
 Anxiety in early withdrawal (Vallejo et al 2009)
 Restlessness/agitation
 History of trauma
 An adjunct, not a substitute for drug treatment
 May require a period of abstinence from substances
Research at Chicago State University
 Urban Mindfulness and Addictions Research
 MBRP in jail drug treatment
 Mindfulness with case managers: enhancing the working
alliance and therapeutic outcomes
 Mindfulness, substance abuse, and medication adherence
 Drug discovery program as adjunct to mindfulness therapy
Addiction and the Criminal Justice System
 More than 60% of prisoners are estimated to have a
substance use disorder(National Center on Addiction
and Substance Abuse 2010)
 In Cook County the majority of detainees are charged
with low level drug offenses(Lyons et al 2013)
Addiction and the Criminal Justice System
 Five fold growth in incarceration rates among people
of color since 1980 has largely been a result of drug
related arrests and convictions(Alexander 2010).
 African Americans are 54% of those incarcerated for
drug offenses and are 10 times more likely than
whites to be sentenced to prison for a drug law
violation(Human Rights Watch 2000).
 Cycles of repeated arrest and imprisonment for drug
related crimes often reflect untreated
addiction(Langan and Levin 2002).
Addiction and the Criminal Justice System
 Much mindfulness meditation research has been
with white, middle class patients.
 No studies of mindfulness meditation that focus on
cultural adaptations for African American men.
 Meditation training in a jail context
Limited in duration
Linked to post-release services
Participants should be over the acute withdrawal stage
Why meditation programs in jail?
 7x as many individuals released annually from jails
as from prisons
 Many jails have existing drug treatment programs
 Enforced abstinence may promote benefit of
mindfulness training
 Mindfulness training may promote engagement in
Goals of the study
 Culturally tailor the MBRP intervention for an
urban, primarily African American population of
 Test efficacy via a quasi-experimental clinical trial
within a men’s drug treatment program at the Cook
County Jail.
Goals of the study
 At 5-month intervals over the course of 36 months,
successive cohorts will be given either mindfulness
training or an attention control communication skills
 Pre- and post-test assessments, at an equivalent
interval, of mindfulness, psychological symptoms,
and PTSD symptoms.
 Participants in the experimental condition will be
referred to post-release meditation groups
Goals of the study
 To assess the efficacy of the intervention,
 rearrest and reincarceration data will be compared for the
treatment and control groups at a minimum of 12 months post
 Contact participants by telephone 3 months post release and
obtain self reported substance use data
 qualitative interviews with a subset of participants in the
experimental group one month post-release will explore
whether and how they implemented mindfulness
Formative research to adapt intervention
 Focus group
 Working with African American, culturally
competent trainers
 Adapting and simplifying manual Mindfulness Based
Relapse Prevention: A Clinician’s Guide (Chawla et
al. 2011)
Some conclusions
 Mindfulness as an attentional state, personality trait,
and goal of meditation practice
 As a trait, mindfulness is probably important for
understanding addiction, but research is just
Related to deficits in executive functioning, impulsiveness, and
sensation seeking
Some conclusions
 Meditation practice changes brain structure and
functional circuits
Most studies cross sectional and involve small samples
Prospective studies with appropriate control groups needed
 Meditation training may be a potent tool in drug
addiction treatment
May have long lasting effects
Stage and context of recovery important
Linking behavioral and pharmacological treatment
Thank you!
[email protected]
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