The origins of
meditation are found within religious and spiritual practice set many thousands
of years ago. Modern western forms of
meditation may have originated from The Islamic practice of Dhikr, Taoist China, Western Christian prayer and contemplative
meditations but the interest, and growth of
meditation generally in western culture in recent decades has settled pointedly
on the concepts and applications of mindfulness originally from the Buddhist Theravanan tradition.
The
focus of this article will be set on Buddhist mindfulness meditation within a western
therapeutic context in the midst of the vast interest in research as well as
social and therapeutic communities in this tradition. A discussion
on the applications of mindfulness meditation within addiction treatment
contexts and the ability of meditation to co-exist and support current
methodologies such as twelve step facilitation and cognitive behavioural
therapy will be debated. The use
of Buddhist mindfulness meditation alongside the current treatment trends in
the area of addiction and co-morbid mental health will be a specific focus.
Our
understanding of addiction certainly benefits more from a Buddhist-style
perspective on normal development which identifies the minds natural predisposition
to fixate on desired goals than from the disease model favoured by Western
scientists and doctors. Although it is apparent that powerful and possibly
permanent neurological changes occur in addiction (Tang, 2010, p107), (Romero,
2010, p57), Sussman, 2001) it is not the whole story. The Buddhist perspective places
an emphasis on the importance of mindfulness and self-control to provide
release from unwholesome attachments. This recent
research points to a useful therapeutic role for mindfulness meditation in a
number of medical and psychiatric conditions such as depression, anxiety and
the obsessions and compulsions surrounding addiction. Buddhism, from where
mindfulness based meditation originates, posits that suffering originates from
our desires and attachments. This perspective describes the processes of
addiction succinctly.
At the centre of Buddhist psychology are the
fundamentals of the mind; clinging, concentration, and mindfulness. Clinging is seen as the grasping of the mind,
concentration is seen as the minds focus and mindfulness refers to the minds awareness.
Physical and emotional pain originating from this clinging is the cause of
suffering and a motivation for individuals to self medicate through substance or
process abuse (Khantzian, 1985, 1990).
It can be seen, in this context that individual’s turn to substances and
processes to alleviate psychological suffering. The craving and grasping create emptiness and loss which leads
to the seeking of something to alleviate suffering. This is the point of craving and addiction is
the deepest form of craving. The obtaining of pleasure or relief from suffering
then reinforces attachment to that object whether high achievements, material possessions,
drugs, alcohol or the rush from the process of gambling. This suffering can be
seen as both the initial cause of addiction and the motivation to find recovery
(Chen, 2010). In Buddhist psychology the craving, desires and associated addictions are seen as
three root causes of human suffering and these addictions are merely the
expression of normal desires transformed into obsessions.
Western
addiction science and treatment schools of thought see addiction as a primary,
chronic, neurobiological disease, with genetic, psychosocial, and environmental
factors influencing its development and manifestations. The American Society for
Addiction Medicine (2012) characterizes
addiction by behaviours that include one or more of the following: impaired
control over drug use, compulsive use, continued use despite harm, and the craving
of desired substances or processes. With
the growth of addiction medicine and scientific research into addiction, the
inclusion of both substance and process addictions, has taken on a broader
definition of addiction.
Current thinking of those working in this
modality such as Marlatt (1987) support maintaining the term craving as a form of
psychological attachment where cue stimuli can elicit both craving and
aversion. This craving is seen to be motivated by external cues as in Buddhist
psychology. A number of leading addiction and mental health
professionals are currently experimenting with applications for psychological treatment.
Segal, Williams, & Teasdale (2002) have researched and worked with
mindfulness based treatments for depression, Jon Kabat Zinn (1992) has
developed a mindfulness based program to avoid stress relapse, and Marlatt
(1995) has combined cognitive behavioural therapy (CBT) with mindfulness
techniques for addiction combining both the cultivation of mindfulness and
concentration.
Buddhist
wisdom has found balance in concepts of mindfulness and in fact, may be seen as
an antidote to this progression to craving while western cultures have appeared
to create and support suffering through desire orientated pathways focusing on
achieving and obtaining. The associated anxiety, depression,
obsessive/compulsive and addictive behaviours can be seen as directly
correlated to the clinging and craving that this path creates. There are strong foundational similarities however, between
Buddhist concepts of craving and the importance placed on cravings and
compulsions within addiction treatment programs. Both see craving as the most critical factor
for an end to suffering.
Cravings
or desires often come disguised in the form of a longing for peacefulness and relaxation.
It is, therefore possible for the desire for peace to be fulfilled by mindfulness in place of addictive substances and
processes. Conscious breathing helps to
collect the scattered workings of the mind and volatile emotional turmoil of
early recovery through mindful observation. The act of understanding the state
of unawareness and the associated emotional involvement in the state of “mindlessness”
can halt the internal triggers. In the
place of mindful awareness, emotional and mental involvement is
alleviated. The position of mindless
emotional involvement can set an individual in early recovery on the path to
relapse without any awareness of how they got there. Mindfulness meditation creates the
opportunity to noticing cravings before they take hold, provides the ability to
experience cravings without needing to react to them and the strength to deal
with or alleviate stress, anxiety or depressed mood. This ability to relate to
unpleasant experiences with clear awareness and gently let go of resistance by
staying with it allows the craving to dissipate naturally. The value of including
formal meditation in addiction recovery creates a momentum of attention and
observation throughout the day lessening a spiral towards “picking-up” and
further providing profound insights into the nature of both the addictive
process and self.
It is the awareness that mindfulness
meditation brings that observes the rising and falling away of emotions and
thoughts. The development of a strong sense of awareness aids with “just sitting”
with difficult feelings without acting on them - sitting with uncomfortable
feelings in not a strength of those struggling with addictions. However current
therapeutic techniques such as “urge surfing” do need a deeper understanding
through further guidance in Buddhist concepts as the clinging and craving
cannot be tricked away – the mindless state will always return with rising
anxiety and the associated obsessions and compulsions which become all
consuming. Understanding, attention and
a focus on practice are needed as a life choice.
Craving is a formidable adversary.
The mindful
awareness and self inquiry contained within Buddhist vipassana meditation are
powerful tools for recovery that encourage the development of personal insights
about the original source of cravings. Having the ability to observe your
thoughts and feelings as they arise without judgement or becoming attached to
them empowers the individual to create the opportunity to become aware of the subtle
patterns, habits and internal triggers around addictive behaviours. With awareness
of these triggers and behaviours, plans and strategies can be developed through
supporting modalities such as cognitive behavioural therapy (CBT). The
development of simple breathing and awareness techniques create the ability to
control anxiety and panic, and calm the sporadic internal chaos of the mind in
early recovery in particular. Developing
these CBT skills alongside mindfulness meditation assist in short circuiting
automatic negative thoughts and internal dialogues, overcome the obsessions and
compulsions of the addicted brain and increase attention and focus on the here
and now. Marlatt’s
Mindfulness Based Relapse Prevention is a combination of mindfulness and
cognitive behavioural therapy is a successful treatment protocol particularly in
the first three months of recovery.
Substance
and process abuse and addiction triggers stem from anxiety which is future
orientated and mindfulness meditation creates an opportunity to develop
mindfulness based stress-reduction techniques and meditation practices set in
the present moment to strengthen recovery. The role of meditation in
addiction recovery is fast becoming the jewel in the practitioners treatment
toolbox after many decades of punitive and pharmacotherapeutic treatment
options. Therapy now more than ever, seeks to free individuals and
groups from suffering with inbuilt mantras of “empowerment” and “do no harm.” Current
effective treatment options utilizing meditation and mindfulness teachings are
have very positive results in many drug and alcohol addiction treatment settings. Two other current successful examples of therapeutic mindfulness are Mindfulness
Based Stress Reduction (MBSR) (Kabat Zinn et al.,1992,) and mindfulness-based cognitive therapy (MBCT) Segal Z. V, Williams, J. M. G., & Teasdale,
J. D. (2000) both of which include significant attention to mindfulness
meditation Research
has indicated MBCT reduces risk of relapse with depressed patients by teaching
relapse prevention skills. It combines psychological education from cognitive
therapy for depression with intensive practice of mindfulness meditation.
Twelve step facilitation (Alcoholics Anonymous - AA and Narcotics
Anonymous - NA) which are compatible with mindfulness meditation have long
struggled with the inclusion of a God concept or higher power. These current interventions therefore, are designed to be
culturally and ideological removed from concepts of religious underpinnings to
attract support and uptake from clinicians
and those with a wide range of diagnoses ( Kabat Zinn,
2003). MBSR has been designed as a therapeutic program for
the relief of suffering through body and mind (Kabat Zinn, 2013) and is foundationally
and functionally compatible with the original ethics of Buddhist mindfulness
practice.
The effective treatment outcomes recently seen when
dealing with drug addiction appear to originate in the physiological
response to the techniques of mindfulness.
Those in recovery who utilized daily meditative practices in conjunction
with spiritual based programs such as Alcoholics Anonymous and Narcotics
Anonymous may exhibit greater long term recovery outcomes thus delaying relapse
into addiction and ensuring greater opportunity to attain the path back to
abstinence. Research consistently supports the hypothesis of maximized potential
for abstinence outcomes when mindfulness meditation is integrated with existing
treatment protocols. Bowens (2009) research supports the efficacy of mindfulness-based
relapse prevention therapy for lowering relapse rates and supported a statistically
significant reduction in cravings, higher levels of awareness and acceptance.
In recent years the Buddhist philosophy of mindfulness and the12
Step philosophy similarly have provided those in recovery with a new resource
and fresh perspective for developing their own spiritual path. Through
examination of the Twelve Steps and the interchange of ideas between Twelve
Steps and traditions and the bringing of awareness to focus
mindfully on the present moment both
spiritual and mental components of recovery are strengthened. Both the 12 steps
and mindfulness practice help in the cultivation of a breath between feeling and
craving. However, there are some differences in thinking. For example, 12 step philosophy along with neuroscience, is that an addict is
an addict for life. Buddhism’s dynamic
view of addiction rejects such static conceptions and prefers to embrace the
potential for positive mental transformation. Buddhism also teaches that
aversion to something is similarly problematic to the original craving and the
ideal state is non-attachment. The
cyclic nature of craving and aversion can only be seen, through a Buddhist
perspective, as insanity. Fortunately, the average person in early recovery
does not need to address such philosophic concepts and therapists and recovery
communities would be wise to cautiously leave such debate to later days.
The body of evidence for the power of meditation in
addiction treatment is growing. The aim of individuals who participate in
meditative practices during recovery is to gain higher levels of coping skills,
as well as a heightened awareness of substance abuse triggers that aided
addiction recovery. (Bowen) found reduced rates of abuse in released
prisoners who learned the Vipassana meditative technique with fewer relapses
and a decrease in co morbid mental health issues.
Interestingly even in the face of concern from
many who are troubled by Theist inclusion, Sussman (2001) established the
effects of both prayer and meditation on dopamine levels created increases in
subjective well being and a sense of calm through neural pathways which had, in
addiction, been produced by the addictive substance or process. The effects of
meditation indicate a similar effect on all processes and psycho-stimulant
substances including nicotine addiction.
Mindfulness practice also correlates with a reduction in withdrawal
symptomology, increased positive mental attitude in relation to ability to
obtain and maintain abstinence (Vidrene 2009).
The discovery of neutral plasticity means that we can now
understand how the brain is designed to change. The brain has evolved to
connect desire and acquisition, wanting and getting, and that connection
depends on the tuning of synaptic networks to a narrow range of goals. With the help of dopamine, meditation can
stabilise or even change these neural pathways. The ability of the brain to
change the way it functions through cognitive processing mirrors meditations
ability to alter brain function and produce neuronal stress-alleviation, reduce
strength and frequency of triggers, withdrawal symptoms and cravings in both
early and long term recovery, significantly lowering relapse rates. It is also
now known that meditation and psychoactive drugs affect the same areas of the
brain. (Romero, 2010), (Tang, 2010).
Craving
is what all addicts’ battle. Craving is what leads to addiction and craving is
what destroys recoveries across the world.
Most treatment options focus on this concept of craving with fear and awe
yet no understanding of this phenomenon has come as close to the depth of
understanding that comes with the teachings of Buddha and the solutions of
mindfulness practice. The power of
combining current western treatment options with this eastern psychology has
changed the face of addiction treatment and created new hope for the many
individuals struggling with this devastating neurological and spiritual
experience.
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