body of research is the self-medication hypothesis. (1) Based on this
hypothesis, alcohol use often arises as a means of coping with or
medicating other psychiatric problems, and individuals with psychiatric
disorders use alcohol to reduce and manage their symptoms. (2) This may
be explained in terms of negative reinforcement, which suggests that the
reduction in aversive symptoms such as anxiety, following alcohol use,
increases the likelihood of future use. (3,4) From this perspective,
meditation may serve as a useful alternative to alcohol use and may
result in some of the same positive consequences, including tension
reduction and relaxation. In keeping with this, Glasser has described
meditation as a "positive addiction" that may not be
especially reinforcing in the short-run, but which is associated with
long-term rewards such as greater psychological balance and wellbeing.
(5) This is contrasted with "negative addictions," such as
heavy drinking, which are immediately rewarding but related to a variety
of negative consequences in the long run. (6)
Meditation and mindfulness may also provide a useful antidote to
the experience of craving, which is often characteristic of addictive
behavior and is strongly related to relapse following a period of
abstinence. (7) The heightened state of present-focused awareness that
is encouraged by meditation may directly counteract the conditioned
automatic response to use alcohol in response to cravings and urges. In
addition, meditative awareness may be elicited as a response to the urge
itself (6) and may create a pause in the individuals otherwise automatic
and mindless chain of responses and reactions. Furthermore, meditation
may encourage a greater understanding of the impermanence of all
phenomena and an acceptance of one's current experience, even if
this experience is one of tension or craving. This is in direct contrast
to an addictive state of mind that is characterized by an inability to
accept impermanence and a desire to alter one's current experience.
(6)
Greater awareness and acceptance of one's immediate experience
may reduce the risk for relapse in a variety of ways. For instance, two
factors that are strongly related to rates of relapse are negative
emotional states and the tendency to attribute failure (to abstain) to
personal weakness (abstinence violation effect). (6) A more accepting
approach may not only encourage greater tolerance with regard to
difficult emotional states but may also support a more compassionate and
balanced evaluation of one's own actions, reducing the likelihood
of spiraling into a relapse following a brief setback or a stressful
event. In addition, continued meditation practice may increase
self-efficacy, which may further reduce the likelihood of relapse and
increase an individual's capacity to cope with stressful
situations. ( cool
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Finally, excessive drinking may also be conceptualized as a form of
experiential avoidance, which is described as the unwillingness to
remain in contact with one's experience (9) and is related to
various forms of psychopathology. (10) Meditation counters experiential
avoidance by encouraging direct, nonjudgmental, moment-to-moment contact
with one's experiences without attempts at alteration and
manipulation.
A number of different meditation techniques have been utilized for
reducing alcohol use and related problems, including transcendental
meditation (TM), Vipassana meditation, and related mindfulness-based
approaches. (11-13) In TM, the meditator is given a mantra (usually a
spiritual word derived from Hindu philosophy) to repeat silently during
two 20-minute periods each day, usually in the form of a morning and
evening sitting practice with eyes closed. If the practitioner becomes
distracted by thoughts or feelings during the meditation period, the
instruction is given to gently return one's attention to the
mantra. A clinical standardized form of TM has been published by
Carrington and lists several mantras to choose from. (14) TM has also
been described as facilitating a basic relaxation response that may
underlie its clinical effectiveness. (15)
Marlatt and Marques were among the first to apply the practice of
TM as an intervention for high-risk college student drinkers. (16) The
promising initial results led Marlatt and his research team to conduct a
randomized trial comparing TM with two control groups (muscle relaxation
and daily quiet recreational reading, each for two 20-min periods
daily). Results showed that all three conditions reported significant
reductions in alcohol use and associated drinking problems. (17)
In a second randomized trial, meditation and daily aerobic exercise were found to be equally effective in reducing alcohol consumption, with
both groups reducing their drinking significantly more than a
no-treatment control group. ( cool These findings are congruent with the
definition of exercise and meditation as "positive addictions"
that can substitute for "negative addictions" involving
alcohol and other drugs. (5)
Vipassana meditation is rooted in traditional Buddhist teachings.
(11) This 10-day course consists of many hours of daily meditation
(alternating sitting and walking meditation periods) that are held in
silence, except for the oral instructions given by the teachers. Instead
of using a mantra, Vipassana students focus their awareness on the
breathing process and on physical sensations that occur throughout the
body ("body-scan" meditations). The course also includes a
series of hour-long evening discourses that cover basic Buddhist
principles, including the "Four Noble Truths" associated with
the cause and cure of human suffering and the misidentification of the
"self" as a separate autonomous being.
Researchers at The Addictive Behaviors Research Center at the
University of Washington recently conducted a study to evaluate the
effectiveness of Vipassana meditation as a standalone treatment program
for alcohol and drug problems among inmates in a minimal-security prison
located in Seattle. (18,19) Inmates were case-matched to a control group
consisting of prison residents who did not choose to take the 10-day
Vipassana course and were assessed for alcohol/drug problems at a
3-month follow-up following release from incarceration. Results showed
that prisoners who self-selected the meditation course showed
significantly less alcohol and drug use at follow-up, compared with
inmates in the control group. (18,19)
Vipassana meditation is one of several techniques that are designed
to enhance "mindfulness," often described as a heightened
sense of awareness that is open, present-oriented, and nonjudgmental
(enhanced acceptance of the "here and now" wink in its
experiential quality. (6) Mindfulness practice has also been shown to be
effective in reducing chronic pain and reducing relapse among patients
treated for depression. (20,21) Both of these programs consist of eight
weekly outpatient group sessions lasting 2 to 3 hours, plus a weekend
"retreat" that offers a more sustained opportunity to practice
meditation and to apply it as an intervention for either pain or
depression symptoms.
As an extension of these mindfulness-based interventions for pain
and depression, researchers in our lab are proposing the development of
a new cognitive-behavioral treatment program for the treatment of
addictive behavior, "Mindfulness-Based Relapse Prevention"
(MBRP). The overall goal of MBRP is to develop awareness and
nonjudgmental acceptance of thoughts, sensations, and emotional states
through the practice of mindfulness meditation, and to practice these
skills as a coping strategy in the face of high-risk trigger situations
for relapse. (22) Teaching clients about the application of mindfulness
skills to the experience of craving is an important tool in terms of
promoting awareness and acceptance of physical reactions to substance
withdrawal. In this 8-week outpatient group program, participants are
taught specific relapse prevention strategies (enhancing self-efficacy
to cope with high-risk situations for relapse, challenging positive
outcome expectancies, and learning relapse management skills) in
combination with setting up a regular mindfulness practice. Repeated
exposure to being mindful in high-risk situations without giving into
alcohol or drug use in the presence of substance-related cues should
enhance self-efficacy and cognitive coping capacity.
One example of how mindfulness meditation can be helpful in
preventing relapse is known as "urge surfing." (23) In this
procedure, clients are taught to visualize the urge or strong craving as
an ocean wave that begins as a small wavelet that gradually increases in
magnitude until it builds up to a large cresting wave. Using the
awareness of one's breath as a 'surfboard,' the
client's goal is to surf the urge by allowing it to first rise up
and decline without being "wiped out" by giving into the urge.
Clients are told that most urges are classically conditioned responses
that are triggered by environmental cues and emotional reactivity. As
with an ocean wave, the conditioned response grows in intensity until it
reaches a peak level of craving. By successfully surfing the urge, the
addictive conditioning is weakened along with an enhancement of the
client's self-efficacy and acceptance. The process of incorporating
a mindfulness practice and learning to accept and tolerate urges is
compatible with the process of developing a repertoire of coping skills
within relapse prevention therapy.
The empirical literature on approaches that utilize some form of
meditation is promising and may provide an efficacious, low-cost
alternative or supplement to existing treatments for substance use
problems. In addition, research suggests that these approaches are not
only related to reductions in substance use, but may also lead to
improvements in psychosocial functioning, and may extend the duration of
treatment effects by providing the skills to prevent relapse.
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