Addiction is a chronic illness characterized by the use of a psychogenic substance despite negative consequences associated with its use. Biological dependence is marked by cravings, increased dose and/or frequency of use due to tolerance, and withdrawal symptoms upon cessation of substance abuse. Addicts gain pleasure via the neurotransmitter dopamine, which is released from the ventral tegmental area of the brain and into the nucleus accumbens. This reward encourages and solidifies the addictive behavior and symptoms of withdrawal corresponding to a decrease in dopamine at the level of the nucleus accumbens (Cami and Farre 2003). Currently, substance abuse research focuses primarily on neurobiological aspects of addiction, and does not address the mind. Despite the mysterious nature of the mind, the medical community must not ignore its relevance in the treatment of addiction.
The brain is an exquisitely complex organ and the nature of how consciousness arises from it is a mystery. The brain and the mind are two entities, but each is virtually inseparable from the other. Much like a computer, the brain acts as the hardware, while the mind, as the software. It is generally thought that the intangible experience of consciousness is mediated by the human mind. The origin of mindfulness resides in Buddhist teachings which began in India and spread to eastern societies. Siddhartha Gautama, who is better known as the Buddha, shared that the right state of mind, or mindfulness, was the pathway to the ultimate goal— enlightenment. The mind allows us to experience the thoughts, memories and feelings produced by our brains. Our self-consciousness, or the ability to be aware of one self, is a trait possessed by few species on this earth. We believe this introspective quality ultimately provides human beings with control over their actions. Being aware of the present moment allows people to choose how to respond to their environment instead of simply reacting to a situation based on past experiences (Appel and Kim-Appel 2009).
The relationship between neurobiological structures and mindfulness is an area that is currently being studied. In 1996, researchers were able to demonstrate an increase in blood flow to both the frontal and occipital regions of the brain during transcendental meditation. The findings of increased blood flow correlate with higher rates of metabolism and cerebral activity (Jevning et al. 1996).This is particularly important because occipital regions of the brain are involved in visual processing while the frontal regions of the brain are associated with reward, attention, executive planning and motivation. Another group of researchers used PET scans to visualize cerebral blood flow distribution in subjects while in a normal state of consciousness and again during a form of relaxation meditation called yoga nidra. The scans showed that during meditation, there was increased activity in several parts of the brain involved in executive cognition and attention, further supporting the link between the brain and mindfulness (Lou et al. 1999). Another study utilized fMRI to study brain activity in subjects practicing Kundalini meditation. They found increased activity in several brain structures involved in attention and autonomic control (Lazar et al. 2000). While the neurobiological origin of mindfulness is still in its infancy, intuitively, it should be given greater consideration in the treatment of addiction.
We hypothesize that the incorporation of mindfulness into substance abuse treatment is essential for achieving abstinence. When an addict continually accepts the urges and compulsions to use, this reinforces the patient’s addiction circuitry. However, if neurological changes due to addiction were fixed and solely neurobiological, how could any addict recover from their addiction? Thus, any addict who successfully recovers from addiction must eventually gain control over their circuitry by making up their mind to quit. We believe if these resilient individuals make a conscious effort to authenticate their lives in accordance with their values, in spite of what thoughts or urges are produced by their brain to keep using, then abstinence can be achieved. The addict must do his or her part to re-direct their thoughts. By elucidating this connection, we believe current substance abuse treatment methods can be expanded.
Past studies support the use of mindfulness in the treatment of addiction. Bowen et al., conducted a study of the effects of mindfulness meditation on individuals with substance abuse problems in an incarcerated population. They evaluated the effect of mediation on both substance use and psychosocial outcomes after release from incarceration. Participants were offered a Vipassana meditation course, where participants were taught to observe themselves without judgement or reaction. They were taught to recognize that feelings such as cravings were temporary events that do not necessarily warrant action. By recognizing these thoughts, they able to observe and dissipate the learned thoughts advocating substance abuse. The results of the study were promising: those involved in the meditation course were less likely to use alcohol, marijuana and crack cocaine compared to those who were not involved in the course (Bowen et al. 2006). Moreover, cognitive behavioral therapy (CBT) is a large part of the substance abuse treatment regimen and teaches what could be considered modern day mindfulness. One of the main focuses of CBT is relapse prevention, where an individual is taught to recognize both cognitive and situational triggers for substance abuse and coping methods to prevent use. A meta-analysis of randomized controlled trials of CBT in adults with alcohol and illicit drug users showed a significant effectiveness across a large and diverse population providing continued support for its use (Magill and Ray 2009). While these studies demonstrate a possible role for mindfulness in addiction, further studies are necessary to encourage widespread acceptance for the role of mindfulness in addiction.
We believe that the future of addiction medicine lies in a multi-faceted, evidence based treatment program which includes mindfulness-based therapy. By improving awareness, developing strengths and personal values, we hypothesize that mindfulness will reduce relapse rates and achieve abstinence in the addiction population. Whether it be meditation, yoga or CBT, any regularly scheduled activities that keep an addict present and mindful should be integral to any treatment plan.