Cover Letter

To: Prof. Kimberly Freeman, COLWRIT 161

From: Mark McLaughlin

Date: August 2, 2022

This article will be submitted to the American Psychological Association’s website, in

the “resources” section of the “substance use, abuse, and addiction” topic. This website is

frequented by mental health professionals. The specific section of the website this article would

be posted to is most likely to be read by the target audience of addiction treatment providers.

Because this is the intended website for publication and the target audience has basic

background knowledge and interest in the topic of addiction treatment, the article makes specific

recommendations for incorporating mindfulness practices in substance abuse treatment

programs. The article then presents an overview of two prominent techniques, then summarizes

the results of studies done on their impact on treatment outcomes. Next is a section which covers

the current understanding of how mindfulness training improves executive functioning, and why

this matters for the addicted brain in particular. Finally, recommendations are offered for

treatment providers on how to incorporate these strategies into their treatment protocol and how

to help further the field’s understanding.

 The Benefits of Mindfulness Training for Addiction

Addiction treatment has come a long way in recent decades. However, a majority of those

who attempt sobriety still fall back into addiction. Therefore, treatment providers should employ

research-backed treatment approaches with the highest rates of proven success. One promising

treatment modality is mindfulness training. Consider incorporating mindfulness training

alongside typical therapy-based treatment for addiction; it might be the missing ingredient your

patients need for long-term recovery.

Mindfulness meditation for addiction involves a clinician-led session of body scans, breathing exercises,

and techniques for developing non-judgmental awareness of internal experiences.

(GuidedMeditationFramework.com)
 Two prominent approaches for this type of training are Mindfulness-Oriented Recovery

Enhancement (MORE) and Mindfulness-Based Relapse Prevention (MBRP). In both these

strategies, a clinician guides a group through a series of body awareness exercises and

breathwork techniques. The practitioners are instructed to mentally note any thoughts and

emotions that arise during the session. However, they are also told to not resist anything that

comes up. Instead, the intention is to recognize the internal states which occur and to accept them

without resistance. By observing states in this way, participants learn to sit with negative

thoughts and emotions and also learn firsthand the impermanent nature of these states. Following

a session of MORE or MBRP, the participants discuss their subjective experiences and the

clinician provides feedback and instruction.

The key differentiation between MORE and MBRP involves how the clinician leader

helps the group process their experiences. MBRP focuses solely on mindfulness practice.

Participants are taught traditional meditation techniques with the goal of improving their ability

to accept their current state without any self-criticism or judgment. On the other hand, the

MORE approach teaches these skills, but also incorporates components from Cognitive-

Behavioral Therapy (CBT). The leader uses these elements to show participants how to “catch”

maladaptive thought patterns and reframe them before they transform into negative emotional

states. MORE also teaches practitioners how to appreciate positive thoughts and emotions when

those arise.

In this way, both MBRP and MORE use mindfulness as a way to become more aware of

one’s thoughts and emotions. While MBRP solely emphasizes non-judgemental awareness of

subjective experiences, MORE aims to extend this awareness into cognitive action using

reframing and savoring techniques.

 Treatment Outcomes

Both mindfulness-based treatment modalities have shown significant positive effects on

treatment outcomes. A 12-month study conducted by Bowen, et al., measured the impact of 8

weeks of once-per-week MBRP sessions on 268 participants who all self-identified as substance

addicts. Both rate of relapse and days of substance use were lower for the treatment group which

received MBRP sessions1. Similarly, MORE interventions led to significantly lower levels of

stress, craving, and substance abuse in several studies involving addicted individuals2. While

both interventions have been shown to improve treatment outcomes, further research is

recommended to compare the two approaches in a side-by-side study.

So, we know that mindfulness training helps the odds of addicts staying sober. Studies

also suggest that the sessions improve their general quality of life by lowering pain, stress, and

levels of co-occurring disorders such as depression and anxiety1. Now, why do these

improvements happen, and how exactly does mindfulness benefit the brain?

Mechanisms of Mindfulness

Neuroimaging studies of addicted brains show that as the disease of addiction progresses,

the addicted individual gradually loses their ability to exercise self-control3. This happens

because of the reward circuitry in the brain. Our brains are powerful association-making

machines that evolved from the bottom up. The trouble is, strong synthetic substances did not

exist when this neural circuitry evolved. In the presence of unnaturally potent rewards, the

midbrain structures which developed eons ago are awed by the flood of neurotransmitters these

substances produce. As far as the ancient midbrain knows, the flood of chemicals is a result of

achieving natural rewards in the environment.

 Addiction is a disease which leads to harmful adaptations in the brains of those affected. (VectorStock.com)

Our evolution wants us to pursue those rewards again. This means that our ancient,

emotion-driven limbic system wants to repeat these experiences. Fortunately, we have evolved

the ability to think and choose long-term benefit over short-term pleasure. This function comes

from our prefrontal cortex, often referred to as the “seat of consciousness.” And, for most

individuals, the prefrontal cortex does a commendable job of allowing us to moderate substance

use or to stop when we realize things are getting out of hand.

 However, for a host of environmental and biological reasons, a segment of the population

is unable to moderate or stop their substance use. This is because the disease of addiction has

taken hold. Their ancient midbrain structures now hijack the entire brain when a substance is

available. In pursuit of that reward, the prefrontal cortex is essentially bypassed as the limbic

system takes over. Addiction has its grip on the reward system, and the addicted person appears

to have lost their capacity to exercise self-control. This is why studies which compare addict’s

brains to those of non-addicts report far lower activity in cortical regions associated with higher

thought and long-term planning in the addict groups3.

Speeding Neurological Repair

Fortunately, this neurological damage does appear to return to baseline levels given

enough time of abstinence from substances4. The difficulty is in maintaining sobriety long

enough for this neuroplasticity to take effect. It’s a conundrum: how to stay sober while the brain

heals, when that very healing process is what is needed to stay sober?

Research teams have tested various cognitive enhancement strategies in attempts to speed

the rate of neurological repair5. In combination with typical treatment involving cognitive-

behavioral therapy, 12-step programs, and community support, these strategies show some

benefit. However, most do not increase participants’ overall state of well-being and involve visits

to a specialized laboratory. That is why mindfulness-based cognitive enhancement approaches

show such potential.

 Increasing the speed of neurological repair improves addicts’ ability to make the right decisions for their

sobriety. (VectorStock.com)

Mindfulness exerts its positive effects by improving the executive functioning skills

associated with the prefrontal cortex. These skills include attention, emotion regulation,

inhibitory control, working memory, and the ability to moderate stress6. Because activity

decreases in the brain regions associated with these executive functions due to addiction, it is

vital to strengthen neural connections in these cerebral structures. By repairing the activity and

connections in these regions, these executive functioning capabilities return to baseline levels

more quickly7. And it does not take much mindfulness to show an effect: one study showed that

a single 11-minute mindfulness session lowered rates of substance use for an entire week8.
 A host of studies have now shown that the benefits of mindfulness meditation practices

merit their inclusion in addiction treatment programs. Treatment providers should consider

incorporating structured mindfulness training in their treatment strategies, and measuring

treatment outcomes in patients who provide consent. By measuring these outcomes and reporting

results to researchers, treatment providers can both improve patients’ odds of recovery and help

further the field’s collective understanding. So far, the evidence suggests that adding mindfulness

to your patients’ recovery program might just be the thing that keeps them sober.

Sources

1. Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., Carroll, H.

A., Harrop, E., Collins, S. E., Lustyk, M. K., & Larimer, M. E. (2014). Relative efficacy

of mindfulness-based relapse prevention, standard relapse prevention, and treatment as

usual for substance use disorders: a randomized clinical trial. JAMA psychiatry, 71(5),

547–556. https://doi.org/10.1001/jamapsychiatry.2013.4546

2. Garland, E. L. (2016, June). Restructuring reward processing with mindfulness-oriented

recovery enhancement: Novel therapeutic mechanisms to remediate hedonic

dysregulation in addiction, stress, and pain. Annals of the New York Academy of

Sciences. Retrieved August 1, 2022, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940274/

3. Volkow, N. D., Michaelides, M., & Baler, R. (2019). The Neuroscience of Drug Reward

and Addiction. Physiological reviews, 99(4), 2115–2140.

https://doi.org/10.1152/physrev.00014.2018
4. Parvaz, M. A., Rabin, R. A., Adams, F., & Goldstein, R. Z. (2022). Structural and

functional brain recovery in individuals with substance use disorders during abstinence:

A review of longitudinal neuroimaging studies. Drug and alcohol dependence, 232,

109319. https://doi.org/10.1016/j.drugalcdep.2022.109319

5. Sofuoglu, M., Devito, E. E., Waters, A. J., & Carroll, K. M. (2013). Cognitive

enhancement as a treatment for drug addictions. Neuropharmacology, 64, 452-463.

https://doi.org/10.1016/j.neuropharm.2012.06.021

6. Tang, Y. Y., Tang, R., & Posner, M. I. (2016). Mindfulness meditation improves emotion

regulation and reduces drug abuse. Drug and alcohol dependence, 163 Suppl 1, S13–S18.

https://doi.org/10.1016/j.drugalcdep.2015.11.041

7. Taren, A. A., Gianaros, P. J., Greco, C. M., Lindsay, E. K., Fairgrieve, A., Brown, K. W.,

Rosen, R. K., Ferris, J. L., Julson, E., Marsland, A. L., & Creswell, J. D. (2017).

Mindfulness Meditation Training and Executive Control Network Resting State

Functional Connectivity: A Randomized Controlled Trial. Psychosomatic medicine,

79(6), 674–683. https://doi.org/10.1097/PSY.0000000000000466

8. Kamboj, S. K., Irez, D., Serfaty, S., Thomas, E., Das, R. K., & Freeman, T. P. (2017).

Ultra-Brief Mindfulness Training Reduces Alcohol Consumption in At-Risk Drinkers: A

Randomized Double-Blind Active-Controlled Experiment. The international journal of

neuropsychopharmacology, 20(11), 936–947. https://doi.org/10.1093/ijnp/pyx064