Mindfulness-Based Treatments for Alcohol and Substance Use Disorders

Transcription

1 Mindfulness-Based Treatments for Alcohol and Substance Use Disorders Katie Witkiewitz, PhD University of New Mexico Research supported by Washington State University-Vancouver, University of New Mexico Psychology Department, National Institute on Alcohol Abuse and Alcoholism, and National Institute on Drug Abuse. No other disclosures or conflicts of interest.

2 2 Overview of Workshop Substance use disorders and relapse What is mindfulness? How does it apply to addiction? Experiential introduction to how mindfulness can be incorporated into treatment for smoking cessation Experiential exercises Treatment intentions, empirical data Facilitating mindfulness-based treatments Adaptations for different populations and settings

3 3 Quitting is not nearly as difficult as staying quit. ~Marlatt et al. (2002)

4 Defining Relapse 4

5 5 The Relapse Cycle Seeking relief, Craving pleasure Temporary alleviation Trigger Discomfort or Wanting Craving Addictive Behavior

6 6 Points of intervention Raise awareness of trigger Raise Raise Seeking relief, awareness of awareness Craving pleasure discomfort of craving Raise awareness Temporary of first alleviation use Trigger Discomfort or Wanting Craving Addictive Behavior Change reaction to trigger Change reaction to discomfort Change reaction to craving Change reaction to use

7 Practicing Mindfulness Present Moment Observe wandering, begin again Observe mind on chosen target Attention Wanders 7 Paying Attention Nonjudgmentally If your attention wanders a hundred times, simply bring it back a hundred times.

8 8 Empirical Evidence Numerous mindfulness based treatments for substance use disorders have been developed and demonstrated efficacy: Mindfulness-Based Relapse Prevention (MBRP; Bowen et al 2009, 2014; Witkiewitz et al 2014) MBRP for Women (Amaro et al., 2014) Mindfulness-Based Substance Abuse Treatment for Adolescents (Himelstein et al., 2015) Mindfulness Training for Smokers (Davis et al., 2014) Mindfulness Training for Smoking (Brewer et al., 2011) Mindfulness-Based Addiction Treatment (Vidrine et al., 2016) Mindfulness Oriented Recovery Enhancement (Garland et al., 2014)

9 9 Mindfulness-Based Relapse Prevention (MBRP) Mindfulness practices with relapse prevention skills training Mindfulness-Based Stress Reduction (Kabat-Zinn, 1990), Mindfulness-Based Cognitive Therapy (Segal et al. 2002) Format Aftercare or post-stabilization Group format, 8 weekly 2 hr. sessions Daily home practice Bowen, Chawla & Marlatt (2011); Witkiewitz, Marlatt & Walker (2005)

10 10 Intentions of Mindfulness-Based Treatment Awareness: Training Attention Daily decisions that increase risk Internal and environmental triggers Seemingly automatic reactions Recognize and disengage from triggers/craving

11 Urge Surfing Exercise Picture the urge as an ocean wave, and imagine yourself surfing, using your breath as the surfboard Bowen, Chawla & Marlatt (2011)

12 12 Intentions of Mindfulness-Based Treatment Acceptance and Curiosity Shift from emotional avoidance to curiosity Decrease the need to fix discomfort, learning to stay with experiences Recognize basic needs that often underlie craving

13 SOBER Breathing Space Stop Observe Breath Expand Respond

14 14 Alternatives to SOBER SABER Stop, Assess, Breath, Expand, Respond STOP Stop, Take a breath, Observe, Proceed RAIN Recognize, Allow, Inquire, Non-Identify PEACE Pause, Exhale, Accept, Choose, Engage TAP Take a breath, Acknowledge, Proceed STIC Stop, Take a breath, Imagine consequences, Choose

15 15 Target of Mindfulness-Based Treatments Direct Experience

16 16 Intentions of Mindfulness-Based Treatment Self-Compassion and Skillful Action Reduce contact with environmental triggers and depleting activities Increase contact with natural/alternative reinforcersand social support Reduce self-judgment Increase resilience

17 17 Mindfulness Based Relapse Prevention Components of MBRP: Formal mindfulness practice Breathing, walking meditation Body scan, mindful movement Mountain meditation Loving kindness Informal practice Mindfulness in daily life SOBER breathing space Urge surfing Relapse prevention coping skills training

18 Facilitating Mindfulness-Based Treatment Inquiry as active ingredient 18 Direct Experience (pain) Reactions, Stories, Judgment (suffering) Adapted from Segal et al., 2002

19 Facilitating Mindfulness-Based Treatment Inquiry as active ingredient 19 Pain in left knee, Restlessness Direct Experience (pain) Reactions, Stories, Judgment (suffering) I can t do this Adapted from Segal et al., 2002

20 Facilitating Mindfulness-Based Treatment Inquiry as active ingredient urge surfing 20 Tearful that was hard (emotional discomfort) 1. What did you notice during that exercise? 2. Is that familiar, similar/different? 3. How does this relate to craving, relapse, recovery? Direct Experience (pain) Reactions, Stories, Judgment (suffering) I was thinking I can t handle this. I need an escape. I need a drink. Adapted from Segal et al., 2002

21 21 Considerations for a rolling group Start every session with mindful check-in Build within session instead of between sessions Shorter practices Elicit discussion from returning members Discussion of practice outside of session Common handouts/cards

22 22 Overview of Rolling MBRP manual Eight 1 hour (or 1.5 hour or 2 hour) modules: 1. Stepping Out of Autopilot 2. Mindfulness and Thoughts 3. Mindfulness and Valued Living 4. Riding the Wave 5. Forgiveness 6. Mindfulness and Emotions 7. Mindfulness in Challenging Situations 8. Mindfulness and Craving

23 23 Module 7: Mindfulness in Challenging Situations Learning Objectives: 1. To learn how the SOBER space can be used in high-risk situations, including substance-related situations 2.To understand how mindfulness in general applies to a range of different challenging or stressful situations Session Outline 1. Describe the group and review expectations (~3-5 min) 2. Mindful Check-In (~ 10 min, including inquiry) 3. Ask orienting questions (~ 5 min) 4. Teach, Discuss, and practice the SOBER space (~ 10 min) 5. Guide the SOBER space in challenging situation (~15 min) 6. Mindfulness of Body and Breath (~5 min) 7. Review session material and discuss practice outside of session

24 24 Resources

25 25 With gratitude Undergraduate Research Assistants Sarah Bowen Neha Chawla Denise Gour Joel Grow Graduate Research Assistants G. Alan Marlatt ( )