mindfulness, addiction & the path to recovery · mindfulness: the path to good health...

Mindfulness, Addiction & the Path to Recovery

Lipi Roy, MD, MPH, DABAMClinical Assistant Professor, NYU Langone Health

Former Chief of Addiction Medicine, Rikers Island

@lipiroy | SpicesForLifeMD | www.LipiRoyMD.com

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http://www.lipiroymd.com/

Mindfulness:The Path to Good Health

“Meditation is a way for nourishing and blossoming the divine within you.”

- Amit Ray, Indian author and spiritual master

Mindfulness

“When meditation is mastered, the mind is unwavering like the flame of a candle in a windless place.”

- Bhagavad Gita



Ref: chopracentermeditation.com

Stress & the Emotional Benefits of Mindful Practice

Strong connection

between stress,

substance use and risk of relapse

Data shows that

Mindful Practice is associated with many

health benefits including

stress reduction



“Mind body interventions have been shown to decrease the frequency and intensity of medical symptoms and improve patient disease management.”

– Benson-Henry Institute for Mind Body Medicine,

Massachusetts General Hospital

Mind Body Medicine



Mindfulness = paying attention in a particular way, on purpose, in the present, without judgement

MBM is the self-care aspect of Medicine designed to reduce stress and build resiliency, and thereby promotehealth and prevent illness

Mindfulness & Mind Body Medicine

Ref: Mind Body Medicine Institute, MGH; Kabat-Zinn, J. Clin Psychol Sci Prac. 2003.



**STRESS**

60-90% of healthcare visits are related to stress-induced conditions


http://www.google.com/url?sa=i&source=images&cd=&cad=rja&uact=8&docid=Agqi8Y6rP6YQ9M&tbnid=gEVxeknhNsmPFM&ved=0CAgQjRw&url=http://www.dreamstime.com/stock-photography-stressed-out-image16725752&ei=RMi9U_DKOsyGyASC5IGYCw&psig=AFQjCNFf32Tjdy6WEiQU1CpQHvgK75Kd-w&ust=1405032901055469


Stress and Illness

Psychosocial Stress

Cellular Oxidative Stress (i.e. cell damage)

Disease


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=XdV7M4oGtLcZVM&tbnid=7VIM81JZNe-HFM:&ved=0CAUQjRw&url=http://www.weber.edu/relax/stress.html&ei=_Mi9U87EGo-UyASJn4GwCw&bvm=bv.70138588,d.aWw&psig=AFQjCNEMqMb5rPtHc35ekTLh5UJHnTB6FQ&ust=1405032913557947


Stress and Illness

Health conditions caused or exacerbated by stress:

• Hypertension• Cardiac Arrhythmias• Chronic Pain• Insomnia• Anxiety

• Depression• Infertility• Cancer & AIDS Therapy side effects• Preparation for Surgery• ADDICTION


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=G09FVXSpPJYXJM&tbnid=9Au1flwbEM4MoM:&ved=0CAUQjRw&url=http://www.invitehealthblog.com/back-pain-the-pains-of-a-busy-life-by-dr-millie-nd/&ei=7sq9U6L6BcOvyATk0YCgBg&bvm=bv.70138588,d.aWw&psig=AFQjCNHS6nJ3JjxvrTg0MZNrlzbvecuAkw&ust=1405033530779977

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Mindfulness:The Path to Good HealthStress and Addiction

Link between stress and substance use is well-established:

Stress is a well-known risk factor in the development of addiction

Stress is a risk factor for relapse

Examples of stressors commonly experienced by individuals with substance use disorders:

HungerPovertyHomelessnessIncarcerationAbuse



“Relaxation Response”

Coined by MGH physician, Dr. Herbert Benson

Physical state of deep rest that changes the physical & emotional responses to stress

Opposite of the ‘fight or flight’ response

Breaks the train of everyday thought


Mindfulness:The Path to Good HealthRelaxation Response

“If all you have is a hammer, you tend to see every problem as a nail.”

- Abraham Maslow, U.S. psychologist



Basic Components to Elicit the RR:

1. Nonjudgmental (receptive) awareness

2. Comfortable position

3. Mental focus, i.e. repetition of a word, sound, prayer, thought, phrase or muscular activity

4. Quiet environment

5. Passive return to the repetition when other thoughts intrude



Techniques used to elicit RR:

• Meditation (mantra, transcendental, mindfulness)

• Yoga (kundalini, kripalu)

• Prayer


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=it5TwR9JdSKydM&tbnid=cE5jHSdQnS2oLM:&ved=0CAUQjRw&url=http://www.huffingtonpost.com/2014/02/12/yoga-health-benefits_n_4768746.html&ei=0M69U93OHcSI0AXWn4HQBQ&bvm=bv.70138588,d.cGU&psig=AFQjCNF5hS7SwRrxususV-0KMqT-tpcFQg&ust=1405034556621973

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Benefits :

• Change physical symptoms, e.g. IBS, HTN, nausea, insomnia, etc.

• ↓ pain & use of pain medications

• ↓ anxiety & fear

• Alleviate depression & anger

• Prepare for & experience medical

procedures, treatments & tests


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=-Di_7bAbkxdl2M&tbnid=atNEnaZagFgJTM:&ved=0CAUQjRw&url=http://www.mindfullivingprograms.com/whatMBSR.php&ei=_8a9U_7eL4ukyATX4ICwBg&bvm=bv.70138588,d.aWw&psig=AFQjCNFTJ4DmdvOtr3KhuzZm_NqvpW2Vng&ust=1404950602800971


Benefits: (cont’d)

• Promote healing & recovery

• Increase self-awareness

• Change negative thought patterns

• Increase feelings of wellbeing, comfort & control

• Enhance inner strength, self-esteem, optimism & resiliency

Relaxation Response


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=JV72K0Kl_HpsqM&tbnid=P2dF3FGVuOuSxM:&ved=0CAUQjRw&url=http://www.globalconnectorz.com/strength&ei=Pd69U4qDBsedyATo_4GoAg&bvm=bv.70138588,d.cWc&psig=AFQjCNEvrFeA_TxcMYQnIQcXfGtQqYDzxg&ust=1405038394710092

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=FJPvst_M9ObRCM&tbnid=95piXD68v6UV3M:&ved=0CAUQjRw&url=http://www.michaelsamuels.com/&ei=hN-9U6DeIsipyASTuIDwAw&bvm=bv.70138588,d.cWc&psig=AFQjCNGLt5imP4Nwnwjbs0hOU5sCMlgWgg&ust=1405038627069968


Term “yoga” 1st appeared in Hindu scripture Katha Upanishad (400 BCE)

Yoga

Ref: Harvard Medical School Guide to Yoga, 2017

Benefits:

1. Reduced stress & ‘fight or flight’ symptoms (sympathetic nervous system)

2. Lower resting heart rate

3. Reduced adrenaline, increased serotonin

4. Improved fitness

5. Reduced depression, anxiety, pain, insomnia

6. Reduced risk factors for chronic diseases (e.g. HTN, heart disease)



Developed by Jon Kabat-Zinn, PhD, Stress Reduction Clinic, Univ of Massachusetts Medical School

– PhD in molecular biology from MIT and long-time student of Eastern philosophy

Mindfulness Based Stress Reduction

“…mindfulness is not merely a good idea or a nice philosophy. If it is to have any value for us at all, it needs to be embodied in our everyday lives, to whatever degree we can manage without forcing or straining.” –Jon Kabat-Zinn



Mindfulness-Based Interventions

Program by Jon Kabat-Zinn:

MBIs including MBSR (mindfulness-based stress reduction) & MBCT (mindfulness-based cognitive therapy):

• 8 weekly 2-2.5 hour classes w/ ~12 patients• 1-day retreat• Key feature: formal & informal mindfulness meditation practices

to train attentional control and nonjudgmental attitudinal aspects



Mindfulness & Addiction: Science

Studies indicate that Mindfulness-Based Interventions (MBIs) reduce substance misuse and craving by modulating cognitive, affective and psychophysiological processes integral to self-regulation and reward processing.

A new field of study but great deal of scientific research shows promising results:

• Significantly lower rates of substance use over 4-month period• Greater decrease in cravings vs control group• Increase in acceptance and acting with awareness



Mindfulness & Addiction: Science

Judson Brewer, MD, PhD

• Significantly less stress arousal• Less desire for opioids• Greater reduction in pain severity



Effects of Mindfulness on Addictive Behaviors

Ref: Eric Garland, Matthew Howard. Addiction Science & Clinical Practice. 2018



Benefits:

1. Emotional: • building skills to manage stress

• focusing on the present

• Reducing negative emotions

2. Medical:• Manage symptoms for anxiety, asthma, cancer, depression,

heart disease, hypertension, pain, insomnia

Meditation


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=ZaryBIg2xyjZsM&tbnid=vmvd9wagVfMxzM:&ved=0CAUQjRw&url=http://en.wikipedia.org/wiki/Theravada&ei=iOK9U8X4KoKjyASh-IKgBg&bvm=bv.70138588,d.cWc&psig=AFQjCNHol6XVu8Bms68oUZ2SaYVpRuU-9Q&ust=1405039590621196


• We know that adopting a wellness lifestyle is integral to recovery

• A healthy lifestyle cannot be completely obtained through an 8-week intervention, but over the course of an entire lifetime (e.g. nutritious meals, regular exercise)

• Similarly, mindfulness should be practiced daily (or near daily) to achieve long-lasting therapeutic effects and maintain recovery, esp’ly in view of the chronic nature of addiction

Mindfulness as a Vehicle for Recovery

Ref: Jacobson, Greenley. Psych Serv. 2001



Lack of time

“Wandering mind” or intrusive thoughts

Past memories/emotions resurface

“Can’t sit still,” restlessness

Falling asleep

Environmental noises

Challenges to Mindfulness



“I shouldn’t have thoughts when I meditate”

“My body should be still and relaxed”

“The surroundings should be completely quiet”

“I shouldn’t be emotional and cry or get anxious or angry”

Common Misconceptions



“Most people are about as happy as they make up their minds to be.”

- Abraham Lincoln, U.S. President

Mindfulness



Happy People:

Appreciate themselves and others

Perceive the world in a positive way

Live in the moment

Live in satisfaction

Don’t compare themselves to others

Don’t allow negative circumstances define them

Are less reactive and less regretful

Mindfulness & Happiness


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=EJTLIQGw4UI6RM&tbnid=Pg7wN7QAeq8BlM:&ved=0CAUQjRw&url=http://samingersoll.com/happiness/&ei=xva9U4reCZSjyATrmYGICw&bvm=bv.70138588,d.aWw&psig=AFQjCNHsrfs_sYML8v5x_EeI_lpSRzWr0Q&ust=1405044789191464

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=4PxJe1O85uId2M&tbnid=1bVZD17mn_BMrM:&ved=0CAUQjRw&url=https://tristarkarate.com/blog/karate-bradley/boost-happiness-8-strategies/&ei=S_e9U6yiGc-pyASJ-YCQBg&bvm=bv.70138588,d.aWw&psig=AFQjCNHsrfs_sYML8v5x_EeI_lpSRzWr0Q&ust=1405044789191464


Power of Words

Awe



1. Honor the food – we take food for granted in a land of abundance

2. Engage all your senses – aroma, touch, sound, taste, beauty of the food

3. Be mindful of portion size– start with a modest amount (start with a smaller plate)

4. Chew – activates enzymes, improves digestion

5. Eat slowly – helps us enjoy food, and eat less

6. Don’t skip meals – we eat more when we’re hungry and tired

7. Eat a plant-based diet – red meat can increase risk of diseases such as colon cancer

Mindful Eating


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=syyEh_wLPYX3JM&tbnid=8OmtwKj3FLbgaM:&ved=0CAUQjRw&url=http://www.umsystem.edu/stories/mindful_eating_blog&ei=HwC-U97vD8mqyATJhIKQAg&bvm=bv.70138588,d.aWw&psig=AFQjCNFpPKRHxqxoHeKCevZppCucS3UGPw&ust=1405047157471553

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=xW2KI_yrIQGT5M&tbnid=HS6pfVFfW3K_fM:&ved=0CAUQjRw&url=http://www.yogapaws.com/yoga-blogs-yoga-paws/?Tag%3Dmindful%2Beating%2Bhabits&ei=BQG-U4zIA8STyASjnYCYDQ&bvm=bv.70138588,d.aWw&psig=AFQjCNFpPKRHxqxoHeKCevZppCucS3UGPw&ust=1405047157471553


• The study of mindfulness as a treatment for stress and chronic pain is over 30 years old; 20+ years for depression

• But the research in the role of mindfulness in treating addiction has proliferated only in the last 10 years

• Promising new treatment approach with several key findings:– Decreased cravings

– Decreased substance misuse

A Few Lasting Thoughts…

Eric Garland, Addict Sci Clin Prac, 2018.



• Alan Marlatt, Mindfulness-Based Relapse Prevention

• Benson Henry Mind Body Institute, Massachusetts General Hospital

• Center for Wellness and Health Promotion, Harvard

• Judson Brewer, MD, MPH, Mindfulness Center

• Jon Kabat-Zinn, PhD, Mindfulness Meditation,

• Lilian Cheung, Savor: Mindful Eating, Mindful Life

• Mayo Clinic: Mindful Exercises

• Psychology Today

• www.Mindful.org

References


http://www.mindful.org/

Thank You !!!www.LipiRoyMD.com

[email protected]

@lipiroy

mindfulness, addiction & the path to recovery · mindfulness: the path to good health...

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