Can MBSR be Effective Addiction Treatment?

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By the Mindful Leader Team

Mindfulness-Based Stress Reduction (MBSR) is well supported as an option to increase mental well-being and health-related quality of life. Since the 1980s, encouraging studies have consistently shown MBSR to help both healthy people and those with various chronic diseases. One new but promising area of study is the impact of MBSR and similar interventions on people struggling with addiction. Typically, people addicted to substances, or even those in their first year of recovery from a substance use disorder, are discouraged from enrolling in MBSR training. Mindfulness has nevertheless been repeatedly shown to aid in addiction recovery and in the quality of life of those with substance abuse disorders. MBSR has also inspired other Mindfulness-Based Interventions (MBI) specifically designed to help addicts, namely Mindfulness-Based Relapse Prevention (MBRP) and Mindfulness-Oriented Recovery Treatment (MORE). Dr. Judson Brewer, a neuroscientist, has adapted mindfulness techniques to help people with smoking cessation and binge eating. Dr. Brewer offers a neuroscientific explanation of the mechanism through which meditation helps the brain shake addictive behaviors.

MBSR as a direct tool for aiding people with addictions and has a few limitations that present barriers to clinical study, as Dr. Eric Garland points out in his 2018 integrative review of mindfulness-based treatments for addiction. Addiction treatment centers require their staff to be licensed medical professionals, which not all MBSR instructors are. This requirement overlaps with the cost and time commitment required to become a certified MBSR instructor, limiting the availability of facilitators for people in treatment for addiction. Those in treatment for addiction are more likely to receive MORE or MBRP interventions. 

As mentioned before, people with substance abuse disorders are discouraged from taking MBSR, for a few reasons. First, MBSR requires a lot of time alone with one’s thoughts, which some instructors worry could cause a relapse for someone new to the recovery process. Dr. Gus Castellanos, an experienced MBSR instructor and somebody who uses mindfulness in his own long-term recovery process, explains why. Dr. Castellanos specified that there is a large difference, for example, between someone trying to recover from addiction for the first time, and someone who had ten years of sobriety under their belt, but then had a relapse a year ago. In the first case, he identified a few good reasons to keep people new to recovery away from MBSR. Firstly, someone just starting down their path to recovery is likely to have legal, financial, relationship, or other problems that would keep them from properly committing the required time to MBSR. In general, it is better for someone who is brand new to recovery to get settled and to address any underlying trauma (which is common) before they try to add a mindfulness practice. Additionally, twelve-step programs, which are common and effective, focus on accepting help from a higher power. This conflicts with the methodology of MBSR, which focuses on developing self-sufficiency. 

Despite these limitations, a few clinical studies with encouraging results have been conducted. In a 2009 study, MBSR was successfully adapted to help prevent addiction relapse in a population of marginalized and poor African American and Latina women with histories of trauma. A 2014 study done on a group of drug addicted men currently undergoing recovery treatment successfully improved Health-Related Quality of Life with MBSR. While not observing the effect of MBSR on those with addiction disorders directly, a 2020 pilot study observed the effect of MBSR on caregivers of drug addicted adolescents. Quality of life and self-compassion were both affected positively, suggesting that MBSR could indirectly help substance users by improving the resilience of their support system.

MORE and MBRP are two common mindfulness-based interventions used to help reduce addictive behaviors. Like MBSR, they are eight-week courses consisting of mindfulness sessions with a facilitator, discussion, and homework. MORE was developed by Dr. Eric Garland in response to the opioid crisis. Usually, the mindfulness techniques used in these programs are meant to help the student cope with their cravings. MORE specifically focuses on mindfulness centered around the breath, then builds the ability to reappraise stressful events and promote resilience, and finally encourages mindful focus on naturally rewarding, healthy, and pleasurable experiences in normal life.

Why is mindfulness useful in breaking addiction? Dr. Judson Brewer, who spoke on the topic at the Mindful Leader 2019 @Work Conference, explored the neuroscience. He found that the brains of experienced meditators show lower baseline levels of brain activity in the Posterior Cingulate Cortex. That region of the brain is related to the sensation of being “caught up” in an experience. Mindfulness will lower activity in this part of the brain acutely, but experienced meditators show less activity there by default. Therefore, if someone’s addiction causes them to be caught up in their craving, meditation experience can help them in two ways. First, they will become experienced at acutely turning off their “craving mind.” Second, a regular mindfulness practice will eventually make their cravings less strong in general.

It is worth noting that the original goal of MBSR is intrinsically linked to the opioid crisis. Opioid misuse often stems from a prescription for pain treatment. If chronic pain treatment was more often supplemented with mindfulness interventions such as MBSR, patients might be less dependent on opioid painkillers and be less likely to develop addictions. Indeed, MORE was shown to reduce risk of drug misuse in pain patients who had already been prescribed opioids.

Mindfulness as a treatment for addiction has only been studied for approximately 12 years, and is a young subject. Mindfulness-Based Interventions show promise in clinical study, but many useful questions are still being asked. How much mindfulness training is needed to be effective? Which intervention is best? Are MBIs effective in the long term, or do recovering addicts need continuing periodic training? While these supplementary questions could optimize MBIs, evidence already leans towards mindfulness having a positive effect on addiction treatment.

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