When it comes to thinking of ways to treat addiction, an abundance of various approaches has been proposed over the years of examining the issue. However, it is reasonable to assume that in order to treat a condition properly, one is to thoroughly investigate the reasons for its formation and development. In regard to addiction, it means delving into the very definitions of notions such as addiction and recovery and then attempting to find a method of treatment that is to address their underlying assumptions.
First of all, it is necessary to note that addiction is not a personal weakness issue – nor is it a mental state or an aspect of personality. According to Munoz and Modir (2018), addiction is an innate cognition and reward disorder in our brain. All addictions – starting from alcohol, drugs, and prescription pills, to behaviors like gambling, work, sex, food, or shopping – are essentially characterized by losing control of the situation. Addiction frequently goes hand in hand with obsession and compulsion; often, an addict behaves a certain way not to experience pleasure but to ease the discomfort caused by the drug abandonment. Dysfunctions of limbic and neocortical brain areas result in a maladaptive disease cycle. This reward-motivation-memory chronic condition stems from complicated biological changes. Multiple systems of survival are connected to genetics, the first stages of brain development, and pathways of learning; these pronenesses are basic – as much as a human’s resistance to pain and a desire to survive.
Addiction gravity and progression vary greatly from person to person. Munoz and Modir (2018) claim that some individuals forms are mild, with a low propensity for misusing and losing control – and some are not able to stop, even if the treatment is extremely intensive and comprehensive. All addicted people struggle with this susceptibility continuum. Determinative factors of who develops an addiction and the rapidness with which it evolves are genetic vulnerability, subjection to addictive substances, stress factors, environments and psychosocial defense mechanisms. These maladaptive control issues are reported to be growing all over the world.
There is a variety of phrasings to refer to when it comes to defining addiction. For example, Munoz and Modir (2018) state that both addiction and substance use disorders are described as a “pro-inflammatory, bio-psycho-social-environmental-spiritual disease state, characterized by compulsive engagement in rewarding stimuli despite adverse consequences” (p.4). Addiction can be viewed as a disorder of an impulse control that is comprised of biological, environmental, spiritual, social, psychological, and nutritional elements. Medical supplies are often needed to help detoxify or maintain sobriety. Drug use or compulsive behavior to solve emotional or social problems are inadequate strategies working only in the short run. Therefore, the development of new psychological tools in order to enable adequate dealing with traditionally unprocessed emotional negativeness as well as with the regular emotional stress accompanying modern life is an essential thing.
In terms of existing within the society, if the environment in which one appears to be is unhealthy, they should distance themselves from people, places and things associated with addiction. In terms of spirituality, the faith requirement that is crucial to improve is believing in oneself. However, any form of spirituality is always better than the absence of one. In terms of nutrition, the assumption of responsibility and control over what kinds of food enter the body is one more important aspect of sustainable success. Each case has its own characteristics; each person needs a comprehensive individual approach to the management of a disease. Nevertheless, assessing and addressing biological, spiritual, social, nutritional, and psychological problems gives people the best opportunity of reaching a full and sustainable recovery.
While the most qualified addiction/recovery specialists draw upon the bio-psycho-social-environmental-spiritual-nutritional model, a lack of uni- or bimodal treatment persists. A great amount of those seeking treatment only have an opportunity to utilize a fraction of what they need to succeed. Examples being only medications, only therapy, only spiritual element, only nutrition, only social support – all of these strategies are popular. With no consistent, targeted, multifaceted prolonged therapy, many will needlessly fall prey to their inability to assuage their drug-use impulses.
It is evident that addiction is a recurrent disease. Similar to other chronic conditions, it is often associated with relapse and remission cycles. While many discrete treatments may be required to achieve long-term remission from disorders related to substance use, treatment success – generally at 30 percent – is obtained with similar-to-other-chronic conditions – such as diabetes, hypertension and hyperlipidemia – rates (Munoz and Modir, 2018, p.5). As opposed to other states of diseases, mind-altering drugs cause uncontrolled behavior, unacceptable emotional reactions, and permanent exposure in spite of considerate detrimental consequences. Progress may vary with remission happening intermittently, but addiction tends to progress. If no treatment is applied, it can lead to death. Still, addictive disorder relapse is often the result of premature inability to maintain effective treatment, for example, when required abstinence pharmaceuticals are terminated impulsively or when a patient discards the outpatient program. Relapse is not inevitable and can be prevented by treatment if it is sustained.
Addiction differs from drug use by a so-called lack of freedom of choice, due to an individual losing control over the quantity, frequency and other measures of consumption. The pathological chase of using drugs combined with the obsessive demand to use them, despite the potential and cumulative adverse effects, defines addiction. Consumption in spite of the damage is a distinctive trait of the user, while the addict is inclined to use – they cannot not use when the drugs are present. These actualizations can manifest themselves compulsively or impulsively, being a reflection of a breach of control. Munoz and Modir (2018) state examples of someone exercising compulsively or being on their phone beyond normal limits. However, if these actions are not pathological, the behavior is not to be deemed addictive.
Reasoning with addiction is often weakened. Substance users often have to deal with problems with perception, judgment, compulsiveness, impulse control and learning. They can demonstrate an unwillingness to change their behavior and are generally unable to discern the magnitude of the problems and the aggravating effects of it. The grand craving to resort to substance use or to engage in what is considered by them to be rewarding behavior emphasizes the compulsive aspect of their condition. The helplessness over addiction and the seemingly uncontrollable nature of life when one is a drug-addict is the basic principle of the 12-step rehabilitation programs.
Current criteria for diagnosis, the DSMs, are divided into substance-induced disorders and substance-use disorders. According to Munoz and Modir (2018), more recently, the nomenclature has shifted its emphasis from dependency to use disorder for a number of substances. Additionally, modifying terms have been developed to describe the condition’s severity – that is, mild, moderate and severe. The diagnosis of a mild substance use disorder requires a minimum of 2-3 criteria, while 4-5 criteria are moderate and 6-7 are severe. The criteria are as follows:
DSM-5 General Criteria for Substance Use Disorder
- Higher levels of and longer-term use of drugs/alcohol than intended;
- Desire to reduce or terminate but not having the ability to do so;
- A lot of time spent on the obtainment of drugs/alcohol;
- Vehement desire or craving to consume drugs/alcohol;
- Persistent inability to perform basic duties at work, at school or at home due to using drugs/alcohol;
- Continued use in spite of enduring or intermittent problems caused or exacerbated by using drugs/alcohol;
- Cessation or reduction of important social, professional, or other activities related to using drugs/alcohol;
- Drug/alcohol recurrent use in physically perilous situations;
- Persistent drug use in spite of recognition of chronic or intermittent physical or psychological problems from drug/alcohol use;
- Tolerance as defined either by the need for significantly increased quantities to reach intoxication or effect desired, or by the markedly reduced effect with the same quantity still used;
- Exemption as a characteristic syndrome – or it is avoided with the use of substances.
After having defined what an addiction is, it is reasonable to try and specify the notion of recovery. According to Morgan (2019), its essence is an experience of improved quality of life and the feeling of empowerment. The recovery principles are based on the concepts of freedom, choice, aspiration, and hope, which are experienced, not simply diagnosed and occur in the outside world, not in the diluted atmosphere of healthcare settings. Recovery is more of a process than a destination, aimed at the constant search for a better life.
Essentially, recovery is not simply sobriety or the stoppage of drug use; it is a multidimensional process involving health, well-being and social activity. Specialized addiction treatment providers continue to focus on primary treatment, the prevention of relapse and, where necessary, re-treatment. However, as Morgan (2019) notes, nowadays there are opinions that more should be done – that is, the linkages between recovery processes and systems should be reestablished and a model of treatment and intervention should be transformed. In their opinion, an attitudinal adjustment from individuals to the whole recovery systems is necessary. Counseling that is sensitive to attachment is a clinical model most appropriate to address the problem of addiction, but its scope should not be limited to treating individuals and families. It is possible to use it in both in-patient and out-patient settings. In addition, there is a proper role to play in mobilizing more resources for recovery and advocacy at the local level.
When it comes to choosing a method to apply to a recovery process, one that is particularly interesting to look at is mindfulness as a method of handling addiction mechanisms. Inherited from the ancient Indo-Sino-Tibetan philosophical views concerning the raising of consciousness, the concept of mindfulness has been interchangeably deployed as a practice, state, and trait in scientific literature. According to Garland and Howard (2018), MBIs – standing for mindfulness-based interventions – deliver training in methods aimed at inducing the mindfulness state. That signifies the metacognitive consciousness state defined by attentive and unbiased monitoring of instantaneous cognition, emotions, sensations and perceptions without insistence on thinking about the past and the future.
Practicing mindfulness has been suggested to include two main constituents: focused attention and open monitoring. The focused attention practice is the practice of concentrating on the sensory object, while one acknowledges their distracting thoughts and then attempts to disengage from them. In its turn, the open monitoring practice, in which both the occurrence of mental contents and the area of awareness where those arise are observed. Open monitoring as a state of awareness is considered to be metacognitive in that it signifies monitoring the consciousness’ content at the same time as assessing the process itself. Although some scientists distinguish open monitoring and focused attention, they are frequently combined in practice – that is, practicing mindfulness usually begins with focused attention. As the session unfolds over time, it evolves into open monitoring.
The frequency and regularity of practicing mindfulness is considered to contribute to steady changes in tendencies to be mindful day-to-day even if the person does not participate in the meditation practice. As Garland and Howard (2018) note, this mindfulness susceptibility increase is assumed to occur due to neurocognitive plasticity ignited by the reactivation of the mindful state during repetitive training sessions. To partially support this hypothesis, the increased focus on the state of mindfulness generated through meditation over time predicts increased mindfulness as a trait. Meta-analysis shows that the MBIs’ influence on clinical outcomes is mediated by increased mindfulness as well. In addition, morphometric neuroimaging meta-analysis shows that increased mindfulness meditation practices are accompanied by neuroplastic changes in the structure of the brain. As construct operationalizations from factor-analytic research have shown, trait mindfulness’ main characteristics are: the ability to accept alarming thoughts and emotions; observation of interoceptive and exteroceptive experiences; discrimination of emotional states and awareness of automaticity. These conscious attributes can be addictive behavior antidotes; in fact, trait mindfulness – having been correlated with aggravated cognitive control capabilities – is extensively coupled with substance abuse and cravings. It also is positively connected to the ability to expel attention and restore autonomic function after being exposed to cues related to addiction.
Unlike trait mindfulness – considered to be cognitively and behaviorally flexible – addiction is linked to mindlessness – that is, responses conducted automatically, with no conscious will or strategic consideration of the possible consequences. Considering how addiction is classically considered a product of automaticity, being mindful of these automatized emotional and behavioral responses might factor into better self-regulation of addictive ways. Thus, practicing mindfulness might result in it mounting with each session of meditation into a sustained tendency that is exercised in daily life, thereby becoming a so-called deafener against addictive behavior.
The best-known mindfulness-based interventions for addiction treatment have been modeled after the first conscious-induced therapies. Typically, as noted by Garland and Howard (2018), MBI treatments are offered as several weeks initiatives (approximately eight), usually in the format of a group therapy. Every week, participants are educated by a qualified clinician in a number of mindful techniques – for example, careful breathing and body scanning meditations. What follows is group feedback sessions, after which new materials are usually presented. Sessions often include practical exercises on consciousness-raising to reinforce the previously didactically introduced principles. Therapeutic homework that includes formal and informal tasks is handed out, as well as self-control assignments to keep track of symptoms such as cravings and adverse effects. The existing MBIs are distinguished in terms of what types of mindful practices are employed, the way in which the practices are carried out, the length of home-based practice sessions, and specific psycho-educational content.
MBIs are generally intended to treat pathogenic mechanisms linked to addiction. It is conducted by applying methods of being mindful towards addictive behavior – for example, craving mindfulness – and by contemplating the application of these skills in order to handle addiction on a daily basis. For instance, the participants in the program MORE tend to take part in so-called chocolate exercises – a practice of empirical thinking aimed at increasing awareness of automaticities and cravings. The essence of the exercise is the following: participants have to keep a chocolate treat near their faces. Then they are to become mindful of the craving that arises as they abstain from flinging themselves on chocolate. This experiment compares the desire to eat food with the desire to consume addictive substances. After that participants focus on adopting a metacognitive stance in relation to their experiences and analyze the craving, attempting to break it down into its components, taking notice of the craving fading over time. This technique allows clients to learn the ways to consciously respond to the need to consume substances rather than automatically succumbing to appetizing signals. This modification is considered necessary for the maximization of MBIs clinical effects as addiction treatments, although quantitative comparisons of individualized as compared to general MBIs for people with substance-use related disorders have not been conducted.
In mechanistic theoretical analyses of mindfulness treating addiction, MBI serves as a mental training medium aimed at exercising various neurocognitive processes, which become disorganized during addiction. Such psychological arrangement is facilitated through open monitoring and focused attention practices, which both separately and combined are considered to amplify processes essential to self-regulating addictive behaviors such as refocusing, meta-cognition, reassessment, and inhibitory control.
In this regard, MBIs may be viewed as behavioral strategies that strengthen the entirety of networks of cognitive control which have atrophied from chronic drug use and drug-related signals and cravings in the addiction process. According to Garland and Howard (2018), since adaptive cognitive control is regained via conscious exercising, MBIs can enhance the functional relationship between descending prefrontal networks and ascending limbic-striatal brain circuits. Broadening the link between bottom-up and top-down brain networks involved in addiction can serve as the physiological basis with the help of which mindfulness de-automates addictive behaviors. By increasing the prefrontal cortex’s ability to govern subcortical brain networks in a targeted manner, MBIs strengthen a common neurocognitive resource’s domain, which can be used in the modulation of various mechanisms tampering with addiction.
In conclusion, when it comes to the MBIs, these are among the newest additions to the addiction treatment’s toolkit, which can be effectively utilized by professionals. Recognition of addiction as of largely a consequence of cognitive and behavioral automaticity resulting from changes in the brain systems may be central to recognition of it as particularly appropriate for treating with approaches such as mindfulness. Ultimately, MBIs can provide an ingenious means of relieving a person of the pressure and influence of the brain dis-regulation, which is at the forefront of addiction.
References
Garland, E. L., & Howard, M. O. (2018). Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research. Addiction science & clinical practice, 13(1), 1-14.
Morgan, O. J. (2019). Addiction, attachment, trauma and recovery: The power of connection (Norton series on interpersonal neurobiology). W. W. Norton.
Munoz, G. & Modir S. (Eds.). (2018). Integrative addiction and recovery. Oxford University Press.