We spend much of our waking lives on autopilot; our subconscious brain is always busy taking in data, analyzing it, and ultimately guiding the vast majority of our actions. In other words, we’re not directly in charge of most of our behavior1.
Substance use is in part just such an impulse—one that typically does not align with our long-term goals. But once you’ve trained your brain to respond automatically to stress or difficult emotions by reaching for drugs or alcohol, how can you unlearn?
An unknown source said, “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” Mindfulness-based relapse prevention is one method designed to help you regain that space—and ultimately recover from addiction.
The Importance of Habit Change in Long-Term Recovery
If the subconscious guides much of our behavior, what guides the subconscious brain?
Put simply, it does whatever it’s done before. Every action you take (or don’t take) trains the brain. Do a thing enough times in a similar way, and the brain automates the process. This is what psychologists refer to as learned behavior—otherwise known as a habit.
When people go through withdrawal from drugs or alcohol, they are pushing past many of the physiological aspects of addiction. But afterwards, once physical withdrawal is over, the habit often remains. It is this subconscious impulse that often drives relapse, even for those with many years of sobriety. In fact, rates of relapse following treatment for alcohol use disorder can be as high as 60 percent.
Clearly, finding a way to help people make lasting changes to their impulses and habits is key in recovery. But with so many of our habits essentially wired into our brains, most of us need some techniques and tools for overcoming these old patterns. This is where mindfulness comes in.
The Evolution of Mindfulness-Based Relapse Prevention for Addictive Behaviors
For many years, 12-step programs such as Alcoholics Anonymous (AA) were the only options for recovering addicts. Although these programs were successful for some people, they didn’t work for all. In particular, those not interested in faith or spirituality-based programs had few alternatives.
Research into addiction coincided with the development of cognitive-behavioral therapies (CBT), and much of it was informed by CBT-based concepts. The relapse prevention (RP) model was developed as an alternative approach to recovery2.
Using the principles of CBT, the RP model identifies erroneous thought patterns and beliefs that could lead to unwanted behaviors. It aims to develop coping skills for challenging situations, eliminate myths about recovery, and ultimately increase self-efficacy.
However, although RP models offered secular alternatives to 12-step programs and had some advantages, they weren’t ultimately more effective at preventing relapse. Mindfulness-Based Relapse Prevention (MBRP) was designed to help solve this problem, by adding the element of mindfulness to existing models of addiction and recovery.
MBRP is an 8-week program with weekly 2 hour sessions, which include both formal meditation practice as well as discussion of therapeutic techniques3. It combines the proven logic of CBT-based relapse prevention protocols with the awareness and acceptance of thoughts and behaviors that potentially trigger a cycle of substance use.
The Benefits of Mindfulness
Mindfulness is most often defined as “nonjudgmental awareness.” It involves not only paying attention to whatever is happening in the present moment, but also cultivates an attitude of acceptance or nonreactivity. It is a state of neutrality, free of both desire and aversion. Both of these components are shown to bolster relapse prevention programs4.
As mindfulness has made its way to the West, its contribution to psychotherapy paradigms is growing steadily. Programs like mindfulness-based stress reduction (MBSR) and cognitive therapy (MBCT)5 have already shown great promise in a number of different therapies aimed at reducing stress and improving mental health in general.
Mindfulness has shown itself beneficial for improving the following6:
- Difficulties in emotion regulation
- Experiential avoidance
- The intensity of psychotic delusions
Stress—and, possibly more importantly, the response to stress—is seen as a major driving factor behind alcohol cravings and subsequent relapse7. Studies show both physiological8 and psychological9 improvements in response to stress when using mindfulness strategies. Changing the way one responds to stress increases one’s level of self-efficacy in staying sober.
Mindfulness Starts With Awareness
The awareness component of mindfulness provides a critical first step to behavior change. While CBT may be effective in identifying distorted thought patterns and subsequent behaviors, these observations tend to be made after the fact. Remember your brain’s autopilot; how can a person change once their behaviors have become automatic?
While CBT addresses the content of one’s thoughts, mindfulness seeks to change one’s relationship to those thoughts10.
Letting Go, Acceptance, and Compassion
CBT-based programs often attempt to modify behavior in part by “avoidance of associative cues” and suppression of “unwanted” thoughts.11” Research has shown, however, that suppression of such thoughts can backfire12.
The mindfulness view, in contrast, sees all experiences, thoughts, and behaviors as neutral—not good or bad, simply events that happen. Mindfulness recognizes that it’s impossible to fully avoid triggers, high-risk situations, negative emotions, and any other obstacle to staying sober. Letting go of attachments, desires, and aversions and accepting things as they are can break the cycle of shame and relapse.
This is particularly relevant for targeting the “abstinence violation effect,” in which any use of the substance being abstained from produces a spiral of shame and guilt and greatly increases the chances of full relapse13.
Mindfulness encourages self-compassion. It recognizes that the challenges of life, stress, negative emotions, etc., are real and cause pain. It acknowledges that substance use is not “wrong,” but simply represents a coping mechanism that no longer serves your goals.
Who Is MBRP For?
While 12-step programs such as AA benefit many, programs like mindfulness-based relapse prevention provide secular options for those not interested in treatments involving faith in a “higher power.”
Programs like AA put the responsibility on a higher power to “remove these defects of character” causing addiction. Many people who choose secular programs like MBRP instead do so because they place emphasis on self-efficacy and personal responsibility.
Although anyone interested in mindfulness-based sobriety could benefit from MBRP, research has shown that it’s particularly beneficial for those with comorbid conditions such as depression and anxiety14.
The Bottom Line on Mindfulness-Based Relapse Prevention
Uprooting addiction means reprogramming the automatic reactions your brain has learned over time. Programs like mindfulness-based relapse prevention can help people in recovery learn to “pause, observe present experience, and bring awareness to the range of choices before each of us in every moment.15” This can be a powerful tool in breaking free from the cycle of addiction.
Learn more about how Ria Health uses mindfulness and CBT to treat alcohol addiction, through our online coaching program.
|9↥, 10↥, 11↥, 12↥||https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045038|