Can Mindfulness Meditation Prevent Relapse?

By Elizabeth Brico
Published in The Fix on February 21, 2018

Mindfulness meditation teaches people how to accept suffering as a normal, cohesive experience, and then move on from it.

Relapse has always been a harsh reality of addiction, but as the opioid black market fills with powerful synthetics, relapse on heroin and similar drugs grows increasingly dangerous. Fatal overdoses nearly doubled between 2015 and 2016—the majority of which are attributed to opioid-based drugs. We are bombarded daily with news headlines—some factual, some fictitious—announcing the newest therapy, or the latest hysteria-provoking scare (does death by fentanyl dust at the grocery store sound familiar?) as we scramble to unearth an affordable and effective way to curb the tragic rise in overdose deaths. Advocates wage vicious wars using news stories and social media, trying to figure out what treatment works best; what will finally fix it?

What if one of the most promising treatments to help prevent relapse has not only already existed for thousands of years, but is free and available to anyone?

Although research is still young, several studies have shown that mindfulness meditation may prevent relapse by helping people in recovery acclimate to the idea of stress as a normal experience that can be handled without the aid of substances. Opioid addiction is especially problematic because these powerful drugs actually change the way the human brain functions. Prolonged opioid use damages the pleasure-reward system and alters the way we experience both pleasure and pain. Opioid agonist medicines like methadone and buprenorphine are often used to help mitigate these brain changes, either for the short or long-term, but Derek Alan Crain, the Executive Director for Mindful Therapy Group based out of Seattle, Washington, thinks that mindfulness meditation can be an incredibly useful tool in concert with other evidence-based treatments.

“With mindfulness you’re teaching patients how to tune into their feelings; you’re teaching them how to suffer,” says Crain.

The idea of teaching people in recovery from addiction how to suffer may sound counter-intuitive. After all, isn’t addiction pretty much just a ton of suffering? But when a mindfulness practitioner like Crain talks about teaching people “how to suffer,” he means providing the tools and space that will allow us to accept personal suffering as a normal, cohesive experience and then move on from it. It’s true that people with substance use disorders suffer a lot. Addiction is a vicious, complicated cycle that often reinforces itself by generating more suffering which we try to escape by using or drinking. Viewed in that light, teaching someone in recovery how to suffer makes a lot of sense.

Mindfulness is a type of meditation that involves accepting experiences without judgment, including negative experiences. Rather than aiming to empty the mind or think nothing, as in other types of meditation, mindfulness asks only that the practitioner resist valuing certain thoughts and feelings over others. So, if a person is engaging in mindfulness meditation and finds herself worrying about that fight she just had with her spouse, instead of pushing that anxiety away, she would honor it.

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Mindfulness asks that she recognize that the thought is there and that it’s uncomfortable, but she doesn’t quantify the experience – she doesn’t try to fix it. She can ask it to pass but she doesn’t force it away. Eventually, if someone practices this enough, she starts to understand the inherent transience of emotional states. This is very useful for people in addiction recovery, because it allows them to understand their suffering as something with an end. It also helps them to develop patience and perspective, two qualities that are often overridden by an addiction. Ashley and Jaime are both in outpatient treatment for opioid addiction. Ashley had been using prescription opiate painkillers to mask childhood trauma for a number of years, and Jaime was addicted to heroin and pills for nearly three decades. Now, they both use medication-assisted treatment (buprenorphine), peer support, and individual counseling, but each expressed that the addition of mindfulness meditation helped prevent them from relapsing.

Jaime tells The Fix that he meditates for about 10-20 minutes each morning, using his breath as the anchor of his focus. Ashley reports that she engages in mindfulness meditation three times a week for about an hour each session—though she admits it took six months to work up from a few minutes at a time.

“I don’t think about using drugs nearly as much as I used to,” Ashley admits. “I’m more patient and more positive,” she says with a wry chuckle. “A lot of my addiction was unresolved issues I didn’t want to feel or think about. Now I’ve learned how to process them instead of getting high.”

Ashley is well-dressed, with clear skin and a posture relaxed almost to the point of ambivalence. The only visible cue to the traumatic history she discloses to The Fix is her flat affect and a slight unmeasurable distance in her eyes. Beyond that, she looks like any other middle-class young white woman. She admits that before she integrated regular meditation into her recovery, she struggled with frequent relapses. Although buprenorphine reduces the drug cravings and blocks the euphoric effects of opioids, people with trauma histories—like both Ashley and Jaime—may still have problems with frequent relapses when triggered.

Bessel van der Kolk, a Boston-based psychiatrist who has devoted his career to the study and treatment of trauma, says that “[trauma] lies in your body, so when you start taking drugs, you feel calmer. When you stop taking drugs, you have a dual issue: one is the withdrawal from the drug, the second is that you’re dealing with pain and trauma that’s still in the body.”

While medication-assisted treatments like methadone and buprenorphine have been proven effective at reducing cravings and correcting some brain changes likely attributed to drug use, they don’t target traumatic responses. That’s where mindfulness comes in.

Van der Kolk says that current addiction programs in the United States tend to ignore the curative effects of becoming re-connected with one’s body. He says we need more “programs where people become familiar with their bodies. Self-regulating their bodies should be the focus of treatment because it’s bodies [that] are stuck.”

Jaime, who could easily blend in with any group of average middle-aged men, echoes Ashley. “Meditation minimizes my [drug] use thoughts. It helps me realize when I’m trying to justify doing a shot of heroin or something.” He speaks with the plain, unapologetic candor of someone who has long accepted his identity as someone with addiction, a quality often mirrored in followers of the 12-steps; a group to which Jaime proudly belongs.

He adds, “It helps with my anxiety too—I’m not as fidgety. I’m more in tune with myself and the world around me.”

Finding something relatively simple and freely accessible that can deter relapse is no laughing matter. While it’s impossible to know for certain how many of the 42,000 opioid overdose deaths reported in 2016 can be attributed to a relapse, it is well established that using opioids after a period of abstinence can be fatal. For people on opioid agonist medications, like Ashley and Jaime, attempting to overcome the blocking effects of the treatments can also lead to a fatal overdose. Even without the risk of death, relapse can be an emotionally debilitating experience that leads some users to discontinue treatment altogether. Most of our current treatments focus on detoxification or acute stabilization, but relapse prevention is just as important—and a recovery practice that can function as well 10 weeks into recovery as it does after 10 years could be a vital piece of the puzzle.

Crain believes that another reason meditation helps with relapse prevention—in addition to its role in repairing maladaptive stress responses—is that it encourages an intimacy with the self.

Results from some rat studies imply that social isolation plays a role in addiction. Rats who were isolated and kept in cages demonstrated more addictive behaviors than those that were housed in a social environment. The phenomenon was also observed in Vietnam vets; a large number of soldiers became addicted to heroin while overseas, but a disproportionately high number of them discontinued use when they returned home to their communities. These studies have led specialists to speculate a social component to addiction.

Crain thinks that meditation helps people in recovery fall in love with themselves, sometimes for the first time in their lives. This self-intimacy, and the concurrent production of oxytocin, colloquially called the “love hormone,” helps people integrate and bond with their social communities, which is an important aspect of addiction recovery.

Meditation is not a magical cure for addiction. Although a mindfulness meditation practice can help re-form and strengthen opioid-damaged neuropathways so that they are better able to respond to stress, mindfulness alone can’t treat acute addiction or prevent someone from experiencing withdrawal. It can, however, be a powerful tool against relapse.

As Crain says, “An addict has been hiding from suffering his whole life. With meditation you’re embracing that suffering. You’re normalizing it.”