Transcript Dr Paramabandhu Groves

Buddhist Approaches
to Addiction Recovery
Dr Paramabandhu Groves
Consultant Psychiatrist
Islington Specialist Alcohol Treatment Service
Clinical Director, Breathing Space
London Buddhist Centre
From craving arises sorrow and
from craving arises fear. If a man
is free from craving, he is free
from fear and sorrow.
(Dhammapada, 216)
Buddhist therapeutic
approaches
 Addiction in early Buddhism
 Approaches to addiction in countries with established
Buddhist cultures
• Thai detoxification
• Naikan
 Contemporary western approaches
• Mindfulness
• Non-theistic 12 step
• Integrated approaches
Buddha exhorted disciples
to avoid intoxicants
Untoward effects of intoxicants:
• loss of wealth
• increased quarrelling
• susceptibility to disease
• losing a good reputation
• indecent exposure of the body and
• weakening of intellect
Dangers of gambling
• the winner makes enemies
• the loser grieves for his losses
• loss of wealth
• his word is not trusted in assemblies
• he is despised by friends and associates
• he is not in demand for marriage, since he would not be
seen to be able to afford to maintain a wife
Behavioural
interventions
Thai detoxification
• Response to heroin epidemic
• One month detox using herbal medicine & religious rites
• 20-30% abstinent at 6 months
• Some go on to enter monasteries
Naikan
• Based on Shinshu Buddhism
• Used since 1960s to treat
alcoholics
• One week of intensive meditation
with reflections on family & friends
• Less intensive meditation
encouraged subsequently
• Support owing to cultural
congruence
Mindfulness
• Translation of ancient Pali word “sati” “awareness”
– direct, open-hearted “knowing”
• Traditionally cultivated by
meditation practices
– Learning to pay attention
• Moment by moment
• Intentionally
• With curiosity and compassion
Applications of mindfulness in the
addictions
• Mindfulness-based Relapse Prevention
(MBRP) / Mindfulness-based Addiction
Recovery (MBAR)
• Dialectical Behavior Therapy (DBT)
• Acceptance & Commitment Therapy (ACT)
ABC of Mindfulness-Based Approaches
• Develop Awareness
• Learn to Be with experience
• Making skilful Choices
Bowen et al (2011)
MBRP programme
eight 2 hour sessions, each including:
1. formal mindfulness practices
2. exercises and skills designed to bring these
practices into daily life, specifically into
situations in which an individual is at high risk
for relapse.
SOBER Breathing
Space
Stop – step out of automatic pilot mode
Observe – what is happening for you
Breath – focus simply on your breathing
Expand – be aware of mind, body & situation
Respond – notice that you can respond with awareness.
Bowen et al’s MBRP Session
Structure
1)
2)
3)
4)
5)
6)
7)
8)
Automatic Pilot and Relapse
Awareness of Triggers and Craving
Mindfulness in Daily Life
Mindfulness in High Risk Situations
Acceptance and Skilful Action
Seeing Thoughts as Thoughts
Self-care and Lifestyle Balance
Social Support and Continuing Practice
Research Evidence
• Review by Chiesa & Serretti (2014)
• 21 studies; 14 RCTs
• 10 compared with waiting list, 9 with active
intervention & 2 with non-specific intervention
• Reduction of substance use
• Some showed a reduction in craving and increased
mindfulness
• No adverse effects
• Methodological limitations
Alberto Chiesa & Alessandro Serretti (2014) Are Mindfulness-Based Interventions Effective for Substance Use
Disorders? A Systematic Review of the Evidence. Substance Use & Misuse, 49:492–512
Research Evidence (2)
• Review by Zgierska (2009)
• High patient satisfaction
• Between half and 80% continued to practise
mindfulness after the programme had finished
Parents under Pressure
• RCT 64 methadone maintained patients
• Parenting intervention including mindfulness v
conventional parenting programme v tau
• Improved parenting, child behaviour and dose
of methadone
• Dawe et at (2007)
Playful, happy,
creative thought
Mindfulness training
associated with enhanced
activity in left prefrontal
cortex
Davidson et al 2003,
Barnhofer et al. 2007
Left prefrontal cortex
associated with feeling happy
and more optimistic outlook
EEG Studies
Decrease in alpha and theta
brain waves reported in
meditators
Chiesa and Serretti, 2010
Decreased alpha and theta
waves are associated with
heightened attentional
activation and focus
Attention and
awareness
Long-term mindfulness practice enhances activity in brain regions
related to introspection and attention
Lazar et al. 2005, Holzel et al 2008
Areas related to visceral awareness (i.e bodily sensations) also
show heightened activity
Lazar et al. 2005
Mindfulness for dual diagnosis?
• Mindfulness appears to help depression,
anxiety, stress, poor emotional regulation &
avoidance coping
• Helps cope with risk factors to relapse (e.g.
depression)
• Commonality of rumination & stress
vulnerability
DBT
• Developed by Linehan for
borderline personality disorder,
subsequently adapted for
substance misuse treatment
• Mindfulness is part of package of
treatment
• Mindfulness is used to encourage
acceptance and to extinguish
automatic avoidance of emotions
ACT
• Developed by Steven Hayes
• Based on relational frames theory
• Not consciously drawn from
Buddhism
• Key components are accepting
difficult mental states & committing
to positive action
Buddhism and the 12 steps
Reasons for adapting / modifying 12 steps:
1. Seeking further spiritual support /
sustenance
2. Rekindled earlier or complemented
concomitant interest in Buddhism
3. Deeper levels of attachment to addiction
not being addressed
4. Language off-putting or applied in dogmatic
way
5. Group experienced as having evangelical
Christian flavour
Overlaps between Buddhism
and the 12 steps
• Meditation – 11th step (meditation and prayer)
• śīla or ethics – 4th & 5th step (fearless moral inventory)
Buddhism and the 12 steps
Alternative formulations based on:
Buddha
The Three Jewels
Vajrasattva
Mutual aid
Integrated Buddhist
approaches
• Refuge Recovery
• Eight Step Recovery
Based on Four
Noble Truths &
Eightfold Path
First: addiction creates
suffering
Second: repetitive craving
is the cause of addiction
Third: recovery is possible
Fourth: path of ethics,
meditation and wisdom
Step One: Accepting that this human
life will bring suffering.
Step Two: Seeing how we create extra
suffering in our lives.
Step Three: Embracing impermanence
show us that our suffering can end.
Step Four: Being willing to step onto the
path of recovery, and discover freedom.
Step Five: Transforming our speech,
actions and livelihood.
Step Six: Placing positive values at the
center of our lives.
Step Seven: Making every effort to stay
on the path of recovery.
Step Eight: Helping others to share the
benefits I have gained.
Thank you