Using Mindfulness Techniques in Substance Abuse Treatment

Mindfulness involves a keen awareness of the here and now, and a mindset that is open and receptive to new ideas, information and experiences.  In substance abuse treatment, mindfulness can be a way to cope with feelings, stress, triggers and urges and a way to manage stress and anxiety.  Mindfulness can be the difference between responding effectively to the trauma symptoms that often co-occur with substance abuse, and a relapse to substance use to escape the unpleasant symptoms. 

Mindfulness, if practiced regularly can be a positive, substitute addiction with one distinction that separates it from a self destructive addiction.  It is not an escape or a means of avoidance.  It is a way of staying present with pain and discomfort, rather than fleeing from pain and discomfort.  Instead of staying compulsively busy to avoid an urge, running from an urge or giving in to an urge by using; a person practicing mindfulness observes and accepts the urge, and rides it like a wave – knowing that every urge has a beginning, middle and end - and that this one too will pass.    

Mindfulness is a way of engaging the rational mind in response to the fight or flight response of the primitive, addictive brain.  Mindfulness helps a person recognize strong urges or feelings as invitations to accept or decline after careful consideration, rather than commands to act immediately.  Mindfulness allows a person to remain calm under fire, and choose a rational response to a stimulus that is in his/her long term best interest. 

There are mindfulness skills that need to be learned and practiced. If practiced routinely, twice a day when calm, it will be easier to call upon the skills in a crisis and to apply them when needed. Part of the beauty of mindfulness practice, is that the practice does not necessarily require sitting in a certain position or closing the eyes. Mindfulness can be practiced throughout the day during activities and as part of the activities. Some essential mindfulness skills are:

Awareness:  Awareness involves focusing attention on one thing at a time, while at the same time recognizing that there are many things going on. Some of these things are external such as sounds, odors, touch, and sights, while some of these things are internal, such as our feelings, thoughts, urges, impulses, etc.

Non-judgmental:  The emphasis is on observing without judging or labeling things as “good” or “bad.” The idea is to observe my angry feelings without judging them as bad or feeling a need to get rid of them or do something about them. It’s like holding my anger at arm’s length and just noticing that this is anger. Then understanding that not only is it anger, but that it’s ok that it is anger and even understandable that anger would be there.

Present Moment:  A present moment focus or being in the present moment means fully participating in the present without being distracted by guilt from the past or worry and anxiety about the future. It means engaging in activities that are meaningful today, not just mindlessly doing what I have always done or going through the motions without attention to what I am experiencing.

Open Mind (or Beginner’s Mind):  An open mind or beginner’s mind is childlike (not childish). It is being open to new experiences and seeing them as they are; not how you have judged them to be or think they should be. If I attend an event with the mindset that “this is going to be a waste of time,” I have a preconceived notion about the event that prevents me from experiencing the event as it is. Likewise, if I already know it all, I’m not open to learning anything new, or experiencing the joy and bliss of learning. A Beginner’s Mind is what a child has who experiences something for the first time.

Mindful of Breathing:  Mindful breathing involves focused attention on breathing. Notice how you are breathing. Notice slower breathing and fuller breaths. Notice your belly rise and fall as you breathe in and out. When your mind drifts away from your breathing, and it will, simply notice what caught your attention and gently shift your attention back to your breathing. (For more information on using deep breathing and muscle relaxation to reduce stress, click here.)

Mindful of Sounds:  Following mindful breathing, focus your attention on sounds; soft sounds, loud sounds, nearby sounds, distant sounds. Notice your response to sounds. Notice if you are annoyed by a sound or judging a sound; then gently re-direct yourself to listening to sounds without judging. When your attention drifts away to a thought, notice what thoughts you were distracted by, and gently return your attention to sounds.

Meditation: The purpose of mindfulness meditation is to become more aware and accepting of internal processes; thoughts, feelings, urges, sensations, cravings, triggers, etc. Meditation is not intended for relaxation. People who are extremely anxious about internal processes or have difficulty sitting still may need to work up to a full session of 20 minutes, beginning with only 2-3 minutes at a time and working on other exercises more at first. The goal is 20 minutes of meditation two times a day. During meditation, if your mind drifts to thoughts about the past or worries about the future, gently re-direct your attention to the present moment. Mindfulness meditation is about staying in the present, not about achieving a heightened state of awareness or bliss. For more information about Transcendental Meditation, click here.

Mindful Eating: When eating mindfully, choose a place that is quiet and free of distractions. Before beginning to eat, look at the food. Notice what it looks like; its shape and size and color, and how it smells. Notice any internal sensations; salivation, hunger, urges before you taste the food. Now take a bite. Notice the taste, texture, and sensations in your mouth. Notice your chewing. Notice urges to swallow. Notice your swallowing. Notice your stomach as you swallow. Continue eating mindfully, noticing sensations in your stomach; feelings of hunger and fullness. Decide when you are finished eating based on when you are no longer hungry. Avoid eating while engaged in other activities, such as watching television, reading, or working. Notice feelings and thoughts associated with eating and urges to eat between meals.

Beginner’s Mind: Pick an object in the room that is familiar to you, and examine it with your beginner’s mind; that is, as if you have never seen the object before. Some people imagine they are an alien from another planet or an alien on another planet, and are seeing the object for the first time. Notice the shape, weight, texture and color of the object. Try to imagine what the object could be used for. As you continue to examine the object, do you notice anything about it that you may not have noticed before? When you put the object away, reflect on what you learned about the object that you didn’t already know. Consider what would happen if you approached other areas of your life with a beginner’s mind; people, places, objects, situations. How would these other areas of your life be the same or different if you approached them with beginner’s mind? What expectations do you now have that you would not have if you saw them for the first time?

Mindful of Thoughts: Once you are comfortable and have become mindful of your breathing, shift your attention to your thoughts. Become aware of whatever enters your mind. Remember that your purpose is simply to observe the thoughts that are in your mind without judging them. Observe thoughts as they come and go in and out of your awareness without trying to engage them, continue them, stop them or change them. Simply notice them. If you find yourself getting caught up in a thought, notice what caught your attention, then gently re-direct yourself to observing your thoughts. It is normal to get caught up in thoughts. When this happens, return to observing thoughts.

Mindful of Emotions: Begin by getting comfortable and becoming mindful of breathing. Think of an event in the past in which you experienced a particular feeling that you want to get in touch with; happy, sad, glad, scared, upset, angry, proud, embarrassed, etc. Remember the situation and imagine you are in the situation now. What do you see, hear, taste, smell, and touch? Notice what thoughts, feelings and sensations come up as you remember the situation. Pay particular attention to your feelings. Is there one feeling or more than one? Notice any urges to hold onto or push away your feelings. Respond to these urges with understanding. Notice how your body responds to the feelings. Is there tension anywhere? Sweaty palms? Racing heartbeat? Urge to cry? Urge to run or hide? Urge to fix it or make it go away? Simply be aware of your emotions without judging or trying to get rid of them. Re-direct your attention to just observing your emotions. Notice any changes in your emotions during this exercise. Do they change or stay the same? Get stronger or weaker? Return to mindful breathing before ending this exercise, as it can be a difficult one. This exercise can be done with moderate, less intense feelings at first.

Mindful of Physical Sensations: Physical sensations can be urges, pain, tension, hunger and racing heart. Begin to focus on sensations involved in your body as your body contacts the surface you are sitting or laying on. Notice the parts of your body that are not in contact with the surface. Notice the sensation of air on skin or a sheet touching the skin. Notice the air temperature. Notice any body sensations: urges, cravings, hunger, pain, muscle tension, racing heart, stiffness, cramps, body temperature, etc. Notice any thoughts or judgments you are making about your physical sensations; then gently re-direct your attention to your body sensations. After 5-10 minutes, shift your attention back to the sensations you feel as your body contacts the surface of your chair or bed, then focus on breathing.

Mindfulness in All Activities: We can apply mindfulness to any activity at any time during the day. We can drive mindfully and do household chores mindfully; meaning we are keenly focused on what we are doing at the moment. We can practice mindfulness in the shower, during a walk, in a park, at work, during exercise, in a store, in the Dr’s office, in the waiting room, while dressing, while playing or drawing, etc. When we find feeling of guilt about the past or anxiety about the future creep in, or unwanted thoughts, memories or cravings, we gently re-direct our focus to the here and now.

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