Mindful Recovery

BY: T. Franklin Murphy | June 14, 2019

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Mindfulness can assist in the battle against addiction, assisting in recovery by developing better coping strategies to handle stress.

Recovery is serious business, as anyone struggling with these demons knows. Life in sobriety is difficult; but life addicted is excruciating. The addict must navigate a complex world without an effective internal guidance system to point the way. The internal guiding system, evolved from millions of years of adapting, is confused by the infusion of foreign substances. Survival is a fine-tuned, highly responsive process of adapting to harsh environments; but with a swallow, snort or injection the normal guidance of emotional pushes if knocked off kilter.
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A new push for solutions has begun. We are stunned by the surging numbers of opioid deaths; children being snatched from life. This attention has brought additional funds to the battle. Unfortunately, treatment remains expensive and allusive. Police officers still arrest with impunity, courts prescribe ineffective treatments, while those most in need receive little practical guidance to maneuver through the complicated red tape. Stigmatized labels continue with many politicians and voters preferring to condemn and ignore.

Obviously, no system can force individuals into sobriety. The individuals suffering must also be committed to the work. Many parents with handsome resources attest that money alone isn’t sufficient. For those mired in addiction, dodging responsibility is a certain path to failure. The best we can expect from society is a system that assists rather than complicates; a system that provides access to programs and medicine that will ease this difficult journey.

For those mired in addiction, dodging responsibility is a certain path to failure.

Personal responsibility requires soul searching, not a hunt for external causes to blame. Even under the disease model of addiction, prescribed treatment must be followed for a cure. Addiction is not a condemnation to death. There is an escape. Many successfully emerged from the rubble of servitude to live happy and enjoyable lives; but for this to happen, the addict must be willing to work through the challenges and endure the discomforts of change.

Perhaps, some answers may be found by travelling beyond the institutions of western medicine. A brief encounter with eastern philosophy reveals the intriguing practice of mindfulness. Can mindfulness cure addiction? We westerners envision mindfulness as something limited to yoga and meditation. But mindfulness is much more; mindfulness is a way of life—a practice central to all aspects of living. Free of the ridiculousness of government regulation and stigmatized labeling, a mindfulness is available to all.

First, there is no magical pill. Period. Mindfulness doesn’t miraculously cure. A desire for an effortless path to recovery is part of the problem—an expectation of ease. Getting high is an easy escape from emotional upheavals. Unfortunately, intoxication has the nasty side-effect of a destroyed future.

Success isn’t stress free, learning how to cope with the strains of living a productive life is essential. Sobriety requires facing many difficult choice points—moments where decisions should be made—often involving facing rather than escaping emotion. Our body may scream to act one way, but our mind knows better and calmly can recite reasons to support a more productive choice. Success comes when we learn to successfully navigate these choice points where body and mind conflict.

The Roman poet Ovid captures this complex dilemma of opposing forces within the mind. She laments: “I am dragged along by a strange new force. Desire and reason are pulling in different directions. I see the right way and approve it, but follow the wrong.”

Change is a sharp and twisted path. Looking at the daunting climb, we beg for something easier. We postpone the choice, hoping to discover an easier path—that avenue doesn’t exist. Self-discipline, pharmacological prescriptions and a supportive environment must collaborate, grasping hands to pull the addict up the trail and past the many critical points that litter their journey to recovery. Mindfulness can play a supporting role in this drama.

Helpless Victims or Autonomous Beings

We must adapt. When life collides with expectations, we adjust, changing directions. Somewhere during adaptations, addictions invade, creating tempting shortcuts that soothe anxieties that fail to advance towards our dreams. We enjoy the relief but ignore the cost.

Behavior theories explains many of the causes of this destructive process. During the early part of the twentieth century, prominent figures such as Ivan Pavlov, B.F. Skinner, and John Watson flooded psychology with behavior and stimulus-based theories of learning. Birds, animals and even children were described as products of their environments, their actions dependent on a stimulus and past learning.

These studies provide important pieces, helping us understand the addiction puzzle. New science doesn’t invalidate these past theories. Cognitive psychology adds to behavioral science, addressing the space between stimulus and response that behaviorism minimized and overlooked. We now know that people are more than a rat pushing a lever for a pleasant reward.

A lot happens between stimulus and response. In this space, we discover self-efficacy—the ability to direct change. Self-efficacy challenges learned behaviors, manipulates environments and seeks external assistance. Self-efficacy is a powerful weapon we must utilize to combat addiction. Our willpower can conquer alter and replace learned maladaptive responses.

Addictions are persistent and damaging. Even though an injected chemical can provide relief, it also compounds future problems, creating more anxiety to avoid. These circular adaptations are maladaptive, generating more need for continued reliance. An addiction is self-reinforcing, creating a craving for more.

While misfortune, opportunity and availability are all compounding factors, they only represent a portion of the cause—the external stimuli. Full understanding requires examining internal processes. External sources are not sufficient explanations to provide a workable path towards recovery. We must examine the role of cognitive functions as well.

At first glance, we wince and shout, “stop blaming the victim!” Yet, by ignoring internal contributions, we narrow our vision, missing the most workable solutions. If we only blame external sources, we condemn ourselves to be hapless victims, waiting for outside sources to save us. This may be a long wait. Society has failed to provide adequate assistance up to this point. Majority still are biased, suggesting the only cause is the addict’s weak character. These biases are expressed through lack of policies to fund workable solutions. While society should focus on external causes, the individual is better served by focusing on their internal efficacy to change. If internal change is possible, then there’s hope for recovery.

During the early 1970’s Martin Seligman conducted a series of experiments on motivation, leading to a theory of learned helplessness. He placed dogs in a shuttle box and administered painful shocks (damn scientists). The shocks motivated the dogs to action, searching for an escape. They frantically moved around the box until they discovered an avenue to freedom. However, when no escape was possible, the dogs eventually gave up—and helplessly endured. These dogs learned helplessness. Later, when Seligman returned the dogs conditioned to be helpless to the box where an escape was available, the dogs exerted no effort to find it. They simply endured the shocks. (Seligman, 1972). We act much the same when our repeated efforts to change fail; we give up, we lie down and accept the pain.

Physical urges gain or lose power through our mental representations—by the meaning we give them. During the Vietnam war, many soldiers frequently used heroin—the drugs provided an escape from the horrors of war. Interestingly, the majority of soldiers who reported addiction while in Vietnam didn’t continue use the drug after returning home (Robins, 1974). The physical dependency that was intractable on the battlefield didn’t translate to helpless addiction at home.

Ellen Langer’s studies found that heroin addicts were less likely to report withdrawal if they didn’t consider themselves addicts. The expectations contributed to the strength of the symptoms. Referring to the Vietnam veterans, Langer stated, “since this external justification was left behind in Vietnam, so was their perceived need for the drugs.” (1989, p. 184)

I’m not suggesting addiction is all in your head—it’s not. Withdrawal is painful and occasionally deadly. The path to recovery is a courageous journey through hell. What we learn from the Vietnam Soldier’s study is that outside changes and internal representations play an important role. A different environment and new thought patterns assist recovery efforts. Sometimes thought patterns that generously protect the ego by eliminating personal blame interfere with recovery by blinding the person from personal deficits that must be addressed. This is a difficult chasm that must be crossed. The sufferer, missing their own contributions to protect their ego, finds suggestions from parents, therapists and friends that point to choices as attacks on their character, and quickly dismissed.

Aldo complicating recovery efforts is drug use is an adaptation to the current environment. Drug and alcohol being the go-to response for stress. The same stresses that led to escape adaptations typically remain during sobriety. All the triggers continue to fire, making change difficult. The addiction has been positively reinforced by providing relief. Drug use often effectively eliminates stress, working so well that many users fail to realize the problem until their lives are completely destroyed. For many users, any experience of stress is habitually responded to with another dose.

Maia Szalavitz looking back on her addiction to heroin wrote, “But as unbelievable as it now seems even to me, despite shooting up dozens of times a day and facing felony drug charges, despite being on a methadone program for heroin addicts and having dropped out of college following my arrest, I didn’t yet see myself as a real drug addict.” (2017, location 285).

The problem, however, is normal anxiety has a purpose. Anxiety motivates action. By chemically eliminating anxiety, we kill motivation. If the intended goal is to maximize pleasure and minimum stress, then coping through intoxication, at least temporarily, is an effective strategy (see The Experience Machine).

Many of those suffering from long-term consequences of addiction often seek an equally effective substitute to abolish the anxiety. This is a fruitless search. The side-effects are from the altered states of mind caused by the drug. Stress is a necessary ingredient to create a better life. Stress motivates action. No matter what the adaptation, if it removes too much of the discomfort, it will fail to produce the stable life we seek. Susan David refers to these goals (such as a stress-free life) as “dead people’s goals.” (2016). These are the goals we only obtain once in the grave.

Fast-emotional-relief strategies fail to create brighter futures. These strategies focus on the present. Albert Ellis theorized that fast-relief strategies were adaptations for Low Frustration Tolerance (LFT). Individuals with biological sensitivities and life trauma develop LFT. The pain experienced by these individuals stems from an inability to process frustration. Problems are intensified by the anticipation of any small disruption. Ellis referred to this as “discomfort anxiety.” (DiGiuseppe & McInerney, 1990). Since anxiety is unbearable, those with LFT implement fast-relief strategies; addiction becomes the easy remedy.

We can’t eliminate these maladaptive coping strategies without a replacement. Major changes require eliminating and replacing cognitive functions at foundational levels. Deficit coping strategies must be identified and either replaced or modified.

According to the Cognitive-Behavioral treatment mode, “the most critical predictor of relapse is the individual’s ability to utilize effective coping strategies in dealing with high-risk situations (Witkiewitz, Marlatt, & Walker, 2005). Scientific evidence supports this claim.

We adapt to difficulties by either approaching or avoiding them. Neither strategy is perfect. We must rely on a blend, approaching at times but avoiding when necessary. We have a limited willpower. When approaching, even with effective coping strategies, we eventually fatigue. Avoidance limits exposure, conserving energy for other unavoidable contact. Stress is inherent to life. We can’t avoid everything. Habitual lack of exposure weakens our ability to cope. We must willing approach some difficulties, just not to the point of overwhelm.

As we approach and succeed, we strengthen self-efficacy. We experience mastery in that small domain. We empower ourselves to escape the unnecessary shocks. Experience changes cognitions—we learn and build confidence. Our mastery enhances our self-efficacy. (Bandura, 1977, p.191).

Mindfulness

Most adaptations are not conscious choice. We encounter a stimulus and react. Our biological system experiences internal change that prompts action. Typically, occurs without thought; we just act—and then justify.

Mindfulness brings these invisible reactions to light, exposing avoidance adaptations. Alan Marlatt refers to mindful observation as an act of inaction, or as referred to in Buddhism as Skillful Means. Here, mindfulness diverges from Albert Ellis’s cognitive behavioral approach of challenging faulty beliefs and instead just observes the process. Mindfulness is the being mind or wise mind that experiences emotion without the need for a responding action.

Eugene Gendlin taught six-steps for integrating mindful awareness into cognitive restructuring (see Focusing on Feelings). His steps include observing, identifying, labeling, evaluating, seeking guidance, and receiving with openness. Multi-step techniques—such as Gendlin’s focusing—nudge us forward when we are stuck.

Mindfulness helps integrate experiences of relapse into healing through deeper awareness of the surrounding happenings. This knowledge provides rich sources of information. An intimate contact with the interpersonal and intrapersonal landscape associated with relapse helps with both approach and avoidance strategies that we can use for better contingency planning.

Sobriety is only achieved through successful navigation of thousands of choice points—dozens of times a day at first, slowly reducing in frequency and intensity. As we successfully work through these temptations without collapse, new patterns become the norm. We accumulate mastery in our environment, creating a comfortable distance between opportunity and urge.

We may momentarily fail; but mindfulness helps turn those failures into strength and wisdom. We’re not helpless animals in an unescapable torture box, listlessly enduring shocks. We have a choice to suffer or leap, experiencing (with gratitude) the grace of this glorious life full of emotion and bright futures.

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Resources:

Bandura, A. (1977) Self-efficacy: Towards a unifying theory of behavioral change. Psychological Review, 84, 191-215. Retrieved from DeepDyve.com

David, S. (2016). Emotional Agility: Get Unstuck, Embrace Change, and Thrive in Work and Life. Avery; First Edition edition

DiGiuseppe, R., & McInerney, J. (1990). Patterns of Addiction: A Rational-Emotive Perspective. Journal of Cognitive Psychotherapy, 4(2), 121. Retrieved from Questia.

Langer, E. J. (19 89). Mindfulness. Cambridge, MA: Perseus Books

Marlatt, G. A., Gordon, J. R. (1985) Relapse Prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Giolford.

Robins, L.N. (1974). How Permanent Was Vietnam Drug Addiction?. American Journal of Public Health, 64.

Seligman, M. (1972). Learned Helplessness. Annual Review of Medicine, 23(1), 407-412.

Szalavitz, M. (2017) UNBROKEN BRAIN: A Revolutionary New Way of Understanding Addiction. Picador; Reprint edition.

Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-Based Relapse Prevention for Alcohol and Substance Use Disorders. Journal of Cognitive Psychotherapy, 19(3), 211. Retrieved from Questia.