Mindfulness-Based Stress Reduction

as a Treatment for Addiction

Rachel Fintzy, M.A.

David Geffen School of Medicine at UCLA,Semel Institute for Neuroscience and Human Behavior

What Do We Know About Methamphetamine Addicts?

Active Users show impairments in:

Response inhibition Mental flexibilityProblem solvingAbstract thinking

What Do We Know About Methamphetamine Addicts?

Abusers in abstinence show impairments in:

Inhibitory controlVerbal learningDecision making

VIG

Hippocampal Atrophy is Associated with Impaired Vigilance

London et al, 2005, Biol Psychiatry 58: 770-778

MEM

Hippocampal Atrophy in

MA Abusers is Linked

With Poorer Memory

Performance(Thompson et al., 2004; J. Neurosci. 30: 6028-36)

IMAG

Experiential Index is Lower in Subjects with Hippocampal Damage

Hassabis et al, 2007, PNAS, on-lineSPAT

Hippocampal Damage Impairs Imagination

Hassabis et al, 2007, PNAS, on-line

IFG

MA Abusers Exhibit Gray Matter Deficit in Inferior Frontal Gyrus

(Thompson et al., 2004; J. Neurosci. 30: 6028-36)

SST

MA Abusers Impaired on Stop-Signal

Monterosso et al., 2005, Drug Alcohol Depend. 79: 273-77

MA Use

Inhibitory Deficits Related to MA Use

Monterosso et al., 2005, Drug Alcohol Depend. 79: 273-77

RETENT

Cognitive Deficits Predict Retention in Cocaine Users

Aharonovich et al., 2006, Drug Alcohol Depend. 81: 313-22

N=56, coc-dependent

IMPULS

High Impulsivity Associated with Poor Retention in Cocaine Users

Moeller et al., 2001, J. Substance Abuse Treatment 21: 193-198

SUM

Summary

Active and newly abstinent MA abusers exhibit deficiencies in cognition, decision making,

impulse control, and abstract thinking.These behavioral changes have been linked to

brain abnormalities.

Pharmacotherapies are being investigated, but non-pharmacotherapies may also work.

What Is Being Done About This?

WHY

Why Mindfulness Training For Addiction?

Hippocampal atrophy: Connection between methamphetamine addicts in early abstinence,

depression, and anxiety.

Mindfulness training has demonstrated effectiveness in treating depressive and anxiety disorders.

WHAT

What Is Mindfulness?

a receptive attention to and awareness of present events and experiences. (Brown & Ryan, 2003)

a way of being that combines increased alertness with an optimal state of physical, emotional, and mental equilibrium (Kabat-Zinn)

 “going with the flow” or adaptation to the situation at hand with a minimum of excessive stress and/or volatility (Kabat-Zinn)

NOT

Mindfulness is not…..

relaxation sleeping

fantasizing

Med. & DA

Dopamine Increased During Meditation

Kjaer et al, 2002, Cognitive Brain Research 13:255-259

MA & DA

65%Attn to Speech Attn to Speech

DA D2 Receptors Reduced in MA AbusersDA D2 Receptors Reduced in MA Abusers

1.51.51.51.5

2222

2.52.52.52.5

3333

3.53.53.53.5

4444 Caudate (p < 0.0002)Caudate (p < 0.0002)

1.51.51.51.5

2222

2.52.52.52.5

3333

3.53.53.53.5

4444Putamen (p < 0.02)Putamen (p < 0.02)

Controls MethControls MethControls MethControls Meth

Controls MethControls MethControls MethControls Meth

[11C] Raclopride

Volkow et al. AJP 2001

CortThck

Meditators Have Thicker Cortical Regions

Lazar et al, 2005, Neuroreport 16(17):1893-1897

Age & CT

Frontal Cortex

Insula

Meditators Maintain Cortical Thickness While Aging!

Lazar et al, 2005, Neuroreport 16(17):1893-1897

Insula Frontal Ctx

InsSm

Insular Damage Stops Smoking

Bechara and colleagues 2007, Science 315, 531-4VM

Meditation Decreases Substance Use

Bowen, 2006, Psychology of Addictive Behaviors 20(3):343-347

MBCT

Ma, SH & Teasdale, JD, 2004, J Consulting & Clinical Psych 72(1):31-40MBCTGr

Mindfulness-Based Cognitive Therapy Improves Outcomes for Treatment-

Resistant Depression

Mindfulness-Based Cognitive Therapy Improves Outcomes for Treatment-

Resistant Depression

Ma, SH & Teasdale, JD, 2004, J Consulting & Clinical Psych 72(1):31-40 MBSR

Mindfulness-Based Stress Reduction Improves Outcomes for Anxiety

Disorders

Miller et al, 1995, General Hospital Psychiatry 17:192-200

ADHD

Self-report ADHD Symptoms Reduced After Mindfulness Training

Zylowska et al 2006, Amer Acad Child Adolsc Psychiatry, Poster Presentation

BPD

Dialectical Behavior Therapy Decreases Drug Use In Patients

with BPD

Linehan et al, 1999, American Journal on Addictions 8:279-292

CurrTrt

Substance Abuse and Affective Disorders: Current Mindfulness

Treatments

Mindfulness-Based Stress Reduction Dialectical Behavioral Therapy Mindfulness Based Cognitive Therapy Acceptance and Commitment Therapy 12-Step Programs Cognitive Control Training/Attention Training

StrEf

Affects of Chronic Stress on Body, Mind, and Behavior

•  habituation to stress and subsequent down- regulation • low cortisol levels associated with long- term chronic physiological and/or psychological stress• subsequent need to “re-boot” system (SSRI’s = neurogenesis, reversal of hippocampal atrophy)

Summary of Mindfulness Training

FutDir

• practice of nonjudgmental awareness of one’s thoughts, feelings, and environment• increases endogenous dopamine release• increases cortical thickness• effective for depression, anxiety, ADHD, and apparently substance use

Future Directions

• 8-week mindfulness training• weekly two-hour group sessions• 15-30 minute/day home practice • thrice weekly urine testing• weekly cognitive assessments• weekly BDI, SUI, VAS • evaluate effect of mindfulness practice on abstinence, cognition, and mood• retention in treatment

Acknowledgments

Thomas Newton, M.D.Richard De La Garza, II, Ph.D.

Lidia Zylowska, M.D. Gilles Fleury, M.D. J. David Creswell

Life is not the way it’s supposed to be. It’s the way it is.

The way you cope with itis what makes the difference.

Virginia Satir