mindfulness, meditation, and drug and alcohol use

41
THOMAS LYONS, PH.D. LOYOLA NEUROSCIENCE SEMINAR MARCH 18, 2014 Mindfulness, Meditation, and Drug and Alcohol Use

Upload: daxia

Post on 15-Jan-2016

65 views

Category:

Documents


0 download

DESCRIPTION

Mindfulness, Meditation, and Drug and Alcohol Use. Thomas Lyons, Ph.D. Loyola neuroscience seminar March 18, 2014. Mindfulness, Meditation and Drug and Alcohol Use. What is mindfulness? Enhancement of mindfulness through meditation training Neurobiology of meditation and drug addiction - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: Mindfulness, Meditation, and Drug and Alcohol Use

THOMAS LYONS, PH.D.LOYOLA NEUROSCIENCE SEMINAR

MARCH 18, 2014

Mindfulness, Meditation, and Drug and Alcohol Use

Page 2: Mindfulness, Meditation, and Drug and Alcohol Use

Mindfulness, Meditation and Drug and Alcohol Use

What is mindfulness?Enhancement of mindfulness through meditation

trainingNeurobiology of meditation and drug addictionMindfulness Based Relapse PreventionAddiction and the criminal justice system:

mindfulness programs in jails and prisonsResearch program at Chicago State UniversitySummary and conclusions

Page 3: Mindfulness, Meditation, and Drug and Alcohol Use

“Life is available only in the present moment.”

― Thích Nhất Hạnh

Page 4: Mindfulness, Meditation, and Drug and Alcohol Use

What is mindfulness?

“Paying attention in a particular way; on purpose, in the present moment, and non-judgmentally.” (Kabat-Zinn) Attention to thoughts, emotions and feelings in the

present moment Attitude of acceptance/non-reactivity and non-

judgement

A very old concept Sati in Sanskrit means “awareness”, also

remembrance, an important concept in Buddhism Came into Western languages in the 1970s through

work of Vietnamese monk Thich Nhat Hanh and others

Page 5: Mindfulness, Meditation, and Drug and Alcohol Use

What is mindfulness?

Can be conceptualized as A mental state that varies from moment to moment in

an individual A personality trait or disposition perduring over time

that can be measuring with personality inventories The goal of mindfulness practice

Page 6: Mindfulness, Meditation, and Drug and Alcohol Use

Five Facets Mindfulness Questionnaire (Baer et al 2006)

Page 7: Mindfulness, Meditation, and Drug and Alcohol Use

Dispositional Mindfulness

Dispositional mindfulness is associated with adaptive functioning (Baer et al 2006). Anxiety levels and history of depression (Grossman et al

2004) less severe gambling outcomes (Lakey et al 2007). diabetes self-management (Gregg et al 2007). Many other cross-sectional studies

Difficulties with the construct of mindfulness as a trait (Grossman 2011) Self reports may not be accurate Experienced meditators may be more aware of their

own limitations and rate themselves as less mindful

Page 8: Mindfulness, Meditation, and Drug and Alcohol Use

Dispositional Mindfulness and Drug/Alcohol Use

Among college age drinkers, relationship to alcohol use is “paradoxical” (Eisenlohr-Moul et al 2012) Higher levels of awareness Lower levels of non-reactivity Lower levels acting with awareness

Sample in drug treatment (Bowen and Enkema, 2014)

Mindfulness inversely related to severity of dependence

Page 9: Mindfulness, Meditation, and Drug and Alcohol Use

Cultivating Mindfulness

Meditation Types of meditation

Concentration or focused meditation, including TM Insight or mindfulness meditation

Certain types of Hatha Yoga

Page 10: Mindfulness, Meditation, and Drug and Alcohol Use

Insight Meditation

Various eastern traditions including Zen, Vipassana and Tibetan traditions can be grouped under mindfulness meditation

Often builds from awareness of the breath to awareness of the whole field of phenomena at the present moment Can include sitting, walking meditation

Short demonstration: Mindfulness Based Cognitive Therapy (0:39:00)

Several short term or medium term interventions but for many, a lifetime practice

http://www.youtube.com/watch?v=6-91LUJZoHo

Page 11: Mindfulness, Meditation, and Drug and Alcohol Use

Neurobiology of meditation

Types of studies: Measurement of brain state changes during

meditation vs. rest or other activities Cross sectional comparison between long term

meditators, short term participants in interventions, and/or non-meditation control groups Neural correlates of meditation/mindful states in these

groups Or response to a stimulus such as pain stimulus,

emotional triggers Longitudinal studies before and after meditation

training Comparisons to control group

Page 12: Mindfulness, Meditation, and Drug and Alcohol Use

Neurobiology of meditation

Structural vs. functional studiesHealthy samples vs. clinical samples (with

symptoms of depression, addiction etc)Evidence from EEG, PET, fMRI, and SPECT

Page 13: Mindfulness, Meditation, and Drug and Alcohol Use

Multiple brain structures affected

Prefrontal cortex Somatosensory regions Dorsolateral PFC

HippocampusInsulaeAmygdalaFunctional networks

Eg insula plus somatosensory regions Cortex plus limbic system

Page 14: Mindfulness, Meditation, and Drug and Alcohol Use

Neurobiology of meditation

Cross sectional comparison of long term meditator vs non meditators show enhanced activity in the PFC, right anterior insula and right hippocampus (Chiesa & Seretti, 2010)

Eight week meditation training increases grey matter density in hippocampus, cerebellum compared to controls (Hölzel et al 2010) Specific or non-specific effect?

Page 15: Mindfulness, Meditation, and Drug and Alcohol Use

Mindfulness Meditation as a Behavioral Therapy

“Third wave” of therapeutic interventions based on acceptance of negative thoughts and emotions rather than attempts to manage or control them. Mindfulness-based Stress Reduction for chronic pain

(Kabat-Zinn 1980) Acceptance and Commitment Therapy for depression

and anxiety (Hays et al 2006) Mindfulness-based Cognitive Therapy for depression

(Segal et al 2002) Dialectical Behavior Therapy for borderline

personality disorder (Hays et al 2004)

Page 16: Mindfulness, Meditation, and Drug and Alcohol Use

Possible mechanisms of clinical benefit

Strengthening connectivity between the cortex and limbic system (Chiesa, 2013)

Dampen automatic amygdala activation stress response, anxiety and other emotional states pain perception May be interpreted as an increased conscious control

Increasing grey matter density in specific regions (Hölzel et al 2010)

Page 17: Mindfulness, Meditation, and Drug and Alcohol Use

Before meditation, high emotional reactivity is observed. The amygdala easily activates in response to negative stimuli and the PFC is not able to inhibit the amygdala. (Chiesa et al. 2010)

Page 18: Mindfulness, Meditation, and Drug and Alcohol Use

After meditation training, amygdala activity is usually reduced. If amygdala activates in response to negative stimuli, PFC is engaged in order to dampen automatic amygdala responses. (Chiesa et al 2010)

Page 19: Mindfulness, Meditation, and Drug and Alcohol Use

Neurobiology of addiction

Effect of drugs of abuse is related to the mesolimbic reward system: ventral tegmental area, ventral striatum, amygdala and medial PFC – the “reward circuit”.

Compulsive use also involves the dorsal striatum – “habit circuit”

Addiction also involves dysfunction in the cortex, including dlPFC and activation of subgenual ACC

Page 20: Mindfulness, Meditation, and Drug and Alcohol Use

Effect of mindfulness meditation training

Mindfulness training primarily targets the cortex; at least initially, a “top down” process of improving control over functioning

Self referential thinking and rumination activate midline PFC areas in both depression and addiction (Brewer et al. 2009)

Mindfulness practice may shift activation from midline PCC to dlPCC – more objective awareness

Lateralization of brain activation

Page 21: Mindfulness, Meditation, and Drug and Alcohol Use

Effect of a brief mindfulness meditation training

47 treatment-seeking smokers (12-h abstinent from smoking) viewed images while undergoing fMRI (Westbrook et al 2011). Passively vs. trained to engage in mindful attention

Mindful attention reduced neural activity in subgenual anterior cingulate cortex (sgACC)

Reduced connectivity with other craving related regions including insula and ventral striatum

Also reduced self-reported craving (Westbrook et al. 2011)

Page 22: Mindfulness, Meditation, and Drug and Alcohol Use

Effect of a brief mindfulness meditation training

47 treatment-seeking smokers (12-h abstinent from smoking) viewed images while undergoing fMRI (Westbrook et al 2011). Passively vs. trained to engage in mindful attention

Mindful attention reduced neural activity in subgenual anterior cingulate cortex (sgACC)

Reduced connectivity with other craving related regions including insula and ventral striatum

Also reduced self-reported craving (Westbrook et al. 2011)

Page 23: Mindfulness, Meditation, and Drug and Alcohol Use

Top-down or bottom-up process?

Experienced meditators exhibit changes in limbic system functioning during meditation that are independent of cortical control.(Chiesa et al 2013)

May depend on length of involvement in meditation

May depend on type of sample: healthy vs. clinical samples (eg smokers trying to quit)

Page 24: Mindfulness, Meditation, and Drug and Alcohol Use

Mindfulness Based Relapse Prevention (Chawla et al 2011)

Based on Mindfulness Based Stress Reduction

An eight week course including meditation, yoga, and discussion of relapse, triggers, and relapse prevention

Designed for individuals coming out of drug treatment

Page 25: Mindfulness, Meditation, and Drug and Alcohol Use

Mindfulness Based Relapse Prevention

In a randomized controlled trial (RCT), significant reductions in substance use and craving were observed in the MBRP group compared to treatment as usual (Bowen et al, 2009b)

A second RCT compared mindfulness meditation to cognitive behavioral therapy for substance use and found reduced craving and physiological stress indices in the treatment group (Zgierska et al 2010)

Page 26: Mindfulness, Meditation, and Drug and Alcohol Use

Mindfulness Based Relapse Prevention

Might have particularly long-lasting effects on reducing drug use (Zgierska et al 2009).

However, strong evidence for effectiveness of mindfulness-based treatment for substance use disorders is still lacking. (Zgierska et al 2009)

Page 27: Mindfulness, Meditation, and Drug and Alcohol Use

Difficulties with MM in drug treatment

Anxiety in early withdrawal (Vallejo et al 2009)

Restlessness/agitationHistory of traumaAn adjunct, not a substitute for drug

treatmentMay require a period of abstinence from

substances

Page 28: Mindfulness, Meditation, and Drug and Alcohol Use

Research at Chicago State University

Urban Mindfulness and Addictions Research MBRP in jail drug treatment Mindfulness with case managers: enhancing the

working alliance and therapeutic outcomes Mindfulness, substance abuse, and medication

adherence Drug discovery program as adjunct to mindfulness

therapy

Page 29: Mindfulness, Meditation, and Drug and Alcohol Use

Addiction and the Criminal Justice System

More than 60% of prisoners are estimated to have a substance use disorder(National Center on Addiction and Substance Abuse 2010)

In Cook County the majority of detainees are charged with low level drug offenses(Lyons et al 2013)

Page 30: Mindfulness, Meditation, and Drug and Alcohol Use

Addiction and the Criminal Justice System

Five fold growth in incarceration rates among people of color since 1980 has largely been a result of drug related arrests and convictions(Alexander 2010).

African Americans are 54% of those incarcerated for drug offenses and are 10 times more likely than whites to be sentenced to prison for a drug law violation(Human Rights Watch 2000).

Cycles of repeated arrest and imprisonment for drug related crimes often reflect untreated addiction(Langan and Levin 2002).

Page 31: Mindfulness, Meditation, and Drug and Alcohol Use

Addiction and the Criminal Justice System

Much mindfulness meditation research has been with white, middle class patients.

No studies of mindfulness meditation that focus on cultural adaptations for African American men.

Meditation training in a jail context Limited in duration Linked to post-release services Participants should be over the acute withdrawal

stage

Page 32: Mindfulness, Meditation, and Drug and Alcohol Use

Why meditation programs in jail?

7x as many individuals released annually from jails as from prisons

Many jails have existing drug treatment programs

Enforced abstinence may promote benefit of mindfulness training

Mindfulness training may promote engagement in aftercare

Page 33: Mindfulness, Meditation, and Drug and Alcohol Use

Goals of the study

Culturally tailor the MBRP intervention for an urban, primarily African American population of inmates

Test efficacy via a quasi-experimental clinical trial within a men’s drug treatment program at the Cook County Jail.

Page 34: Mindfulness, Meditation, and Drug and Alcohol Use

Goals of the study

At 5-month intervals over the course of 36 months, successive cohorts will be given either mindfulness training or an attention control communication skills intervention.

Pre- and post-test assessments, at an equivalent interval, of mindfulness, psychological symptoms, and PTSD symptoms.

Participants in the experimental condition will be referred to post-release meditation groups

Page 35: Mindfulness, Meditation, and Drug and Alcohol Use

Goals of the study

To assess the efficacy of the intervention, rearrest and reincarceration data will be compared for

the treatment and control groups at a minimum of 12 months post release.

Contact participants by telephone 3 months post release and obtain self reported substance use data

qualitative interviews with a subset of participants in the experimental group one month post-release will explore whether and how they implemented mindfulness

Page 36: Mindfulness, Meditation, and Drug and Alcohol Use

Formative research to adapt intervention

Focus groupWorking with African American, culturally

competent trainersAdapting and simplifying manual Mindfulness

Based Relapse Prevention: A Clinician’s Guide (Chawla et al. 2011)

Page 37: Mindfulness, Meditation, and Drug and Alcohol Use

Some conclusions

Mindfulness as an attentional state, personality trait, and goal of meditation practice

As a trait, mindfulness is probably important for understanding addiction, but research is just beginning Related to deficits in executive functioning,

impulsiveness, and sensation seeking

Page 38: Mindfulness, Meditation, and Drug and Alcohol Use

Some conclusions

Meditation practice changes brain structure and functional circuits Most studies cross sectional and involve small

samples Prospective studies with appropriate control groups

needed

Meditation training may be a potent tool in drug addiction treatment May have long lasting effects Stage and context of recovery important Linking behavioral and pharmacological treatment

Page 39: Mindfulness, Meditation, and Drug and Alcohol Use

[email protected]

Thank you!

Page 40: Mindfulness, Meditation, and Drug and Alcohol Use

References

Alexander, M. (2010). The new Jim Crow: Mass incarceration in the age of colorblindness. New York: New Press. Baer, R. A., Hopkins, J., Krietemeyer, J., Smith, G. T., & Toney, L. (2006). Using self-report assessment methods to

explore facets of mindfulness. Assessment, 13(1), 27-45. Bowen, S., & Enkema, M. C. (2014). Relationship between dispositional mindfulness and substance use: Findings

from a clinical sample. Addictive Behaviors, 39, 3, 532-537. Bowen S, Marlatt A. (2009a) Surfing the Urge: Brief Mindfulness-Based Intervention for College Student Smokers.

Psychology of Addictive Behaviors 2009;23(4):666-671. Bowen S., Chawla N., Collins S.E., Hsu S., Grow J., Clifasefi S., et al. (2009b) Mindfulness-based relapse prevention

for substance use disorders: A pilot efficacy trial. Substance Abuse 2009;30(4):295-305. Chiesa A., Serretti A. A systematic review of neurobiological and clinical features of mindfulness meditations.

Psychological Medicine 2010;40(8):1239-1252. Chiesa A, Serretti A, Jakobsen JC. Mindfulness: Top–down or bottom–up emotion regulation strategy? Clinical

Psychology Review 2013;33(1):82-96. Eisenlohr-Moul T.A., Walsh E.C., Charnigo Jr. R.J., Baer R.A., Lynam D.R. The "What" and the "How" of Dispositional

Mindfulness: Using Interactions Among Subscales of the Five-Facet Mindfulness Questionnaire to Understand Its Relation To Substance Use. Assessment 2012;19(3):276-286. 29

Gregg, J., Callaghan, G. Improving diabetes self-management through acceptance, mindfulness and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology. 2007. Vol. 75. No. 2 336-343.

Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res. 2004 Jul; 57(1):35-43.

Grossman, P., & Van, D. N. T. (May 01, 2011). Mindfulness, by any other name…: trials and tribulations of sati in western psychology and science. Contemporary Buddhism, 12, 1, 219-239.

Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and Commitment Therapy: Model, processes and outcomes. Behav Res Ther 2006;44(1):1-25.

Hayes SC, Follette VM, Linehan M. Mindfulness and acceptance : expanding the cognitive-behavioral tradition. New York: Guilford Press; 2004.

Page 41: Mindfulness, Meditation, and Drug and Alcohol Use

References

Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (January 01, 2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research, 191, 1, 36-43

Human Rights Watch. Punishment and prejudice: Racial disparities in the war on drugs. 2000. Retrieved from http://www.hrw.org/reports/2000/05/01/punishment-and-prejudice-racial-disparities-war-drugs

Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry 1982;4(1):33-47.

Lakey, Campbell, W., Brown, K. Goodi, A. Dispositional mindfulness as a predictor of the severity of gambling outcomes. Personality and Individual Differences. 2007. Vol. 43: 1698–1710

Langan PA, Levin DJ, United States. Bureau of Justice Statistics. Recidivism of prisoners released in 1994. 2002; . National Center on Addiction and Substance Abuse. Behind bars II : substance abuse and America's prison

population. New York, NY: National Center on Addiction and Substance Abuse at Columbia University; 2010. Lyons T, Lurigio A, Roque L, Rodriguez P. Racial Disproportionality in the Criminal Justice System for Drug Crimes:

A State Legislative Response to the Problem. Race and Justice 2013;3(1):83-101. Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression : a new approach to

preventing relapse. New York: Guilford Press; 2002. Thorsten, B., Duggan, D., Griffith, J. Dispositional mindfulness moderates the relation between neuroticism and

depressive symptoms. Pers Individ Dif. 2011 December; 51(8): 958–962. Vallejo Z, Amaro H. Adaptation of Mindfulness-Based Stress Reduction Program for Addiction Relapse Prevention.

Humanistic Psychologist 2009;37(2). Westbrook C, Creswell JD, Tabibnia G, Julson E, Kober H, Tindle HA. Mindful attention reduces neural and self-

reported cue-induced craving in smokers. Social Cognitive and Affective Neuroscience 2011(12). Zgierska A., Rabago D., Kushner K., Chawla N., Marlatt A., Koehler R. Mindfulness meditation for substance use

disorders: A systematic review. Substance Abuse 2009;30(4):266-294.