Mindfulness Training for Addictions

A Prison Setting

Pat Harris

Specialist Forensic Physiotherapist

Heather Gillespie

Smoking Cessation Officer

What does it mean to you?

It’s topical at the moment - its everywhere.

It’s used in a variety of settings in health, education, prisons

and businesses.

It’s living in the present and being more awake to our lives

rather than operating from our 'automatic pilot'

where we are cut off from our experience.

It’s an ability to cultivate a relationship with ourselves

It’s paying attention to our thinking processes and the way we

interact in the world

It’s paying attention to the present moment, in a particular way on

purpose.

By becoming familiar with what’s going on in our body and mind things change.

Mindlessly carrying out tasks or checking out is bad for us.

It’s not good for our body or our minds.

Can take it’s toll on us and leaving us stuck in the flight or fight

response.

Functioning in a more mindful state -aware of the present – is a

healthier way to be.

Can help change the relationship we have with ourselves and those

around us.

We live on autopilot - moving from one thing to the next with no

experience of any of it.

Research claims paying attention to the present changes our brain

functioning.

Noticing cultivates our ability to connect to our body, mind and the

wider environment.

By focusing on the present without filling it up we cultivate

awareness.

This changes the way our mind and body functions and is a more healthy less stressful way to be.

By observing what’s in your mind moment to moment

Watching your thoughts and not getting caught up and driven

by them

Not worrying about the past or projecting the future

Observing the stories we buy into which dominates our

thoughts.

This helps us to respond rather than react to situations

This in turn builds a healthier relationships with ourselves and

those around us.

Letting go of our thoughts without getting caught up

makes room for new ways to deal with things.

Breath and meditation is the way in - but it has to be EXPERIENCED!

Evidence suggests..........

It creates changes in brain functioning which support us to build

better resources and strategies

These allow us to meet challenges effectively and develop

resilience

It helps us develop coping techniques and strategies which

affect our relationship with others

It protects us from burnout and compassion fatigue

It builds our emotional intelligence and wellbeing.

When we pay attention to our present moment experiences it

cultivates a state of mind (strategies) that are beneficial to us

Switching off autopilot creates more nurture, acceptance of the

present (good/bad) and letting go.

Less caught in emotions of past or future projections which lead to

planning, fixing, stressing and worrying

When we’re not distracted and multi-tasking we’re more connected.

It changes us and is a healthier, more resilient way to be.

Nicotine Dependence

Abstinence –Induced Cue or Affect –Induced

(Due to lack of nicotine) (Urges such as after a meal or when stressed)

NRT & other Pharmacotherapy's can be used to

alleviate abstinence-induced cravings

Behaviour treatments for smoking cessation have focused heavily on teaching individuals to avoid

cues

o 76% of prisoners smoke (Scottish Annual Prisoner Survey)

o 55-58% reported they would like to stop smoking

o The Prison environment and regime can reinforce smoking especially as a coping mechanism for stress & anxiety

o Tobacco is used as a common form of currency

o The ritual act of rolling and smoking tobacco individually or in groups alleviates boredom

o Typical behavioural support for smoking cessation such as avoiding cues has little effect within a prison setting.

The course focused on helping participants to define the craving that directly drives smoking behavior, and provide training in how to stop

feeding this behavior.

8 week ‘Mindfulness Training for Addictions: Smoking Edition’ developed by Judson Brewer et al (2011) at Yale Medical School

Literature review to analyse the evidence and the potential role for Mindfulness in relation to smoking cessation.

Essential skills that are taught within the 8 week training can be practiced by anyone who has cravings. Therefore it was suitable for individuals who were just contemplating quitting (as it can show them more clearly the suffering that their habits are creating), actively trying to quit, or have achieved a period of abstinence

10 long term prisoners participated in the 8 week training course

NRT or Varenicline made available if requested

The course focused on helping dismantle the links between the cue and affect induced cravings through the process of non-judgemental acceptance, exploration of these feelings, and the development of new skills to cope with these urges.

Topics explored included automatic pilot, cravings & triggers, thoughts, emotions and loving kindness, changing habits for good, high risk situations & nourishing healthy habits

Practice involved body scans & mindful movement

Automatic

Pilot

Triggers

Emotions

Emotions

Habits

Mindfulness

Thoughts

Action &

Reaction

Making It

Stick

Automatic Pilot And Craving.

Skills:

Mindfulness of smoking, body scan, setting aspiration, mindfulness of daily activity

Triggers, Thoughts, Emotions and Cravings

Skills:

RAIN

Difficult Emotions and Loving-Kindness

Skills:

Loving - Kindness

Changing Habits for Good:

Motivation, Aspiration and Resolve

Skills:

Reflecting on the Benefits of not Smoking:

“AND THEN WHAT”

Everyday Mindfulness

Skills:

Mindfulness of Breath Meditation.

4 Modes of Walking

Thoughts As Food

Skills:

Getting Caught up in Thoughts

From Reaction to Skillful Action:

Letting Go and Moving Forward

Skills:

RAINing on High Risk Situations

Making It Stick: Nourishing Healthy Habits

Skills:

Reminder Cards

I hoped to stop completely but I think with more time at this I’d do it although I

have drastically cut smoking

I've stopped

smoking and this

is helping me to

keep it up

I have been practising Mindfulness for 8 wks

now and I feel better all round after practice

Feedback from the group suggests that Mindfulness not only aids cessation, but prepares and provides contemplators of quitting the skills to approach abstinence and the skills to maintain this

It was felt that the content of the Mindfulness programme was not always suitable for the target group and some aspects require to be adapted.

Increase training course to 12 weeks

Train Fresh Air-shire cessation advisors to incorporate some of concepts & techniques into the community service provision

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Any thoughts?