Craving to quit: Psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions.

Abstract

Humans suffer heavily from substance use disorders and other addictions. Despite much effort that has been put into understanding the mechanisms of the addictive process, treatment strategies have remained sub-optimal over the past several decades. Mindfulness training, which is based on ancient Buddhist models of human suffering, has recently shown preliminary efficacy in treating addictions. Interestingly, these early models show remarkable similarity to current models of the addictive process, especially in their overlap with operant conditioning (positive and negative reinforcement). Further, they may provide explanatory power for the mechanisms of mindfulness training, including its effects on core addictive elements, such as craving, and the underlying neurobiological processes that may be active therein. In this review, using smoking as an example, we will highlight similarities between ancient and modern views of the addictive process, review studies of mindfulness training for addictions and their effects on craving and other components of this process, and discuss recent neuroimaging findings that may inform our understanding of the neural mechanisms of mindfulness training.

Mindfulness practice moderates the relationship between craving and substance use in a clinical sample

“…For people in remission from a substance use disorder, craving may be the most difficult challenge to successful remission maintenance (Brewer, Elwafi, & Davis, 2014). Many treatments for substance use disorder focus on identifying and avoiding high-risk situations that may trigger relapse (Larimer et al, 1999).…”

“…While this strategy has been successful, avoidance of craving cues may not always be feasible (Moore et al, 2014). Thus, enhancing skillfulness in coping with craving through mindfulness practice may further improve long-term outcomes Brewer et al, 2014).…”

“…Mindfulness practices have been incorporated into treatment for substance use disorder to improve remission maintenance Brewer et al, 2014;Garland et al, 2014;Witkiewitz, Bowen, Douglas, & Hsu, 2013;Zgierska et al, 2009). As a psychological construct, mindfulness can be described as a gentle, kind, and curious awareness of experience (Grossman, 2010).…”

“…Mindfulness practices have played a central role in religious and spiritual traditions for at least several millennia (Hanh, 1998;Hart, 1987). In the Buddhist tradition, practice is intended to increase access to mindfulness, and help people experience freedom from craving and develop insight into the relationship between thoughts, emotions, and behaviors (Brewer, Davis, & Goldstein, 2012;Brewer et al, 2014;Hanh, 1998;Hart, 1987). Although attempts to operationalize mindfulness as a construct within modern Western psychology are ongoing (Kirk Warren Brown, Ryan, Loverich, Biegel, & West, 2011;Grossman & Van Dam, 2011;Grossman, 2010;Bishop et al, 2006;K.…”

“…Current theory suggests that including mindfulness practice in treatment may improve outcomes by altering the craving-use relationship (Brewer et al, 2014;Elwafi et al, 2013;Witkiewitz, Bowen, et al, 2013). Mindfulness Based Relapse Prevention (MBRP) is a treatment based on RP, and includes mindfulness practices focused on developing more skillful responses to craving (Bowen, Chawla, & Marlatt, 2011;Witkiewitz, Bowen, et al, 2013;Witkiewitz, Marlatt, & Walker, 2005).…”