Chemical addiction to drugs and alcohol is a serious epidemic with an estimated 15% of the American population affected,¹ a figure that does not include those impacted indirectly.  Furthermore, treatment studies have found that generic inpatient programs only seem to exert their effects in the short term, and that relapse is an ever persistent problem: in their first year after completing treatment, 80-90% of clients addicted to alcohol relapsed when relapse was defined as a single drink,² and approximately 50% of clients returned to pre-treatment drinking levels.³  “Kicking the habit”—whether it be alcohol, cigarettes, or other drugs—is very difficult, and so, medical professionals and researchers are always looking for new forms of therapy that may prove effective in treating these addictions.  More and more, the focus is shifting toward traditional or alternative therapies, like meditation, and the results of some initial studies are quite promising.⁴ Indeed, meditation seems to reduce a number of risk factors,⁵ like the need for stimulation.⁶

It has been proposed that meditation can be an effective adjunct to conventional interventions for substance abuse and addiction.  Its inter-related mechanisms are three-fold:

First, there appears to be a strong correlation between substance abuse and depression, and some researchers have suggested that this reflects an attempt to self-medicate.⁷ It is possible that some people use drugs as a way of dealing with negative states, or life’s problems in general, but ironically, evidence indicates that drug use actually exacerbates aversive moods and other problems, rather than correct them.⁹ At the same time, withdrawal symptoms—like depression and irritability—seem to encourage drug use as a means to alleviate dysphoria.  For example, smoking cessation may precipitate depression,^7,10 which explains why it is so difficult to quit: many are tempted to “cave in” in order to treat or cope with the depression associated with withdrawal.  Negative emotions and chronic stress account for a number of relapses,⁸ and a negative mood can be sufficient to elicit the desire for drugs or alcohol.¹¹

To this end, it follows that treating a patient’s negative states, be it pre-addiction depression or withdrawal-related anxiety, also addresses the drug dependence.  Addictions are characterized by an inability to tolerate painful emotions, and so cultivating the ability to endure and overcome these states can facilitate recovery.¹²  Depressed cocaine users reduced their drug intake by 90% after starting a regimen of desmethylimipramine, a tricyclic antidepressant.¹³ 

Meditation seems to provide a sense of stability and relief to those facing the tumultuous context of early substance abuse recovery.¹⁴  Moreover, evidence suggests that meditation is effective in reducing both depressive¹⁵ and anxious¹⁶ symptoms, and can thus help ease the road to recovery by reducing the need to self-medicate.  Many of those who abuse substances acquire a “learned helplessness” wherein they perceive life’s problems as being inescapable and uncontrollable¹⁷; meditation seems to restore a certain sense of control, and can therefore alleviate this “learned helplessness.”  A sense of vulnerability predicts relapse, whereas high self-efficacy (i.e., a strong confidence in one’s own abilities) may prevent it.¹⁸

Second, meditation seems to facilitate mindfulness.⁴ This increased sensitization, or awareness of cues, automatic thoughts, and preconscious processes, helps those addicted to drugs or alcohol become more aware of environmental stimuli¹⁹ and internal states8 that may evoke urges to use mind-altering substances. 

Coming from the perspective of behavioural psychology, addictions are perpetuated by classical (i.e., Pavlovian) conditioning: at an unconscious level, people come to associate certain cues (like negative states or a pub atmosphere) with drug-taking, alcohol-drinking,⁸ or other automatic reactions.  This is the same mechanism that explains why Pavlov’s dogs automatically salivated upon hearing a bell.  These associations are further perpetuated by another process called operant (i.e., instrumental) conditioning, or the “reward and punishment” system, wherein the consumption of alcohol or drugs provides immediate, short-term relief of negative moods, and is thus reinforced.^7,8 

Reducing the strength of such Pavlovian relationships can help diminish the overwhelming urges to drink or take drugs.  As the client becomes more aware of these cues, and the more often these cues are not followed by episodes of drug-taking or alcohol-drinking, the Pavlovian connection weakens.⁸ Of course, the person must first be aware of these cues before such a relationship can be recognized and overcome.  Concrete stimuli, like loud music or the smell of alcohol, are much more easily identified than emotional or mood cues, like acute stress or depression; however, meditation can increase awareness of internal states, and thus encourage the mindful deployment and self-regulation of attention.^8,20

Third, desensitization to automatic thoughts, emotions and behaviours can help reduce substance abuse.⁸ A negative mood can be sufficient to elicit the desire for drugs or alcohol,¹¹ but mindfulness meditation encourages an “accept and move on” strategy wherein the negative thought is acknowledged and dismissed.⁸  This shifts the focus from being an active participant to a passive observer, reducing the urgency of the thought.⁸  As discussed above, the increased awareness of cues (concrete or emotional) helps extinguish their relationship with drug or alcohol consumption.  This is done by giving less weight to the intrusive thoughts that otherwise induce drug use.  Moreover, meditation seems to be effective in decreasing sympathetic nervous system (SNS) activity—which is related to the stressful fight-or-flight response—and encouraging distinct states of well-being.⁴

Mindfulness can be thought of as actively trying to understand one’s environment without relying on automatic schemas.²¹ Mindfulness meditation helps practitioners confront difficult situations and emotions in a non-judgmental way, investigating the experience rather than avoiding it, and not becoming preoccupied with these states as they happen.⁸  Rather than trying to change or suppress the inevitable thoughts that may otherwise induce alcohol or drug consumption, this acceptance-based approach encourages simple awareness and comprehension of the intrusive thoughts and feelings. 

Active thought suppression and its monitoring actually triggers, indeed strengthens, the intrusive thoughts.²² Take, for example, “Have I thought about a pink elephant yet?  Oops, I just did.”  Avoidance strategies may be useful in the short term, but are maladaptive and ineffective in the long term, prolonging the very thoughts one is trying to avoid.^8,22-24  In a study of clients who underwent conventional therapy for their substance abuse, those still abstinent 6 weeks after treatment decreased their use of avoidance, whereas relapsers increased their use of avoidance as a coping strategy.²³  By accepting the thought and moving on, or in other words, by maintaining a calm detachment to mental events, intrusive thoughts can remain transient24 and exert little to no effect.  Mindfulness desensitizes clients to negative feelings⁸ and aids in extinguishing the automatic avoidance of painful emotions.²⁵ Self-criticism is replaced by increased acceptance.¹⁷ 

Quitting alcohol or drugs can be incredibly difficult and typically requires a significant amount of determination and effort.  It’s not surprising that many trying to quit smoking, for example, eventually take the path of least resistance and start smoking again.  Maintaining abstinence requires vigilance whereas the “action plan” of resorting to smoking or drinking is firmly established and generally effortless.⁸  Furthermore, it is difficult to overcome the cues that urge drug- or alcohol-use, as certain stimuli can involuntarily recruit attention: just as a person’s attention is automatically evoked when they hear their name at a cocktail party, alcohol-related words necessarily elicit an alcoholic’s attention.²⁶  For this reason, some have recommended meditation²⁷ as a stress-reducing, pleasurable replacement for substance use²⁸: it can relieve stress,²⁹ increase mindfulness, and diminish the effects of negative thoughts and emotions.  Indeed, a long-term study found that those trained in meditation had a significant drop in substance abuse relative to controls.³⁰  Meditation is very useful in beating addiction,^14,31 and can encourage the extinction of maladaptive behaviours while promoting conscious decision making.⁸

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