It's tough to kick any habit. Some habits — like smoking or excessive alcohol use — are so dangerous that you want to quit them despite the difficulty. If only you could!
So what works?
Evidence is building that mindfulness is a tool to help people quit addictions. Mindfulness involves learning to accept and tolerate the challenges of withdrawal from addiction, rather than finding ways to avoid these unpleasant experiences.
There are lots of options to help people stop smoking, from nicotine replacement therapy to psychotherapy and self-help programs. But for the most part, the success rates of these programs are discouraging. Most people addicted to cigarettes have to make several quit attempts before they can finally stop smoking for good.
Even then, they may have trouble going without a smoke. Environmental cues and triggers — such as the smell of a cigarette or the pressures of a stressful day — can trigger powerful cravings. These can be hard to resist because of the pleasure smoking brought. That's why most tobacco cessation programs encourage people to avoid triggers, reduce stress and find alternatives to cigarettes.
Researchers at the Yale University School of Medicine studied mindfulness training as a stand-alone treatment for nicotine addiction. They recruited 88 smokers to participate in the trial. On average, participants were smoking 20 cigarettes a day and had made five previous attempts to quit.
Half of the participants were assigned to the American Lung Association's Freedom From Smoking program. The program covered behavior modification, stress reduction techniques and tips on how to avoid relapse. The remaining participants were assigned to mindfulness training, which focused on building awareness and acceptance of key components of addiction and withdrawal, such as intense cravings and mood swings. Participants in both arms of the study met for group therapy twice a week for four weeks.
People who received the mindfulness training were more likely to have quit smoking completely. This was true both immediately after the training ended and at a 17-week follow-up check. Researchers used breath tests to confirm people had quit. The tests measure levels of cigarette byproducts.
At the 4-week mark, 36% of the people assigned to mindfulness training were abstinent from cigarettes, compared with 15% of those assigned to the Freedom From Smoking group. At the 17-week mark, the differences were even more pronounced: 31% of the people assigned to mindfulness training remained abstinent, compared with 6% of those assigned to Freedom From Smoking.
This is a small study with relatively short-term results. That being said, the study is a reminder that mindfulness training — already used along with other stop-smoking techniques — might also be worth trying on its own.
Alcohol and Other Substance Use
Alcohol and other drug use problems are also difficult to solve. A group of researchers at the University of Washington in Seattle studied the effectiveness of an approach called mindfulness-based relapse prevention (MBRP).
Their study compared MBRP to a more common type of relapse prevention that is based on cognitive behavioral principles. Standard relapse prevention examines problems with motivation, teaches coping skills and tries to minimize external factors that may trigger a relapse. Relapse prevention of this sort has already been proven to reduce alcohol relapse rates.
MBRP comes from mindfulness-based stress reduction (MBSR). It is different from standard relapse prevention in that it encourages patients to pay attention to their experiences moment by moment. The idea is to develop the ability to observe thoughts without reacting to them or judging them. The hope is that patients will, as a result, be better able to tolerate their uncomfortable emotions or physical experiences.
All of the 286 participants in the University of Washington study had completed a substance abuse treatment program. Each patient was then given 1 of 3 treatments to help maintain sobriety: MBRP, standard relapse prevention or "treatment as usual." Treatment as usual was a combination of 12-step programming and education about substance use.
The participants were evaluated after 3, 6 and 12 months. Compared with the 12-step group, patients receiving both types of relapse prevention were at lower risk for resuming drug and alcohol use than the treatment-as-usual group. At 12 months, MBRP was most effective at curbing drug use and heavy drinking.
Long Lasting Effects of Mindfulness Practice
In both of these studies, authors conclude that mindfulness skills have a long lasting impact. Patients who practice these techniques appear less prone to follow their impulses automatically or — as it were — mindlessly. They may be in a better position to tolerate cravings without acting on them. And, with these skills, physical and emotional discomfort maybe easier to bear.
The research also supports an idea that seems counterintuitive. To make important behavior changes, particularly when the change is most uncomfortable, it is more helpful to pay very close attention to what you're feeling than to try to avoid the feelings altogether. Avoidance may lead to automatically repeating older destructive patterns. Mindfulness gives you the opportunity to take control and make different choices.
If mindfulness-based relapse prevention is not available in your area, look for people who teach mindfulness-based stress reduction. Or, find a meditation center. You may just find that learning these skills has benefits that extend beyond controlling your addiction.
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Michael Craig Miller, M.D., is the former editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 30 years.