Retraining the addicted brain: A review of hypothesized neurobiological mechanisms of mindfulness-based relapse prevention.

Abstract

Addiction has generally been characterized as a chronic relapsing condition. Several laboratory, preclinical, and clinical studies have provided evidence that craving and negative affect are strong predictors of the relapse process. These states, as well as the desire to avoid them, have been described as primary motives for substance use. A recently developed behavioral treatment, Mindfulness-Based Relapse Prevention (MBRP), was designed to target experiences of craving and negative affect and their roles in the relapse process. MBRP offers skills in cognitive behavioral relapse prevention integrated with mindfulness meditation. The mindfulness practices in MBRP are intended to increase discriminative awareness, with a specific focus on acceptance of uncomfortable states or challenging situations without reacting “automatically.” A recent efficacy trial found that those randomized to MBRP, as compared to those in a control group, demonstrated significantly lower rates of substance use and greater decreases in craving following treatment. Furthermore, individuals in MBRP did not report increased craving or substance use in response to negative affect. Importantly, areas of the brain that have been associated with craving, negative affect, and relapse have also been shown to be affected by mindfulness training. Drawing from the neuroimaging literature, we review several plausible mechanisms by which MBRP might be changing neural responses to the experiences of craving and negative affect, which subsequently may reduce risk for relapse. We hypothesize that MBRP may affect numerous brain systems and may reverse, repair, or compensate for the neuroadaptive changes associated with addiction and addictive behavior relapse.

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

“…Results indicated that both days of formal practice per week and minutes of formal practice per week reduced the strength of the relationship between craving and use. Although many investigators have hypothesized that mindfulness practice may decouple craving and subsequent use (Grow et al, 2015;Brewer et al, 2014;Garland et al, 2014;Witkiewitz, Bowen, et al, 2013;Ostafin et al, 2012), only one locatable study to date has examined mindfulness practice as a moderator of the relationship between craving and use (Elwafi et al, 2013). In a sample of tobacco smokers, results indicated days of informal practice was the only dimension of mindfulness practice that moderated the craving-use relationship (Elwafi 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). Mindfulness practices may increase the ability of individuals with substance use disorders to accept the unpleasant physical, affective and cognitive experiences of craving, and resist engaging in substance-seeking behavior to alleviate the discomfort (Witkiewitz et al, 2005).…”

“…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).…”

“…People are encouraged to observe their experience within sessions as an introduction to the practice of formal and informal skills and behavioral repertoires that increase mindfulness and acceptance outside of group meetings (Bowen et al, 2011). Mindfulness practice may develop skillful coping via the awareness and acceptance of craving without selfdistraction or behavioral disengagement, as hypothesized by behavioral and neurobiological models (Brewer et al, 2014;Witkiewitz, Lustyk, et al, 2013), and demonstrated in recent experimental findings (Grow, Collins, Harrop, & Marlatt, 2015;Moore et al, 2014;Elwafi et al, 2013;Ostafin et al, 2012),…”

Buddhist Approaches to Addiction Recovery

“…Thus mindfulness may be able to both sensitize to automatic processes and desensitize to negative emotions and thoughts. At a neurobiological level, mindfulness may help prevent relapse into addiction through top-down and bottom-up processes [47]. Top-down processes include increasing executive functioning, and improving attention, cognitive and emotion regulation.…”