It is 1 p.m., and just as I have done every Tuesday for the past eight months, I press the magnetic strip of my ID badge against the black plastic sensor outside the locked double doors of the Detox East Unit at Tarzana Treatment Centers. The locks click, and before the alarm sounds, I push open a door and find myself facing a long, ragged line of detox patients. Most are strangers to me, having arrived here within the past week. They look tired or restless as they eye me curiously.
“Are you taking us to the canteen?” one of them asks hopefully. “Nope,” I reply. “I lead the stress management group.” This is met with some grumbling, but one patient who has been here for a month on a methadone detox shakes her head and smiles. “So are we doing a tangerine meditation this week?”
“No tangerines; sorry,” I tell her. “But you're in luck. I've got chocolate.” In a moment we are on our way to the lobby conference room, where for the next hour I'll give them an experiential introduction to mindfulness meditation.
Since Jon Kabat-Zinn, PhD, and colleagues began the practice of mindfulness meditation with patients at the University of Massachusetts Medical Center's Stress Reduction Program in 1979, the use of mindfulness meditation to treat a host of physical and psychological disorders has expanded to more than 240 hospitals and treatment centers throughout North America and Europe.1 Over that same period, a growing number of research studies have demonstrated the therapeutic effects of meditation for physical ailments such as chronic pain, cancer, and AIDS, as well as for depression, anxiety, and borderline personality disorder.2
The work of G. Alan Marlatt, PhD, and colleagues has encompassed nearly 30 years of examining the positive effects of meditation on alcohol and drug abusers.3 While my own work with detox patients is purely anecdotal, it has nevertheless affirmed my belief that mindfulness meditation is a practical tool that can be used for relapse prevention even at the earliest stages of recovery.
Although mindfulness meditation is free of any religious sectarian ideology, its roots may be traced back to Theravada and Mahayana Buddhism practiced in India around 500 BC.1 The practice of mindfulness meditation focuses on insight or vipassana, as it was called in a 5th-century text known as the Visuddhimagga (Path of Purification). The goal of this form of meditation is not to eliminate pain or stress or addiction but to use intentional, focused awareness to achieve a sense of nonjudgmental self-acceptance in the present moment.
Intentional awareness may be understood as putting one's attention to one's intention. It is through this willful, directed attention that the structure and chemistry of the brain begin to change, in what is now called neuroplasticity.4 Just as a constant state of stress or the use of alcohol and drugs can dysregulate the components of the central nervous system, the daily regular practice of mindfulness meditation can enrich the brain's neuronal structures, acting in effect like an antidepressant but without the accompanying side effects.
Achieving a state of nonjudgmental acceptance is, as the Buddhists say about meditation, “simple but not easy.” Patients new to recovery may be deeply self-judgmental, slinging arrows of guilt and shame at themselves for the destructive consequences of their addictive behaviors. In group, I hear stories of legal problems, financial ruin, damaged relationships, and physical and emotional self-destruction. Though some members have found a temporary peace by coming to detox, almost all feel trapped by the past and fearful for the future. To sit still in the present moment and simply breathe is difficult enough given their circumstances, but to cast off critical self-judgment seems nearly impossible.
Observing one's thoughts
How, then, can the practice of mindfulness meditation possibly work with such a troubled population as patients in detox? Rather than target distorted thoughts with the goal of changing them, as in cognitive-behavioral therapy, mindfulness works through a mechanism that may be understood as metacognitive in nature. Mindfulness seeks to change our relationship to our thoughts without changing the thoughts themselves.5
I never directly challenge cognitions, but rather offer group members a means to detach themselves from the thoughts, feelings, and physical sensations that cause what Buddhists call dukkha or suffering.6 I teach the concept of becoming a detached spectator or observer of one's thoughts, in the sense that mindfulness allows us to recognize intrusive thoughts and feelings without asking us to act upon them. Pain may be chronic, but suffering is optional. Meditation allows us to respond rather than react. It reintroduces choice into our lives, and with that choice comes a renewed sense of self-efficacy.