Mindfulness-Based Stress Reduction as a Treatment for Addiction

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Mindfulness-Based Stress Reductionas a Treatment
for Addiction
Rachel Fintzy, M.A.
David Geffen School of Medicine at UCLA, Semel
Institute for Neuroscience and Human Behavior
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What Do We Know About Methamphetamine Addicts?

• Active Users show impairments in
• Response inhibition
• Mental flexibility
• Problem solving
• Abstract thinking

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What Do We Know About Methamphetamine Addicts?

• Abusers in abstinence show impairments in
• Inhibitory control
• Verbal learning
• Decision making

VIG
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Hippocampal Atrophy is Associated with Impaired
Vigilance
London et al, 2005, Biol Psychiatry 58 770-778
MEM
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Hippocampal Atrophy in MA Abusers is Linked With
Poorer Memory Performance
(Thompson et al., 2004 J. Neurosci. 30 6028-36)
IMAG
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Experiential Index is Lower in Subjects with
Hippocampal Damage
Hassabis et al, 2007, PNAS, on-line
SPAT
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Hippocampal Damage Impairs Imagination
Hassabis et al, 2007, PNAS, on-line
IFG
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MA Abusers Exhibit Gray Matter Deficit in
Inferior Frontal Gyrus
(Thompson et al., 2004 J. Neurosci. 30 6028-36)
SST
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MA Abusers Impaired on Stop-Signal
Monterosso et al., 2005, Drug Alcohol Depend. 79
273-77
MA Use
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Inhibitory Deficits Related to MA Use
Monterosso et al., 2005, Drug Alcohol Depend. 79
273-77
RETENT
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Cognitive Deficits Predict Retention in Cocaine
Users
N56, coc-dependent
Aharonovich et al., 2006, Drug Alcohol Depend.
81 313-22
IMPULS
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High Impulsivity Associated with Poor Retention
in Cocaine Users
Moeller et al., 2001, J. Substance Abuse
Treatment 21 193-198
SUM
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Summary
Active and newly abstinent MA abusers exhibit
deficiencies in cognition, decision making,
impulse control, and abstract thinking. These
behavioral changes have been linked to brain
abnormalities.
What Is Being Done About This?
Pharmacotherapies are being investigated, but
non-pharmacotherapies may also work.
WHY
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Why Mindfulness Training For Addiction?
Hippocampal atrophy Connection between
methamphetamine addicts in early abstinence,
depression, and anxiety. Mindfulness training
has demonstrated effectiveness in treating
depressive and anxiety disorders.
WHAT
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What Is Mindfulness?

• a receptive attention to and awareness of
  present
• events and experiences. (Brown Ryan, 2003)
• a way of being that combines increased alertness
• with an optimal state of physical, emotional,
  and
• mental equilibrium (Kabat-Zinn)
•  going with the flow or adaptation to the
  situation
• at hand with a minimum of excessive stress
  and/or
• volatility (Kabat-Zinn)

NOT
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Mindfulness is not..

• relaxation
• sleeping
• fantasizing

Med. DA
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Dopamine Increased During Meditation
Kjaer et al, 2002, Cognitive Brain Research
13255-259
MA DA
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DA D2 Receptors Reduced in MA Abusers
Caudate (p lt 0.0002)
11C Raclopride
Controls Meth
Putamen (p lt 0.02)
Volkow et al. AJP 2001
Controls Meth
CortThck
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Meditators Have Thicker Cortical Regions
Frontal Cortex
Insula
Lazar et al, 2005, Neuroreport 16(17)1893-1897
Age CT
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Meditators Maintain Cortical Thickness While
Aging!
Frontal Ctx
Insula
Lazar et al, 2005, Neuroreport 16(17)1893-1897
InsSm
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Insular Damage Stops Smoking
Bechara and colleagues 2007, Science 315, 531-4
VM
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Meditation Decreases Substance Use
Bowen, 2006, Psychology of Addictive Behaviors
20(3)343-347
MBCT
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Mindfulness-Based Cognitive Therapy Improves
Outcomes for Treatment-Resistant Depression
Ma, SH Teasdale, JD, 2004, J Consulting
Clinical Psych 72(1)31-40
MBCTGr
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Mindfulness-Based Cognitive Therapy Improves
Outcomes for Treatment-Resistant Depression
Ma, SH Teasdale, JD, 2004, J Consulting
Clinical Psych 72(1)31-40
MBSR
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Mindfulness-Based Stress Reduction Improves
Outcomes for Anxiety Disorders
Miller et al, 1995, General Hospital Psychiatry
17192-200
ADHD
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Self-report ADHD Symptoms Reduced After
Mindfulness Training
Zylowska et al 2006, Amer Acad Child Adolsc
Psychiatry, Poster Presentation
BPD
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Dialectical Behavior Therapy Decreases Drug Use
In Patients with BPD
Linehan et al, 1999, American Journal on
Addictions 8279-292
CurrTrt
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Substance Abuse and Affective Disorders Current
Mindfulness Treatments

• Mindfulness-Based Stress Reduction
• Dialectical Behavioral Therapy
• Mindfulness Based Cognitive Therapy
• Acceptance and Commitment Therapy
• 12-Step Programs
• Cognitive Control Training/Attention Training

StrEf
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Affects of Chronic Stress on Body, Mind, and
Behavior

•   habituation to stress and subsequent down-
• regulation
• low cortisol levels associated with long- term
• chronic physiological and/or psychological
• stress
• subsequent need to re-boot system (SSRIs
• neurogenesis, reversal of hippocampal atrophy)

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Summary of Mindfulness Training

• practice of nonjudgmental awareness of
• ones thoughts, feelings, and environment
• increases endogenous dopamine release
• increases cortical thickness
• effective for depression, anxiety, ADHD, and
  apparently substance use

FutDir
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Future Directions

• 8-week mindfulness training
• weekly two-hour group sessions
• 15-30 minute/day home practice
• thrice weekly urine testing
• weekly cognitive assessments
• weekly BDI, SUI, VAS
• evaluate effect of mindfulness practice
• on abstinence, cognition, and mood
• retention in treatment

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Acknowledgments
Thomas Newton, M.D. Richard De La Garza, II,
Ph.D. Lidia Zylowska, M.D. Gilles Fleury, M.D.
J. David Creswell
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Life is not the way its supposed to be. Its the
way it is. The way you cope with it is what makes
the difference. Virginia Satir