Mindfulness has become sort of a catchall term for general self-help advice that focuses on using different practices to attune better to your mind and actions with the hopes of decreasing stress or associated symptoms. Take time to meditate in the morning. Pay attention to your food when you’re eating. Do a gratitude practice every night. Self-care your stress away. It all sounds good in theory, and certainly won’t do you any harm, but what does the term mindfulness really encompass, and is it really something that could change your life? Or it is just another fad and buzzword in the self-improvement culture of today?
As a therapist, I frequently encourage different types of mindfulness practices to encourage my clients to be intentional about their own lives. Attuning to our bodies and our minds and our habits is an important part of both gaining control over our lives as well as our mentality. I often work with people who have had something terrible, or heartbreaking, or unexpected happen to them, and they are struggling for a sense of control. In those times I am often reminded that sometimes the only thing you have control over is your mentality. Sometimes I get pushback from people who don’t necessarily believe that their mentality is within their own power. Their thoughts are stuck in places that leave them thinking:
- How can I help the way I feel?
- What I believe is what I believe, there’s no changing it.
- How can changing my mentality change my circumstances?
- Thinking about my mentality doesn’t change the problems I’m facing.
I can understand why it might sound like a load of new age fluff when people start talking about mindfulness. We have become accustomed to solutions that start and end with well-defined explanations and prescriptions. We like to be able to have a blood test tell us exactly what’s wrong and what treatment is needed to fix the issue. Unfortunately, our minds can be even more mysterious than our bodies are, at least in this day and age. The good news is that our minds are also a lot more powerful than we might believe, and that means that we can use our mentality to improve our overall sense of wellbeing.
I wanted to find out what we really know about mindfulness, and what the evidence says about whether or not it works. Researchers have been studying mindfulness based practices for over 30 years now, and studies have investigated mindfulness as a treatment for conditions such as addiction, trauma recovery, stress, chronic pain, eating disorders, depression, anxiety, and more. There was no shortage of research to comb through devoted to mindfulness and it’s various applications, but the results were pretty consistent. Of course, with large bodies of research on a topic as broad as mindfulness, there are going to be variations in the results that studies present. I found the results optimistic, though. There is consistent evidence that when people are introduced to mindfulness based practices as a way to improve symptoms related to various stressors, they report good outcomes when they apply that knowledge.
Because mindfulness practices can be broad in terms of the actual strategies they refer to, here’s a few ideas about what people are referring to when they use that term:
- Deep-breathing practices
- Meditation (guided or self)
- Attuning to senses
- Intentional gratitude practices
- Night-time de-stressing rituals
- Conscious attention to mentality
- Intentional eating practices
Much of the research out there on mindfulness focuses on using one or more of these practices in a specific setting with a specific group of people. So the ways in which this area has been studied lends itself to a lot of different outcomes for a lot of different kinds of people with different kinds of problems. Nevertheless, I found a lot of examples of some really great ways that mindfulness practices are having a positive impact on people.
A study on mindfulness and addiction published this year found that mindfulness based interventions (MBIs) had a significant effect on cravings and substance misuse in treatment for addictions. This is a great example of how mindfulness practices can function as an auxiliary treatment for people. The goal of a mindfulness practices is not necessarily to serve as a replacement for other therapies, but it can be a good asset to use in addition to other treatment, and can function as a sort of enhancer. It may just give people an extra boost when they are seeking help for addictions or other mental health conditions.
Another encouraging example includes this study from PLOS One, which found that over a 6 year period in which medical and psychology students were introduced to mindfulness practices, the students reported significant increases in measures of their wellbeing. This is especially important given the high rates of mental distress, burnout, and suicide amongst medical professionals. As a person in a caregiving profession myself, I know how important it is to maintain a healthy mentality and how overwhelming the stress can get. It’s good to know more evidence is showing how important it is for caregivers to be given the resources and support to incorporate these practices themselves.
Another study from the International Journal of Occupational and Environmental Health found more evidence that introducing mindfulness in the workplace decreased burnout and reduced stress. This research supports my personal belief that employers should do more to help mitigate stress in the workplace and support the health of their employees by taking it upon themselves to bring stress reduction into the workplace environment. Not only do I believe this will improve employee health and help workers be happier in their work environments, I think it will make workplaces more efficient as well.
There is a lot more research out there on the topic, which I will be working on delving into more this month. However, these studies are a few examples of the research support out there for bringing mindfulness practices into our lives. Our lives have gotten so much more harried and complicated, and sometimes our choices seem out of our control. That’s why mindfulness is helpful in bringing a sense of focus and calm to your mentality, so that you feel more capable of handling whatever life happens to be throwing at you at the moment.
Mindfulness alone cannot solve every problem that you may have, but becoming more intentional about taking care of your mind and staying tuned in to how your mentality impacts your overall mood could help you stick to your goals and keep negativity at bay.
As a therapist, I have worked with countless individuals who fall somewhere on the spectrum of having a serious substance addiction problem, to those who have problematic substance use or drinking habits, but who haven’t hit the proverbial “rock-bottom” we so often hear about. I spent a few years as a case manager in an inpatient substance abuse facility at the beginning of my career, and later I worked as a therapist in an inpatient center treating substance abuse, mental health, and eating disorders. Since then I’ve also worked with clients in individual therapy with problematic drinking habits, those who have significant substance abuse histories, or who use other substances recreationally. The history behind substance abuse treatment has been until recently almost exclusively focused on getting people to commit to and practice abstinence and total sobriety. AA (Alcoholics Anonymous) and NA (Narcotics Anonymous) have been the go-to referral for many people seeking help with sobriety and are considered pre-requisites in any recovery treatment model. Unfortunately, there’s one big glaring problem with these models… they don’t work. At least not for everyone.
There’s several reasons why they don’t work for everyone, and there’s other reasons why we blame individuals for “treatment failure” instead of recognizing that there is a range of ways to measure improvement, and another way to help people improve their lives and weaken the grip of addiction. I’m talking about Harm Reduction, and it is a growing movement in the field of substance abuse treatment that is giving more people hope for a future free from addiction. First, though, let’s look at why AA/NA programs are not working for everyone.
What’s wrong with AA and NA?
It’s not that AA and NA are terrible models for recovery, or that they haven’t helped many, many people achieve sobriety. I always tell my clients that if they find something that works for them, and if it is helping them achieve their goals, they should keep doing it. I have no qualms with people using AA or NA as a support and structure system that helps them gain freedom from alcohol or substance abuse. The problem is that they simply don’t work for everyone, for a variety of reasons. Here’s a few:
- Powerlessness: The first “step” in the 12-step AA model is that you need to admit that you are powerless over alcohol and/or drugs and that you are unable to stop using on your own. This is useful to some people, because it helps them get into the mindset that they do really need help. For others though, it feels, well, disempowering. Some people want power OVER their addiction, they don’t want to give the alcohol/drugs all the power. From the outset, telling people that they are powerless over substances gets them in a mind-frame that they are not capable of controlling their own choices and behaviors.
- Total Sobriety/Failure model: Another part of the AA/NA model is the “chip” system”. When you walk in to a 12-step program on your first day of sobriety, you get a “chip” that serves to commemorate your sobriety. Then you get more chips as you work the program and make progress, achieving markers such as 30-days sober, a year sober, et cetera. If you pick up a drink, or use again, you’re back to day one, and typically you’re expected to come into the group and pick up a 1-day chip, which basically announces to the group that you “relapsed”. Again, for some people, this model of accountability helps them stay on track with their goals; for others, it’s a humiliating exercise that points to them as being a failure and can ultimately cause people to not come back to the group at all because they don’t want to be seen by their peer group as having failed at sobriety. A different approach is needed for some people, who don’t want one drink to mean that their previous efforts at sobriety cease to matter and they’re starting over at square one. Another problem with this total sobriety model is that in all honesty, some people don’t want total sobriety. Some people want to be able to enjoy a few beers at a BBQ, or be able to toast on NYE, but they recognize that they don’t want or need to be getting blackout drunk every weekend. Or perhaps they’ve been on some really hard drugs, and want sobriety from those drugs, but want to be able to go out to dinner and feel like a normal person capable of having a couple drinks without being labeled as an “addict”. AA and NA do not provide any framework for a person who wants this, and thus they leave out people who want to change their habits, but don’t want total sobriety.
- The Higher Power part: The 12-step model requires members to submit to a higher power. While the 12-step program originated with Christianity as its structure for recognizing a higher power, it has since evolved to be more inclusive as to how people interpret their higher power but the requirement to subscribe to a higher power remains. Needless to say, this leaves out everyone who considers themselves agnostic or atheist. Once again, we find that there is part of this model that works for some people, particularly those who want their faith to be a major factor in their road to recovery, but it just doesn’t resonate for others. This aspect of the AA/NA program also relates to the concept of powerlessness. The idea is to turn your power over to a “higher power”, who will presumably help you stay sober. For those who want to feel that THEY control their use, not the other way around, the concept of turning it all over to your higher power doesn’t fit with their idea of being in control of their drinking or use.
There are other criticisms of the 12-step/AA model of recovery, but these are some of the main points that I have found that turn people off from working a 12-step program. Luckily, the concept of Harm Reduction is gaining traction in the recovery industry and helping to provide more options for those people who either have found AA/NA doesn’t work for them, or who are interested in another way.
What is Harm Reduction?
Harm reduction is the concept that people who are abusing alcohol and drugs CAN reduce their overall use of substances without committing to total sobriety, CAN reduce the negative effects that substance abuse has on their lives and the people in their lives, and CAN lower the risky behaviors associated with their substance abuse that ultimately can cause them to experience more severe consequences of their use. It is the concept that one solution does not fit every individual’s needs, and that someone who drinks or uses should have access to a variety of choices when they are seeking help. Harm reduction also includes advocating for policies that do not punish people for being addicted, but seeks to help them find the help they need to have healthier lives, without insisting that people conform to our expectations. Further, harm reduction posits that we should meet people where they are on the road to recovery, and stop insisting that they commit to 100% sobriety before we give them any help. Harm Reduction can encourage people to make the following changes in their lives and habits:
- Going from someone who drinks and drives regularly to someone who still drinks heavily, but no longer gets in the car and drives and is able to choose to get a ride home when needed, no longer risking their own life and the lives of others by being on the road while intoxicated.
- Going from someone who shares needles with others in order to get high to someone who still uses but accesses clean needles and no longer has to worry about contracting or transferring a disease or infection from dirty needles.
- Going from someone who drinks heavily on a regular basis and then verbally or physically abuses others during blackouts to someone who is able to set a limit on the number of drinks they have and eliminates the abusive behaviors associated with their drinking.
- Going from someone who uses high addiction-risk substances such as cocaine, meth, or heroin to someone who smokes marijuana and no longer experiences the damaging physical and addictive effects of those harsher drugs.
As you can see, there are ways that someone who struggles with substances can find ways to reduce the harm and associated risks that using substances or abusing alcohol has in their lives, without requiring that the person be completely sober in order to recognize those achievements. Harm Reduction advocates recognize that we don’t have to require people to be 100% sober before we can call their efforts a success. For one things, it is not our place to tell people what their goals should be. Some people want to be 100% sober and the truth is that some people don’t. As a clinician, I have always been trained to start where my clients are and to let them define their goals, rather than defining what I think their goals should be. Harm reduction fits into that concept as a best practice, because whether I think someone should stop drinking/using is irrelevant if they don’t want to stop drinking. However, if they want to reduce their drinking, feel empowered to make better choices about their drinking and while they’re drinking, or minimize the negative effects that drinking has on their life, then as a clinician I should support them in those efforts however I can.
Some people really do want and need total sobriety, because their behaviors surrounding their addiction have gotten so dangerous and harmful to themselves and to others, and because their efforts at moderation have not worked after multiple attempts. I think this is why most inpatient treatment centers use a 12-step model, because once you are at the point where you need inpatient treatment, your behaviors are probably pretty out of control and dangerous. However, as with all treatment, what one individual needs is not going to be the same across the board. In the meantime, we need to redefine what recovery means, because it doesn’t look the same for everyone. At this time, when I have clients that want to learn more about harm reduction and learn strategies that focus on that goal, I refer them to Smart Recovery. Smart Recovery does focus on abstinence, but it does so without some of the trappings of AA that have been problematic that I mentioned earlier. They also have groups and online meetings, which may be helpful to some people depending on their location and/or comfort with the group setting. Individually, finding a therapist or provider that is familiar with the concepts of harm reduction can be an important step in the recovery process as well.
To learn more about harm reduction, visit HarmReduction.org.
To learn more about Smart Recovery, visit SmartRecovery.org.