Mindfulness for Treating Addiction: A Clinicians Guide

An aspect of our scientific work relating to mindfulness involves investigating its

applications for treating addiction. In this respect, we have a longstanding
collaboration with Dr. Mark Griffiths who is Professor of Behavioural Addiction
at Nottingham Trent University (UK) and is internationally recognised for his
work in this field of study. Todays post draws upon findings from our research
using Meditation Awareness Training and provides ten recommendations on the
psychotherapeutic use of mindfulness in addiction treatment contexts. These
recommendations are primarily intended for mental health professionals, but
individuals with addiction problems may also find them of interest. Although we
have principally based our recommendations on insights gained from using
mindfulness and meditation for treating behavioural addictions (e.g., gambling
disorder, workaholism, sex addiction), we have also consulted the literature
concerning the use of mindfulness for treating chemical addictions (e.g., substanceand alcohol-use disorders). Therefore, whilst we acknowledge that there are
important differences between behavioural and chemical addictions (e.g., the
physical signs of drug addiction are typically absent in behavioural addiction), we
envisage that the following recommendations will be applicable to both addiction
categories.
1. Undertake a Thorough Assessment: Careful evaluation of the clients history (e.g.,
clinical history, social history, education history, religious history, employment

history, etc.) and presenting problems will come high on the list of any
competent mental health clinician. However, we have chosen to include
thorough assessment as one of our specific recommendations because there
appears to be a belief amongst a minority of mental health professionals that
mindfulness is a one-stop cure for all mental health issues. As discussed in one
of our peer-reviewed papers that was recently published in the British Medical
Journal, the only psychopathologies for which the empirical evidence is robust
enough to support the wide scale utilisation of mindfulness are specific forms
of depression and anxiety. In other words, mindfulness is not a suitable
treatment for every individual presenting for treatment. For example, we
recommend that clinicians exercise additional caution (including taking into
account their own experience with using mindfulness) before introducing
mindfulness to clients whose addiction problem occurs in conjunction with
psychotic features.
2. Build Strong Meditative Foundations: Mindfulness is a practice to develop
throughout ones lifetime. It is a marathon and not a sprint. If an individual is
to derive lasting benefit from mindfulness, it is essential that they establish
strong meditative foundations. If we want to become aware of the subtle
aspects of mind, we first need to become aware of the gross aspects of mind.
And before we can do that, we need a method of calming, collecting and
focussing the mind. This is why breath awareness is a vital feature of
meditative development. Using the breath as a concentration anchor provides
the client with a reference point a place of safety to which they can return
whenever their mind starts to run away with itself. The mental cravings that
underlie addiction can be powerful and consuming, and without strong
meditative foundations, it is unlikely that the client will be able to regulate
these cravings as well as withdrawal symptoms that they are likely to encounter
during later treatment phases. Another important foundation of mindfulness is
awareness of the body. At the early stages of treatment, clients should be

taught how to sit with awareness, eat with awareness, walk with awareness and
talk with awareness. Clients should be encouraged to adopt mindfulness as a
way of life and not just a technique to apply when they are feeling low or
susceptible to addiction-related urges.
3. Make use of Psycho-education: In addiction treatment contexts, we suggest that
psycho-education should be utilised at the early stages of treatment and should
focus on two key areas: (i) educating clients in the science concerning the
aetiology and symptom course of their particular addiction, and (ii) explaining
the principles of mindfulness and a meditation-based recovery model. For a
comprehensive and insightful academic resource that clinicians can draw upon
in this respect, we recommend the chapter on mindfulness and addiction by
Dr. Sean Dae Houlihan and Dr. Judson Brewer that features in our recent
edited Springer volume on Mindfulness and Buddhist-Derived Approaches in Mental
Health and Addiction (see further reading list below).
4. Teach Urge Surfing: The term urge surfing has been used in the scientific
literature to refer to the process of mindfully observing the mental urges
associated with addiction. The idea is that the client, having established
themselves in awareness of breathing, takes craving as the object of meditation.
They follow their breath and observe how craving dominates their cognitiveaffective processes. The process of observing mental craving helps to objectify
it and creates mental space whereby instead of feeding the craving (i.e., by
emotionally and conceptually adding to it), craving is allowed to exist as it is.
It may appear as though urge surfing is concerned with controlling craving, but
thats not the case. Rather, the technique involves allowing craving to come
and go such that it can progress through its natural cycle of birth, life and
dissolution. When we teach this technique, we inform clients that if craving is
manifest in the mind, thats OK. We also inform them that if craving is not
manifest, thats OK too.

5. Make use of Bliss Substitution: Substitution techniques are sometimes used in the
treatment of both behavioural and chemical addictions. For example, studies
have shown that some individuals with gambling disorder respond well to
gradually substituting their gambling activity for recreational activities such as
singing, learning computer skills, communication workshops, dance and music.
Our own studies have shown that the substitution principle can also work well
in the case of addiction treatments following a meditation-based recovery
model. One of the key drivers of addiction is the mood modification (e.g.,
feeling high) that results from engaging with a particular substance or
behaviour. Meditation may be particularly suitable as an addiction substitution
technique because specific forms of meditation can induce blissful feelings.
Effectively, the client learns to replace the buzz or high associated with a
negative addiction with the bliss and peace of meditation (i.e., a positive form
of addiction). Eventually, clients should be encouraged to relinquish any
dependency on meditation, but in the early stages of treating addiction, it can
be a useful therapeutic technique.
6. Employ Meditation Exposure Therapy: Exposure therapy is a method employed by
various modalities of psychotherapy, and it can also be used as part of
mindfulness therapy for individuals suffering from addiction. It is all very well
teaching the client how to practise mindfulness from the safety of
psychotherapists consulting room, but at some point it is probable that they
will encounter the stimuli that have previously caused strong mental urges to
arise. Consequently, we encourage the psychotherapist to accompany (i.e.,
where it is safe and realistic to do so) the client in real-world settings that are
likely to induce relapse. For example, if the client is addicted to off-line
gambling, consider accompanying them to a casino in order to demonstrate
that it is possible for them to remain meditatively composed whilst surrounded
by the object of their addiction. Meditation exposure therapy isnt suitable for
every client (or indeed for every mental health clinician), but where applicable,

we generally recommend that it is used towards the end of the treatment

course.
7. Undermine the Value of the Addictive Object: This technique involves guiding the
client to think about the true nature of the object of their addiction. More
specifically, it involves introducing the client albeit at an elementary level to
the concepts of impermanence, interconnectedness and emptiness. Again, the
clinician will have to assess on a case-by-case basis whether this technique is
appropriate, but we have personally found it to be effective in addiction
treatment contexts. By fostering meditative awareness of impermanence and
the empty nature of all phenomena, the client can gradually begin to question
and then undermine the intrinsic value that they have assigned to the object of
their addition. For example, an individual suffering from sex addiction can use
specific meditative techniques in order to better understand that (i) the
individual components that comprise the human body are not particularly
desirable in and of themselves (e.g., nails, hair, mucus, faeces, urine, pus, vomit,
blood, sinew, skin, bone, teeth, flesh, sweat, etc.), (ii) the inevitable destiny of
the body is that of ageing, illness and decay, and (iii) the body exists as a
composite entity but does not exist intrinsically. If the client looks deeply using
meditation, they can learn to see that in beauty and life, there is foulness and
decay (and vice-versa). They can also learn to see that there is other in self
and self in other, and that when they practice kindness and respect towards
themselves, they practise kindness and respect towards the entire world.
8. Schedule Follow-up Sessions: Most of the available treatments that use mindfulness
generally adhere to an eight-week treatment course. However, in the traditional
Buddhist setting, a person would normally be required to engage in day-to-day
mindfulness practice over a period of many years before being deemed to have
gained a reasonable grounding in the practice. Consequently, it is important to
schedule booster sessions and to meet with the client at regular (e.g., monthly)
intervals following the initial programme of treatment. Ideally, clients should

also be encouraged to make contact with mindfulness groups that are

facilitated by competent teachers.
9. Lead by Example: As discussed in a previous post where we offered guidelines
on the general use of mindfulness in psychotherapy (i.e., not specific to treating
addiction), it is important that the mental health clinician emanates a presence
of meditative calm and awareness. This has to be natural and as indicated
above, it can only arise after consistent daily practice over a period of many
years. If the clinician merely acts at being mindful, the client is likely (whether
consciously or subconsciously) to pick up on this and it will inevitably act as an
obstacle to recovery.
10. Be Inspired: Mindfulness has been practised by spiritual traditions for thousands
of years. When a clinician engages with the practice in a sincere manner, and
when they wholeheartedly wish to help the client overcome their suffering, that
clinician is bestowed with the blessings and wisdom of this ancient spiritual
lineage. They become what is known in Buddhism as a Bodhisattva a rare
and beautiful being that conduct acts of kindness in order to alleviate the
suffering of others. Skilled mental health professionals perform an invaluable
role to society. They are inspired individuals who in turn help to inspire the
clients they work with.
Ven Dr Edo Shonin and Ven William Van Gordon

Further Reading
Alavi, S. S., Ferdosi, M., Jannatifard, F., et al. (2012). Behavioral addiction versus
substance addiction: Correspondence of psychiatric and psychological views.
International Journal of Preventative Medicine, 3, 290-294.
Appel, J., & Kim-Appel, D. (2009). Mindfulness: Implications for substance abuse
and addiction. International Journal of Mental Health Addiction, 7, 506-512.

Griffiths, M. D., (2005). A components model of addiction within a

biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Griffiths, M. D., Shonin, E., & Van Gordon, W. (2015). Mindfulness as a
treatment for gambling disorder. Journal of Gambling and Commercial Gaming
Research, 1, 1-6.
Houlihan, S. D., & Brewer, J. A. (2015). The emerging science of mindfulness as a
treatment for addiction. In: E. Y. Shonin, W. Van Gordon and M. D.
Griffiths (eds.), Mindfulness and other Buddhist-derived approaches in mental health
and addiction (pp. 191-210). New York: Springer.
Iskender, M., & Akin, A. (2011). Compassion and internet addiction. Turkish Online
Journal of Educational Technology, 10, 215-221.
Jackson, A. C., Francis, K. L., Byrne, G., et al. (2013). Leisure substitution and
problem gambling: report of a proof of concept group intervention.
International Journal of Mental Health and Addiction, 11, 6474.
Rosenberg, K. P., Carnes, P. J., & OConnor, S. (2014). Evaluation and treatment
of sex addiction. Journal of Sex and Marital Therapy, 40, 77-91.
Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014). The treatment of
workaholism with Meditation Awareness Training: A Case Study. Explore: The
Journal of Science and Healing, 10, 193-195.
Shonn, E., Van Gordon, W., & Griffiths, M. D. (2014). Cognitive Behavioral Therapy
(CBT) and Meditation Awareness Training (MAT) for the treatment of cooccurring schizophrenia with pathological gambling: A case study. International
Journal of Mental Health and Addiction, 12, 181-196.
Shonin, E., Van Gordon W., & Griffiths, M. D. (2014). Mindfulness as a treatment for
behavioral addiction. Journal of Addiction Research and Therapy, 5, e122. DOI:
10.4172/2155-6105.1000e122.
Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014). Mindfulness and the social
media. Journal of Mass Communication and Journalism, 2014, 4: 5, DOI:
10.4172/2165-7912.1000194.

Shonin, E., Van Gordon W., & Griffiths, M. D. (2013). Buddhist philosophy for
the treatment of problem gambling. Journal of Behavioural Addictions, 2, 63-71.
Shonin, E., Van Gordon W., & Griffiths, M. D. (2013). Meditation for the
treatment of addictive behaviours: Sending out an SOS. Addiction Today,
March, 18-19.
Shonin, E., Van Gordon, W. & Griffiths, M. D. (2013). Mindfulness-based
interventions for the treatment of problem gambling. Journal of the National
Council on Problem Gambling, 16, 17-18
Sussman, S., Lisha, N. & Griffiths, M. D. (2011). Prevalence of the addictions: A
problem of the majority or the minority? Evaluation and the Health Professions,
34, 3-56.
Witkiewitz, K, Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse
prevention for alcohol and substance use disorders. Journal of Cognitive
Psychotherapy, 19, 211-228.