Adding mindfulness to a 12 step-based addiction treatment program can be just the right non-prescription medicine. The key to enhancing such a program with mindfulness depends on understanding just how it works, how it can be integrated with the 12 steps, and who is best qualified to teach it.
To understand how mindfulness can be helpful, imagine two scenarios involving the same client who leaves a substance abuse center and enters the real world with all of its addictive triggers and environmental cues. In the first scenario, the client stumbles upon the liquor section of the grocery store while walking towards the produce section. The glimmering bottle of wine on the end of the aisle catches his eye with its smooth, silky shape and its alluring label. Suddenly, the craving to drink is overwhelming and his sponsor can't be reached by phone. The client quickly grabs the produce, proceeds through checkout and runs to his car. While in his car, the urge to drink remains and he toys with the pros and cons of going back into the store and buying that wine. He hears all of the wise and useful tools from the 12 step program coming and going in his mind, intermingled with the craving to use. Because the craving is coming mainly from the midbrain, which often shuts down the rational thinking of the prefrontal cortex, the craving wins out in the end. The client relapses.
In the second scenario, the client stumbles upon the same liquor section and, unable to reach his sponsor, steps away from the section and uses a powerful mindfulness tool that dissolves the craving thought. The sensation in the body that accompanied the thought of drinking dissolves. With this mindfulness tool, the client is witnessing the midbrain directly, which is the part of the brain from which the craving is arising. He loses the desire to drink right there on the spot. He grabs his groceries, goes home and heads to a 12 step meeting where he can share about having one more day of sobriety.
No matter who we are or how many years of clean or sober time we have, we all face the triggers and environmental cues of daily life. We live in a world where we are constantly bombarded with advertisements, marketing and displays of alcohol in grocery stores. We see all the painkillers behind the counter at the pharmacy when we are picking up our cold medicine. We turn on the TV or go to a movie and see beautiful people drinking and doing drugs in a manner that glorifies the substances and the lifestyle around them. We turn on the computer and see ads for any number of prescription drugs that can be shipped to our home with a few clicks of the mouse. In this world in which triggers are everywhere, we can use all of the help we can get in the moment when these environmental cues pop up. Given the scientific evidence that tells us that the midbrain has the capacity to shut down our rational thoughts and our previous decisions to quit or remain abstinent (see "How We Get Addicted," Michael Lemonick, Time Magazine), mindfulness can be a tool that saves our lives in those moments of crisis. Mindfulness can also reduce stress and anxiety on the spot, thereby decreasing the brain's desire to reach for a substance or activity in order to medicate the stress or anxiety.
No matter how successful or unsuccessful an addiction treatment center is, that success rate can go up if the right mindfulness approach is added to its curriculum with all the important variables taken into consideration. Mindfulness is the new buzz word in addiction treatment for good reason. When taught skillfully by someone well-trained in the approach, clients learn to use the tool on the spot – precisely when the desire to use arises. This skills training can be made a part of any good 12 step facility, inpatient or outpatient, and can substantially reduce the relapse rate. It fits quite well with the 12 step program, particularly because it helps clients remain abstinent one day at a time, or perhaps one moment at a time because mindfulness is all about present moment awareness of thoughts, emotions and sensations. On the other hand, when mindfulness is brought into an addiction recovery facility and watered-down, taught by someone who is not trained well or taught merely as a Friday morning "add on" class, its positive effects are greatly diminished.
The key to bringing mindfulness into a 12 step program is to pick your mindfulness coach, counselor or teacher very carefully. Because mindfulness is not taught in any substantial depth in universities that award addiction counselor degrees, an addiction treatment center should thoroughly review the credentials, history and personal practice of any applicant. Reading a resume is not enough to tell you how skilled the mindfulness counselor is. A degree won't tell you much either, since universities don't give out degrees with regard to the actual practice of mindfulness. The subject is often treated in a very academic way in universities. Learning about mindfulness in a classroom is very different than practicing it in one's life or teaching it to others.
Finding the right mindfulness counselor comes down to whether the counselor trained personally with a good mindfulness teacher, has had many years of personal practice with the approach, and has a history of actually helping people with addictions using mindfulness. Good mindfulness teachers are often Buddhists or those who have a history studying with a Buddhist teacher or other qualified mindfulness teacher. Personal practice is a big key. A mindfulness counselor should be someone who uses the practice daily in his or her own life and who can report a drastic change in his or her level of peace and freedom. Because mindfulness is a highly experiential practice, a mindfulness counselor who has not experienced strong addictive cravings and overcome those cravings through mindfulness may not be the right fit for your program.
A good mindfulness counselor should have a history of successfully helping people with addiction. Many mindfulness training programs do not focus on addiction. Therefore, even a well-trained mindfulness counselor may have difficulty with the subject of addiction if he or she does not have a substantial history working with it. Addiction carries its own set of concerns and risks including understanding relapse, how it happens in the mind and how bodily sensations play into the craving to use. A skilled mindfulness counselor will know how to bring clients more into their bodies to be present with the uncomfortable or repressed emotions and addictive cravings that play such a big role in the desire to use. One of the best ways to learn the effectiveness of a mindfulness counselor is to watch her in action as she works with clients, and then ask the clients what effect the session had on their desire to use and their anxiety and stress levels. Because of the experiential nature of mindfulness, picking a good mindfulness counselor is similar to picking a good yoga instructor. Just as you would want to watch a yoga instructor in action, watching a mindfulness counselor in action is equally necessary.
Perhaps an even more important concern when choosing a mindfulness counselor is the degree to which the counselor understands how to integrate the 12 steps with mindfulness. Although the two modalities share many common themes, there are key differences in the approaches. A counselor who can skillfully translate the 12 steps into mindfulness and vice versa will help your clients integrate the practice of mindfulness into their 12 step work more effectively. The following are good questions to ask a prospective mindfulness counselor: How does the 1st step's concept of powerlessness relate to mindfulness? What spiritual principles do the 12 steps and a good mindfulness practice have in common? How does one reconcile the 3rd step concept of higher power with the practice of mindfulness, which does not require a higher power but also does not forbid it? How would one translate the 10th step's daily inventory or even the suggestion to stay clean and sober "one day at a time" with the mindfulness approach of being aware in every moment? These concepts between the 12 steps and mindfulness have key correlations that can be highly beneficial to clients if integration is taught and practiced skillfully by a counselor who has a depth of knowledge about the two programs. But a lack of understanding in how to integrate 12 steps and mindfulness can leave your clients confused and unable to integrate the two approaches in a beneficial way.
As we move into a new era in addiction treatment where mindfulness becomes integrated with 12 step programs, let us first be mindful of who we are choosing to teach this skill and how we are adding it to our programs. A good mindfulness program involves daily practice with a skilled and carefully chosen counselor.
Scott Kiloby is an author, international speaker and founder of the Kiloby Center for Recovery, Inc. in Rancho Mirage, California. See www.kilobycenter.com