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Mindfulness-Based Stress Reduction as a Treatment for Addiction

Mindfulness-Based Stress Reduction as a Treatment for Addiction. Rachel Fintzy, M.A. David Geffen School of Medicine at UCLA, Semel Institute for Neuroscience and Human Behavior. What Do We Know About Methamphetamine Addicts?. Active Users show impairments in: Response inhibition

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Mindfulness-Based Stress Reduction as a Treatment for Addiction

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  1. 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

  2. What Do We Know About Methamphetamine Addicts? Active Users show impairments in: • Response inhibition • Mental flexibility • Problem solving • Abstract thinking

  3. What Do We Know About Methamphetamine Addicts? • Abusers in abstinence show impairments in: • Inhibitory control • Verbal learning • Decision making VIG

  4. Hippocampal Atrophy is Associated with Impaired Vigilance London et al, 2005, Biol Psychiatry 58: 770-778 MEM

  5. Hippocampal Atrophy in MA Abusers is Linked With Poorer Memory Performance (Thompson et al., 2004; J. Neurosci. 30: 6028-36) IMAG

  6. Experiential Index is Lower in Subjects with Hippocampal Damage Hassabis et al, 2007, PNAS, on-line SPAT

  7. Hippocampal Damage Impairs Imagination Hassabis et al, 2007, PNAS, on-line IFG

  8. MA Abusers Exhibit Gray Matter Deficit in Inferior Frontal Gyrus (Thompson et al., 2004; J. Neurosci. 30: 6028-36) SST

  9. MA Abusers Impaired on Stop-Signal Monterosso et al., 2005, Drug Alcohol Depend. 79: 273-77 MA Use

  10. Inhibitory Deficits Related to MA Use Monterosso et al., 2005, Drug Alcohol Depend. 79: 273-77 RETENT

  11. Cognitive Deficits Predict Retention in Cocaine Users N=56, coc-dependent Aharonovich et al., 2006, Drug Alcohol Depend. 81: 313-22 IMPULS

  12. High Impulsivity Associated with Poor Retention in Cocaine Users Moeller et al., 2001, J. Substance Abuse Treatment 21: 193-198 SUM

  13. 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

  14. 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

  15. 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

  16. Mindfulness is not….. • relaxation • sleeping • fantasizing Med. & DA

  17. Attn to Speech Attn to Speech 65% Dopamine Increased During Meditation Kjaer et al, 2002, Cognitive Brain Research 13:255-259 MA & DA

  18. 4 4 3.5 3.5 3 3 2.5 2.5 2 2 1.5 1.5 DA D2 Receptors Reduced in MA Abusers Caudate (p < 0.0002) [11C] Raclopride Controls Meth Putamen (p < 0.02) Volkow et al. AJP 2001 Controls Meth CortThck

  19. Meditators Have Thicker Cortical Regions Frontal Cortex Insula Lazar et al, 2005, Neuroreport 16(17):1893-1897 Age & CT

  20. Meditators Maintain Cortical Thickness While Aging! Frontal Ctx Insula Lazar et al, 2005, Neuroreport 16(17):1893-1897 InsSm

  21. Insular Damage Stops Smoking Bechara and colleagues 2007, Science 315, 531-4 VM

  22. Meditation Decreases Substance Use Bowen, 2006, Psychology of Addictive Behaviors 20(3):343-347 MBCT

  23. Mindfulness-Based Cognitive Therapy Improves Outcomes for Treatment-Resistant Depression Ma, SH & Teasdale, JD, 2004, J Consulting & Clinical Psych 72(1):31-40 MBCTGr

  24. Mindfulness-Based Cognitive Therapy Improves Outcomes for Treatment-Resistant Depression Ma, SH & Teasdale, JD, 2004, J Consulting & Clinical Psych 72(1):31-40 MBSR

  25. Mindfulness-Based Stress Reduction Improves Outcomes for Anxiety Disorders Miller et al, 1995, General Hospital Psychiatry 17:192-200 ADHD

  26. Self-report ADHD Symptoms Reduced After Mindfulness Training Zylowska et al 2006, Amer Acad Child Adolsc Psychiatry, Poster Presentation BPD

  27. Dialectical Behavior Therapy Decreases Drug Use In Patients with BPD Linehan et al, 1999, American Journal on Addictions 8:279-292 CurrTrt

  28. 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

  29. 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 (SSRI’s = • neurogenesis, reversal of hippocampal atrophy)

  30. Summary of Mindfulness Training • practice of nonjudgmental awareness of • one’s thoughts, feelings, and environment • increases endogenous dopamine release • increases cortical thickness • effective for depression, anxiety, ADHD, and apparentlysubstance use FutDir

  31. 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

  32. Acknowledgments Thomas Newton, M.D. Richard De La Garza, II, Ph.D. Lidia Zylowska, M.D. Gilles Fleury, M.D. J. David Creswell

  33. Life is not the way it’s supposed to be. It’s the way it is. The way you cope with it is what makes the difference. Virginia Satir

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