Taking Addiction to the Mat

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Taking Addiction to the Mat

By Jenifer Talley PhD 08/06/15

How mind-body practices can effectively help address substance misuse.

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The addiction and mental health treatment communities have always regarded practices such as meditation, yoga and other mind-body practices as useful adjuncts to treatment. But more and more evidence continues to accumulate suggesting that these modalities are actually extremely powerful therapeutic modalities on their own. For some people, regular engagement in mind-body practices can be a foundational part of a recovery plan. Dr. Jenifer Talley, a clinical psychologist and an expert in the integration of mind-body techniques in addict treatment, spells it out and describes her work with a client…Richard Juman

When we consider the factors that contribute to problematic substance use and other risky behaviors, several themes emerge. Most notably, there is a tendency to avoid experiencing discomfort through dissociation and disconnecting from one’s body during times of distress. I commonly hear clients say they use substances to alter how they are feeling and to quiet the endless stream of self-critical thoughts. Some are seeking an experience of euphoria, while others aim for relaxation or to attain a state of being numb. Implicitly, there is a lack of acceptance of what is occurring in the moment and a strong desire to alter one’s state. Many struggle with allowing emotions to run their course and seek an immediate form of relief. I often say that we have to “roll out the welcome mat” to all our experiences, as avoidance and reacting with aversion only prolong our discomfort and make us more susceptible to substance misuse.

As I introduce the concept of mindfulness and the notion of attending to the present moment with acceptance, it's clear that many clients are not inhabiting their bodies on a regular basis and instead rely on substances or other behaviors to act as a buffer or shield to difficult experiences. I’m met with skepticism when I suggest that a simple daily practice of devoting time to focusing on breath, attending to bodily sensations, and observing the contents of one’s mind with ease and compassion can have a positive impact on one’s relationship to substances. But, as I’ve seen countless times, once there is a commitment to learning how to cultivate awareness throughout the day, subtle shifts begin to happen and people begin to experiment with sitting through discomfort and riding out cravings and urges to use. To me, this is harm reduction therapy in action. It is a self-empowering way to help people build inner resources and awareness to work towards positive change goals. For many clients, the goals of therapy may include reducing risky behaviors, learning moderation strategies, or pursuing abstinence. The key here is that goals are developed and attained incrementally and in collaboration with clients.

Multi-tasking and being over-scheduled are our new norms, and the frenetic pace of life contributes to this sense of disconnection, as there is less time to “check in” with one's self. All of these factors, coupled with a culture that promotes excessive lifestyles and self-medication, place people at a greater risk for developing substance use issues or other problematic behaviors such as binge eating. Being a member of a stigmatized and marginalized group, in addition to having endured traumatic experiences, are also associated with substance use issues. Feeling “out of control” often mirrors what can happen with substances or other problematic behaviors.

While many people find that substances may be associated with predictable feelings of relief, with time this increased reliance on external tools to self-regulate makes it more difficult to manage one’s use and can lead to negative consequences. A pattern of reacting to experiences by self-medicating may occur outside of one’s awarenessI often hear clients say they cannot recall what led to a binge and describe being in a state of “autopilot.” It is therefore essential that we offer clients a way to work with discomfort and suffering—as those experiences are often linked with problematic behaviors.  

By adopting a harm reduction approach that is focused on honoring each person’s unique goals and developing personalized plans for change, we can engage people in an exploration of what they would like to change about their substance use and what important needs they believe are being met through their use. Then, we can begin to offer alternative ways of addressing those needs and the complex interactions of biopsychosocial factors associated with problematic use. 

These beliefs are foundational in the Harm Reduction Training for therapists that I do with with Dr. Andrew Tatarsky. One of our aims is to help shift the narrative in substance use treatment and in the larger culture, so that people feel welcome to create their own path towards healing and growth—one that is highly individualized and not bound by a belief that abstinence is the only acceptable goal. The development of skills that promote awareness and change are an essential part of this approach. It is through the process of helping people direct their attention to the patterns associated with substance misuse and clarifying the ideal relationship with drugs (if any) they wish to develop that distinguishes this approach from others that emphasize complete abstinence as the only acceptable goal.

Mindfulness practices and an emphasis on building awareness of sensations in the body is a useful starting point for helping clients attend to their habitual reactions to situations, which in many cases involve substance misuse or other problematic behaviors. Important data can be gathered by listening to the body and observing how we react to our experiences. For those who find it particularly difficult to sit still and practice a traditional seated meditation, I offer body-oriented practices as a way to start the process. We begin with simple breath practices such as observing the sensation of air flowing through the nostrils, and slowly incorporate awareness of sensations in the body using very gentle movement practices. In the mindfulness groups that I lead we incorporate mountain pose as one of our practices. Each group member stands as I guide them through subtle adjustments in their posture while fostering awareness of sensations in the body starting with their feet. This is a simple and portable pose that can be practiced anywhere and at any time. I often encourage clients to try to practice this pose whenever they are waiting in line. It is an invitation to slow down, check in, and observe how the body is in that moment—the sensations and position of the body.

With time, people begin to notice that there is gripping or tightening in certain parts such as around the neck and shoulders. Gradually, with practice, they may begin to soften and release those parts. Gentle seated twists can also bring awareness of the position of the spine and what it feels like to breathe while in a twist. It is an easy way to demonstrate the importance of linking breath with movement as inhales are paired with lengthening upward while the twist occurs during the exhale. By regularly observing the body and the ways in which we react to circumstances by tightening, clenching or freezing, and building alternative ways of responding, clients rely less on substances in order to self-medicate and self-soothe. And, most importantly, they build a greater sense of self-efficacy as they now have evidence that they are capable of living with more equanimity and peace.

Here is a case example to illustrate how I implement these practices in my clinical work. “Amy” (details of her treatment have been modified to protect her privacy) began working with me to address excessive alcohol use, along with symptoms of anxiety and depression. She previously attended more traditional, abstinence-based treatment programs and struggled with the rigid standards she was expected to adhere to. As a result of her experiences in those settings and the expectation that she must be abstinent, Amy felt more isolated, ashamed, and self-critical, as she was not ready to commit to lifelong abstinence and was determined to develop a safer relationship to alcohol. Since her goal was to pursue moderation, we began to explore instances associated with overdrinking, and we established safe drinking parameters. She initially had trouble identifying when she was experiencing a craving, so we began to incorporate mindfulness practices to help her be more aware of her moment-to-moment experiences and the sensations in her body. We focused on how she narrated her experiences during times of increased distress and interpersonal conflict, and how her narrative then led her to overdrink to manage intense emotions.

This “microanalysis” allowed us to identify when in this cycle she could incorporate a strategy such as breathing and mindful movement to reduce the intensity of what she was feeling—rather than immediately relying on alcohol. She often struggled to detach from “worry thoughts,” and we agreed that she would begin to identify when she engaged in this type of worrying and self-judgment so that she might try to shift her focus to something such as stretching and breathing. Slowly, she was able to pause and take a step back to recognize the pattern she was engaging in—without overly attaching herself to it—and shift to breathing and movement practices. She found modified versions of legs up on the wall and downward facing dog poses to be especially helpful when she was able to catch herself engaging in this cycle. Practicing these poses reduced the intensity of her cravings and she relied less on alcohol as a tool to self-soothe. She felt empowered that she had the capacity to regulate her mood on her own and felt more confident about her ability to follow the“ideal use plan” we developed together, which included clear guidelines about safe versus unsafe drinking practices.  

By the end of our work together, Amy’s drinking had decreased significantly, and she reported feeling more comfortable in her body and a greater sense of self-efficacy. She no longer drank alcohol on a daily basis, and was less likely to drink when feeling anxious or agitated. Over time, her symptoms of anxiety and depression also lessened. She developed a morning meditation ritual that set the tone for the day, and she learned that she could shift her focus when she noticed herself worrying excessively. We used several metaphors in our work: one of her favorites was the notion of pumping the brakes when she noticed feeling uncomfortable—a shift from being reactive to considering alternative and more skillful responses. Another benefit was that she became more aware of her relationship with food. She ultimately developed healthier eating habits as a result of practicing mindfulness and limiting her alcohol use, which had previously led her to make unhealthy food choices.  

Jenifer Talley, PhD is a clinical psychologist and Assistant Director of The Center for Optimal Living and Assistant Director of the Concentration in Mental Health and Substance Abuse at The New School for Social Research. She is also the Program Director of the Harm Reduction Psychotherapy Certificate Program at The New School for Social Research. To learn more about Dr. Talley, please visit her website.

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