Mindfulness and Recovery: The Reward Circuit

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The disordered use of alcohol and drugs is a complex phenomenon.

Therefore, it’s not surprising that intervention, treatment, and recovery often require complex and nuanced approaches. One part of the recovery picture that’s becoming more and more common is mindfulness.

Simply defined, mindfulness – often associated with various types of meditation practice – is the habit of becoming more aware in the present moment. Mindfulness techniques require practice and instruction, but the concept behind them is simple. They involve training the mind to focus on immediate cues and sensations while observing and accepting all thoughts, sensations, feelings, and emotions without judgment.

Research shows the effectiveness of mindfulness in a wide variety of medical applications, from pain management to stress reduction. Increasingly, these techniques are being explored as a part of the medical arsenal against addiction.

Since mindfulness has its roots outside of the medical mainstream, some patients, as well as some medical professionals, may still approach it with suspicion. They may also hesitate to take the benefits of mindfulness seriously.

From the outside, mindfulness may appear too simple – just sitting and thinking – and it may seem inadequate to address serious problems such as addiction treatment and recovery. That’s why it’s important that a growing body of research supports the benefits of mindfulness techniques in treatment and recovery. This combination of techniques is known as Mindfulness-Oriented Recovery Enhancement (MORE).

Avoiding Pain, Experiencing Joy

Scientists know that alcohol and substance use disorders (AUD/SUD) hijack the reward system in the human brain. A solid understanding of what that reward system evolved to accomplished can help treatment and recovery. While neuroscientists spend their entire lives studying the reward system, its basic functions is easy to explain. Humans evolved to avoid pain and seek pleasure because these behaviors increased likelihood of survival.

That’s why mindfulness makes intuitive sense in this context. It supports the same processes that AUD and SUD disrupt. One theory holds that behaviors related to AUD/SUD are grounded in self-medication. In order to temporarily alleviate the painful emotions related to trauma, stress, or psychiatric disorders, people use alcohol or drugs. Self-medicating behavior often backfires, however, as individuals build tolerance to the substances they use. When the numbing or sedative effect only occurs at higher and higher doses, the risk of overdose and other negative consequences increases.

One recent study looked at the effectiveness of mindfulness techniques when combined with medication. For people in recovery from opioid use disorder (OUD), methadone maintenance therapy (MMT) has been shown effective in reducing cravings for the drugs. Methadone works by blocking the receptors in the brain that produce the feeling of euphoria known as a high. Absent that sensation – the reward for using the drug – people in recovery can break the cycle of craving and seeking.  When prescribed along with mindfulness training and meditation practice, MMT patients showed increased ability to resist craving, and avoid relapse, making methadone-supported recovery more stable.

Enhancing Natural Reward

Another recent study examined the theory that mindfulness techniques augment natural reward processing. Participants trained to strengthen their attention to natural reward. They viewed rewarding images, like a sunset or an affectionate couple, which in many people elicit a naturally rewarding chemical response. In people with AUD/SUD, the intensity of drug-related rewards can diminish naturally occurring reward. Study subjects trained to strengthen their attention on the rewarding images. The result: over the eight weeks of the study, responses to natural stimuli showed measurable increase. This demonstrates that while AUD/SUD can alter the reward system, mindfulness can play a part in restoring the reward system to its original state.

The bottom line from this research is that mindfulness techniques target the same reward mechanisms in the brain impacted by AUD and SUD. It can help repair those mechanisms where they changed. Mindfulness training shows promise in mitigating some of the key challenges that patients in recovery face. It helps control cravings and their associated emotional state. Perhaps most importantly, though, mindfulness training has the potential to restore the natural cycle of reward that disordered alcohol and substance use disrupts. This allows people in recovery to regain a sense of purpose, meaning, and joy in living without alcohol or drugs.