Alternative Treatments for Addiction.docx

Chapter 14 Alternative Treatments In This Chapter * Looking at psychedelic research and treatment opportunities * Discovering acupuncture * Reviewing nutritional therapies * Meditating yourself to health * Harm reduction In the last decade, increasing numbers have sought out alternative treatments i...

Chapter 14 Alternative Treatments In This Chapter * Looking at psychedelic research and treatment opportunities * Discovering acupuncture * Reviewing nutritional therapies * Meditating yourself to health * Harm reduction In the last decade, increasing numbers have sought out alternative treatments in North America and in Europe. Currently, more people consult alternative treatment professionals than licensed physicians, a statistic reflecting this shift. Despite the trend, there has been reluctance in investing the funds needed to scientifically assess alternative treatments. As a result, we’re in a transition. Some early trial evidence, case studies, and anecdotes about treatment alternatives are available. But in most cases, we know less about the evaluation of alternative treatments than about the evaluation of standard medical treatments. <warning> The important consideration in any experimentation with alternative therapies is to ensure your safety by concurrently maintaining conventional treatments and regular contacts with trusted physicians. You don’t want to ignore the wisdom of centuries of medical science. It makes sense to go for the best combination of treatments available — but be sure some of it includes the best that Western medical science can offer. Although we don’t cover all the alternative treatments that are used in addiction treatment, our goal is to describe the more important ones and to provide a framework to use in deciding what to try and how to try it out. The thorough scientific evaluation of these treatments is still in the works, despite the fact that people have voted with their feet to consult alternative health professionals. So although you need to evaluate the scientific data that exists, you should evaluate it critically and be willing to trust your own experience of what works for you. Psychedelic Treatment and Research It may seem ironic that your history of substance exposure might have caused you to become addicted or remain free of it. But if you were first exposed to psychedelic substances like psilocybin or LSD, which, in testing, have proven anti-addictive and useful in moving from addiction to abstinence, you might have had a different experience. The point here is that some chemicals when ingested within experimentally validated protocols, are anti-addictive. The current psychedelic research supplies a needed ‘corrective’ to the hysteria of the Harvard experiments in the early 1960’s. There is much to read about these past errors of judgment that led to systematic research being legally prevented (for decades). Most important, however, is the current availability of anti-addictive experimentation that can suggest a potent pathway to personal recovery. To properly understand why and how we arrived at the current situation, we must review some of the history that unfolded after psychedelics were discovered experimentally. First, they were rediscovered, experimentally, given the documentation of psilocybin mushroom and peyote cactus use for centuries before applied science. Most of the initial experiments were in Canada, in the province of Saskatchewan. Tommy Douglas, the charismatic leader of the socialist provincial government (established in Saskatchewan), was intent on bringing innovative researchers to reform the health system. British psychiatrist, Humphrey Osmond, accepted a position at the Saskatchewan Mental Hospital, an overcrowded facility with major reform needs. He invited Abram Hoffer, a newly graduated psychiatrist, with biochemical training, to collaborate. Together, they began experiments with the single psychedelic substance most accessible at the time, namely LSD. Fortunately, they primarily confronted alcoholism, focusing on single session effects. What did they find? Because Osmond believed LSD induced symptoms like delirium tremens, he and Hoffer treated 2000 alcoholics under carefully controlled conditions (1954 to 1960). They were astonished that 40% to 45% of the LSD treated alcoholics remained abstinent after a year’s worth of observation. These were early days of research and it’s hard to now find the follow up data on these nearly 1000 patients. But this was carefully executed research. Recent studies undertaken by multiple researchers reflect the anti-addictive effects of LSD and other psychedelics for a cluster of addictions. A meta-analytic review that assessed all study results between 1966-1970 involved 536 patients who demonstrated significant benefits in reduced alcohol use at short (1 month), medium (2–3 months) and longer term (6 month) follow-ups after LSD administration. Promising results are now also being observed with psilocybin although the studies are in earlier developmental stages. The clinical trials for nicotine dependence (Johnson et al., 2014) and alcohol dependence (Bogenschutz et al., 2015) have shown significant abstinence outcomes, with additional trials now under way. Specifically, psilocybin was administered to 15 treatment-resistant tobacco/nicotine-dependent smokers, along with cognitive behavioral therapy for smoking cessation. A first dose was administered on the participant’s target quit date to quit smoking, with a second and third doses administered 2 and 8 weeks after the target quit date. At the 6-month follow up, 12 of 15 participants (80%) were abstinent from tobacco use based on biological verification. At a 12-month follow-up, 10 of 15 participants (67%) were biologically verified as abstinent. In a long-term term follow up that averaged 2.5 years after the target quit date, 9 of the 12 participants (75%) were again biologically verified as abstinent. Another study examined psilocybin in the treatment of alcohol dependence with ten alcohol-dependent participants administered psilocybin along with a 12-week program of motivational enhancement therapy. Participants had to abstain from alcohol for 24 hours before their first psilocybin session. A second session occurred 4 weeks later with therapy sessions conducted between two psilocybin sessions, and after the second psilocybin session. Self- reported alcohol use decreased significantly after the first psilocybin session and remained lower than baseline at 36-week follow-up. Drinking was reported to have occurred on 40% of days at baseline, and on < 20% of days at follow up. Consistent with prior findings from the studies of psychiatric distress, higher mystical- type experience scores in the psilocybin session were related to greater reductions in alcohol consumption. Encouraged by these promising signs, a large, randomized trial of psilocybin in the treatment of alcohol dependence is now underway. These are early findings, so what relevance might they have for you? First, you may have already had experiences with psychedelics you’re wondering about. An important message from current experiments is that the benefits occurred within precise and disciplined experiments that combine psychotherapy with substance intake. Unlike other drugs, generally, the ‘set’ and ‘setting’ when psychedelics are ingested appear very important to benefits. We have fortunately progressed beyond the ‘turn on-tune in-drop out’ days of Tim Leary when potent psychedelics were wrongly considered ‘entertainment’ drugs. Now we know, experimentally, from precise fMRI imaging, that they alter the default brain networks with results that persevere for months and years. It is far from an evening at the theater or a concert. It is a life-changing experience that you will ‘live with’ for some time to come, whatever the results are. Second, you may just be a psychedelic responder (a person for whom these drugs are beneficial) and willing to apply for participation in an ongoing study happening sufficiently close to your residence. We will show you how you can find out about the currently ongoing studies online. Third, there will be an increasing number of qualified therapists offering psychedelic therapy for addiction recovery in the foreseeable future. Finding the right psychedelic therapist, if motivated to try the therapy, will take some rigorous searching. With a psychedelic, the ‘inner you’ will become more exposed and subject to influence than in non-psychedelic therapy. It is very important to trust and feel confident in the professionals you are working with. Acupuncture What is acupuncture? And why would anyone believe it might help with addiction? The practice of medical acupuncture involves inserting needles in the body in various combinations, locations and patterns. According to the theory of acupuncture, the choice of needle patterns stimulates the flow of qi (pronounced chee), a subtle type of invigorating energy. Different disorders are caused by obstructions in the energies that flow through meridians or channels by which they circulate throughout the body. Treatment involves inserting needles into the channels affecting the disordered organs to stimulate the energy circulation that restores energetic balance and proper organ function. Many people are convinced of the benefits of acupuncture due to its long history in Asian (especially Chinese) medicine. How could so many people believe they’ve been helped, over a history that spans several thousands of years, if there were no beneficial effects? The long history of traditional acupuncture is an important point because it brings up another question. Could a treatment work well in one environment and not in another? It is certainly possible. First, because of the placebo effect where a person’s positive expectations affect treatment outcomes. Whenever you take a treatment out of its natural cultural environment, you’re changing that treatment because you’re changing the mindset of those receiving treatment. When we put acupuncture to the Western scientific test, in a Western medical clinic, we’re changing mindset and thus treatment. You may argue we’re changing it in a minor way. However, we really don’t know just how major or minor the changes are. What we do know is that the acupuncture being tested, in the end, is different from the acupuncture practiced throughout the ages in China and other parts of Asia. In Western science, evidence about acupuncture varies. In terms of treating drug abuse and addiction, the correlational evidence is much stronger than the clinical trial evidence. <technicalstuff> A clinical trial takes place when individuals agree to undergo an experiment in which they will be randomly assigned to receive a particular treatment. The new treatment investigated is called the experimental treatment. (It’s called experimental because the scientists don’t yet know if it works as well or better than the standard treatment). Sometimes, the comparison treatment condition is a placebo because the scientists want to test whether the experimental treatment works better than the effects people can actualize themselves through their positive expectations about treatment effects. Which results do you trust, the correlational results or the clinical trial results? We can’t say for sure, but there are two perspectives to consider. The first is that the difficulties involved in conducting a high-quality clinical trial in acupuncture are so extensive that such a trial has not been done satisfactorily. From this viewpoint, you can trust the correlational evidence more, because this evidence is derived from easier forms of experiments that, because they’re easier, have been undertaken more frequently and effectively. The second view is that the clinical trials provide the most exacting evidence of effectiveness, and acupuncture just doesn’t measure up under these stringent conditions of testing. We will go over examples of both types of evidence, so you can see for yourself what makes sense. Acupuncture research Much animal research in acupuncture is devoted to testing whether the treatment reduces addictive behavior. First, addictive responses are induced (for example, in laboratory rats), then the strengths of the addictive responses are tested following acupuncture treatment. For example, rats induced into a nicotine addiction (the addictive tobacco ingredient) are given acupuncture and then observed. The treated rats show decreases in addictive behaviors consistent with lesser addiction levels. An important aspect of these studies is that the same anti-addictive effects observed externally, in terms of behavior, are also observed internally, in terms of biological responses. The human research is more varied, although similar. One important question has been whether acupuncture assists patients in withdrawing from addictive states. If it does, its anti-addictive action may be effectively rebalancing the biological processes that become disordered during drug abuse and addiction. If true, the anti-addictive effects of acupuncture may also be effective in preventing relapses. In several randomized clinical trials with humans, acupuncture has effectively reduced the addictive withdrawal responses of patients detoxifying from nicotine, alcohol, cocaine, and opiates. However, the picture isn’t all clear because other clinical trials, specifically testing nicotine and cocaine addiction, have yielded opposite results — little or no differences between acupuncture effects and the effects of a sham needle treatment. The sham treatment is meant to look like acupuncture, but the needles inserted aren’t placed in any of the real acupuncture points. Thus the sham treatment is purposely ineffective. If it turns out to be as effective as acupuncture, then either a new, effective needle treatment has been discovered (highly improbable) or there’s some placebo response involved that suggests the action of acupuncture isn’t crucial to the benefits derived. How do you interpret these positive and negative study results? You may conclude that some studies were done more precisely and that the more precise studies showed either positive or negligible results. Or you may conclude that some patients are highly responsive to acupuncture, and others are unresponsive. Whenever results are compared across patient groups, the data of each group is analyzed as a whole. Therefore, there is an overriding of differences in the responses of individual people. Plainly put, if the most acupuncture-reactive patients were compared with the control groups of these studies, different results may be obtained from the ones reported. In practical terms, it may be that certain sectors of the patient population, or the general population, have a strong response to acupuncture. Other sectors are less responsive. In most studies, thus far, both responsive and unresponsive sectors are mixed together in evaluating responses. Practically speaking, if you, individually, are a strong responder to acupuncture, you may have more positive responses than those reported in the published studies. This kind of responder research could be done systematically, but the science in this area hasn’t progressed there yet. You could be justified, on the basis of current findings, to try out acupuncture as part of a treatment regimen. Then you can evaluate how strong your response is — and see whether you feel you’re a responder and, if so, whether you will continue with treatment to derive the benefits. Ibogaine Treatment Ibogaine is a fascinating, plant-based remedy believed to have anti-addictive properties. As a biochemical, it’s referred to as an alkaloid that alleviates opiate dependency and withdrawal. It has been categorized elsewhere as a hallucinogen (like peyote) and was perhaps originally used for its anti-addictive action by the tribes in West Africa that discovered it. How ibogaine may work The research on ibogaine is simple to interpret, because most of the reliable studies have been done on animals. Most indicate ibogaine reduces opiate withdrawal symptoms and alcohol dependency. For example, in morphine-dependent mice, ibogaine reduced physical withdrawal reactions. In rats that have been preconditioned to be alcohol-preferring, ibogaine reduced the subjects’ desire for alcohol intake, with minimal side-effects on food intake. Historical beginnings of ibogaine treatment Despite the observation that the visions associated with ibogaine can be stressful, it has a history of underground use from the early 1960s onward. At that time, it was transported to North America in sufficient quantities to become known as an anti-addictive substance. One of its discoverers, Howard Lotsof, gave it to seven heroin and cocaine addicts and reported that five of the addicts stopped their use for 18 months, experiencing minimal withdrawal problems. Lotsof pursued efforts to patent the drug, finally succeeding in 1985 with a patent for its use in opioid withdrawal. Addiction treatment with ibogaine began in informal clinics in the Netherlands as early as 1989, and has progressively expanded so that clinics now use it in the U.K., Canada, Slovenia, and Mexico. Although ibogaine is legally used in most countries, it is, unfortunately, outlawed in Belgium and the United States. Although scientists in the United States continue to try to evaluate its effects, at this time there is insufficient research data to warrant FDA approval. Ibogaine research With humans, ibogaine research has been controversial, partly because of its hallucinogenic properties. In low doses, ibogaine is a mild stimulant. At high doses, users report emotionally provocative visions, some pleasant and some harrowing. One formerly addicted patient who credits ibogaine with 3 years of sobriety after 15 years of addiction, stated, “It was like dying and going to hell 1,000 times.” Because this described his experience after ingesting ibogaine, you can see why ibogaine wouldn’t be addictive in itself. Ibogaine may induce an emotional catharsis that motivates one to never again ingest anything that could be addictive. <warning> At this point in time, it’s unwise to use ibogaine without the careful supervision of a physician experienced with its use. Although not yet legal in the United States (at the time of printing), some clinics in Mexico, the Caribbean, and Europe administer it. One of ibogaine’s investigators, K. Alper of the New York University School of Medicine states that ibogaine seems to work on “every neurotransmitter system we know about.” That’s a general statement but it leaves a lot of room for how it might have positive or negative effects. Certainly, one of its important actions is as an antidepressant agent that acts on the serotonin levels in the brain. The available data suggests that ibogaine is safe, but careful supervision of patients is also indicated as the safety data is in early stages and may not be as reliable as preferred. Ketamine Research Ketamine is a relatively safe drug that’s been used as a general anesthetic in most hospitals (internationally) for decades. Until recently, its antidepressant (psychoactive) effects were relatively unknown and unstudied. These effects are observed only with doses much lower than those used for anaesthesia. The lower intake is associated with depersonalization effects that can be so disruptive that Ketamine is sometimes casually (and wrongfully) referred to as a psychedelic. But sufficient experimentation has resulted in the current acceptance of Ketamine having surprisingly powerful anti-depressant effects. Unfortunately, these effects are not stable over time, meaning that they reduce in intensity. Therefore, current experimentation focuses on extending the therapeutic effects by using them to enable patients to benefit from talk therapies (especially Cognitive Behaviour Therapy). At the same time as antidepressant effects were identified, pain reduction and anti-addictive effects have been observed. The ongoing question is whether some effects (e.g. antidepressant effects) are leading to other effects, or whether the multiple effects observed are separate and independent. In terms of addictive disorders, depression and anxiety symptoms can precipitate attempts to self-medicate to reduce distress, or simply escape symptoms through distraction. For Ketamine to effectively assist, it’s important to identify how much depressive and anxiety symptoms play a role in one’s unhealthy urges. That identification, alone, can be helpful as there are multiple approaches to reduce anxious-depressive symptoms and by doing so, reduce urges and ‘slips’ that can result in stronger addictive patterns. Ketamine use is not without its own risks of addiction. One can imagine that the antidepressant impacts would be very attractive and, because short-lived, lead to repeated use. As ketamine therapy becomes better established in psychiatric treatment, there are now nasal (i.e. sprays) and oral (e.g. lozenges) forms of delivery, as well as infusion into the blood. One negative effect that must be considered about Ketamine treatment pertains to cardiovascular effects as it can raise blood pressure and act as a cardiovascular stressor. If we look solely at the effects of Ketamine on addiction, we must mention a study that involved seventy detoxified heroin-addicted patients randomly assigned to two groups, both receiving Ketamine-based psychotherapy (KPT) while taking higher and lower doses. The patients in the experimental group received existentially oriented psychotherapy in combination with a strong dose of ketamine (2.0 mg/kg) while the controls received the psychotherapy with a much lower dose of Ketamine (0.2 mg/kg). The results of this randomized clinical trial showed the higher dose (2.0 mg/kg) of Ketamine elicited a more psychedelic-type experience while the lower dose of Ketamine (0.2 mg/kg) elicited ‘‘sub-psychedelic’’ experiences but assisted guided imagery. The higher dose produced a significantly greater rate of abstinence in heroin addicts within the first two years of follow-up, including a greater and longer-lasting reduction in craving for heroin. This certainly is an encouraging study. But oddly it was done and reported on in 2002 and no further testing by this research group has been done. The most advanced research on Ketamine pertains to depression effects. Nutritional Therapy If you believe nutrition is important for health, it follows that you’d believe good nutrition is especially important for recovering from an addiction. Furthermore, scientific evidence suggests that nutrition can play a major role. Addictions and poor nutrition Recently the first comprehensive examination of the link between substance abuse and eating disorders revealed that over one third of the people who abuse drugs or alcohol have an eating disorder. This statistic contrasts with the 3 percent of the general population with an eating disorder. Furthermore, about one half of people classified as having eating disorders also engage in the abuse of alcohol or drugs. What does this mean? Simply put, if you have an alcohol or drug abuse problem, you’re more likely to additionally have an eating disorder. And if you do have an eating disorder or an eating problem, the result for you is probably poor nutrition, which combines with the chemical imbalances in your body that exist because of your use and abuse. And the reverse is also true — if you have an eating disorder, you’re also more likely to have an alcohol or drug abuse problem. Both problems combine in creating chemical imbalances. <tip> Because an unfortunate side-effect of most addictions is a poor diet, your recovery process will benefit by following a healthy diet. What constitutes a healthy diet? Start with what is recommended by authoritative bodies such as the U.S. and Canadian governments (www.health.gov and www.hc-sc.gc.ca/). <tip> Pay attention to your diet. A good nutritional approach is important in counteracting your substance abuse and behavioral addiction tendencies. But what is good nutrition? Even in this era of the Atkins Diet and controversies over how much protein you should eat, everyone agrees on fresh fruits and vegetables. Increasing these consumptions is associated with a reduced incidence of cancer and heart disease, as well as other chronic illnesses. You just can’t go wrong with these basic staples of good nutrition. Another valuable dietary change is reducing daily intake of sugars and refined carbohydrates. This is much more difficult. These foods are broken down easily and raise the levels of your blood sugar precipitously. Then they burn out quickly. You naturally produce higher levels of insulin to match blood sugar levels, so when the burnout happens, you’re left with too much insulin in your blood, and the result is fatigue and often, a lower mood. If you’re going to consume carbohydrates, consume complex carbohydrates — whole grains and cereals. These types of carbohydrates are like the logs that burn longer in your fireplace. They get broken down more slowly and raise your blood sugar levels more gradually and evenly — and your blood sugar levels are maintained at higher (energizing) levels for longer periods. This results in more energy and evener moods. This point about carbohydrates and nutrition, generally, can be very important and difficult for those who abuse alcohol. Because alcohol intake impairs absorption of nutrients by interfering with two major body organs, namely the liver and the pancreas, following withdrawal, it’s important to be on the lookout for imbalances of fluids, calories, and electrolytes as well as vitamin deficiencies involving pyridoxine, thiamine, and vitamin C. Furthermore, because you get accustomed to a good deal of carbohydrate intake in the form of alcohol, you can find yourself experiencing an acute, refined carb deficit after withdrawal. The result is a residual sweet tooth. You find yourself prone to eating lots of sugars — pastries, ice creams, chocolates, and hard candies. You will probably have to adjust gradually to a lower carb intake or, alternatively, to an intake of the healthier complex carbs. This transition usually requires a good deal of attention and discipline. Macrobiotic diets Among the special diets that can help people overcome health problems, this Asian-style vegetarian diet has been promoted as one of the most effective. It emphasizes low fat intake and eating whole grains, vegetables, and nonprocessed foods. It may prove helpful in dealing with food allergies, chemical sensitivities, and addictive tendencies. The macrobiotic diet is based on ancient Chinese philosophy. It is a nutritional attempt to balance the complementary opposites known as yin and yang — the forces that the Chinese believe must be kept in harmony to achieve good health. These forces are woven into every aspect of life. Their characteristics are as follows: * Yin is said to be expansive, cold, wet, slow, passive, sweet, loose, and dark. * Yang is contractile, hot, dry, fast, aggressive, salty, tight, and light. <remember> Alcohol and drugs are extremely yin in character. The macrobiotic dietary regimen strives to bring daily dietary intake into balance. According to the Chinese philosophy, some food substances are neither yin nor yang but rather in-between. The most balanced foods in the yin/yang continuum (though not necessarily in nutritional science) are brown rice and whole grains. Hence, these foods constitute the foundation of the macrobiotic diet. To this foundation, the macrobiotic regimen adds foods reflecting different degrees of yin and yang, selected in accordance with the individual’s dietary needs and temperament. In practice, this usually works out to a diet consisting of: * About 50 to 60 percent whole grains, including brown rice, barley, millet, oats, corn, rye, wheat, and buckwheat. Keep in mind that whole grains are considered the best types of carbs to consume in current Western nutritional circles. * About 25 to 30 percent fresh vegetables. Especially recommended are cruciferous vegetables (members of the cabbage family) and other dark green and deep yellow vegetables. They should be grown organically and locally, if possible. Macrobiotic advocates recommend lightly steaming or boiling them, or sautéing them with a small amount of vegetable oil. For purposes of the macrobiotic diet, vegetables fall into three categories: Eat frequently: Cruciferous vegetables, including arugula, bok choy, broccoli, cabbage, cauliflower, collards, kale, kohlrabi, mustard greens, radishes, rutabaga, turnip greens, turnips, and watercress; also included are Chinese cabbage, dandelion, onion, daikon, orange squashes, and pumpkin Eat occasionally: Celery, iceberg lettuce, mushrooms, snow peas, and string beans Avoid: Potatoes, tomatoes, eggplant, peppers, asparagus, spinach, beets, zucchini, and avocado * About 5 to 10 percent of your food in the form of beans, soy-based products, and sea vegetables. In this category, tofu (soy bean curd) is a favorite. Sea vegetables to consider include wakame, hiziki, dombu, noris, arame, agar-agar, and Irish moss. * About 5 to 10 percent of your food as soups. Miso soup, a broth made with soybean paste, is a popular choice. Also permissible are soups made with vegetables, grains, seaweed, or beans. Macrobiotic diets and substance addiction From the macrobiotic perspective, an overabundance of substances like drugs and alcohol creates an imbalance of too much yin in your diet. Accordingly, you need to counteract the dominance of yin in your diet with more yang substances. From this perspective, if you establish a balance between yin food items and yang food items, you will reduce your craving for alcohol and drugs. The research on macrobiotic diets as an aid to substance abuse treatment <warning> At this time, no scientific evidence supports the idea that a macrobiotic diet will reduce your urges for alcohol or drugs. Nevertheless, evidence shows that when addictions dominate your life, a healthy diet is often neglected. Moreover, some of these addictions (alcohol abuse/addiction) impair your body’s ability to properly process the nutrients in foods. Macrobiotic diets do help ensure a more nutritionally balanced diet than what you are likely achieving when consumed by an addiction. Meditation Meditation techniques were once difficult to scientifically evaluate. This has changed radically as we enter a new era of exciting findings about meditating offering important benefits. Underlying this revolution-in-the-making are innovative ways of detecting subtle brain signals within different parts of the brain. By using sophisticated forms of fMRI and electroencephalograph tests, subtle changes in neural signals can now be detected at very high rates (e.g. 1,000 times per second). With these tests, we’ve discovered that high levels of neural activity in the left prefrontal cortex are associated with states of happiness, vitality, and alertness. High levels of activity in the right prefrontal cortex, in contrast, are associated with emotional distress, depression, and anxiety. The consistency of these and other findings raise questions as to whether people can be taught the mental disciplines that shift and amplify the patterns associated with happiness and vitality. Can people, for example, be taught to activate the brain sectors associated with happiness while deactivating the brain sectors associated with depression? If so, could these disciplines lead to cultivating happiness and alertness, and increased vitality? Preliminary answers have been derived from studies of Buddhist meditation masters and the general population. During a form of compassion meditation, the advanced meditators demonstrated a remarkable leftward shift in prefrontal brain activity — a shift that stimulated the same brain areas associated with positive emotion, vitality, and alertness. Although this was an important finding, it was possible that it required many years of meditation discipline to accomplish this shift. Can these meditation techniques be useful for regular people unable to devote years to meditating? To demonstrate that these same shifts were possible for ordinary citizens, a randomized study was conducted on healthy employees from a large company. Half the group was randomly allocated to an eight-week training in mindfulness forms of meditation, and the other half was placed on a waiting list group and assessed but not trained. The results indicated significant increases in left-sided activation for the meditators when compared with the nonmeditators. These and other findings demonstrate that brief trainings in mindfulness meditation generate positive effects on brain function similar to those achieved by advanced meditators. Briefly put, ordinary citizens can learn meditation techniques that assist them in cultivating positive emotional states, vitality, and alertness. How does this relate to addictions? Addictive states are associated with people becoming dependent on substances or engaging in behaviors that, temporarily, generate excitement and satisfaction. The hardest part of detox and recovery is that after withdrawal, you must find new ways to sustain positive states — without the substances or behaviors that once did the trick. As we have seen in the experimental results, meditation techniques, particularly mindfulness approaches, can be useful in cultivating positive states of mind. Rather than subjective reports of positive changes, we now can observe actual brain signals — the ‘biology’ associated with positive emotional states. With meditation techniques and new methods of observation, we may be ushering in a new era of seeing what’s healthy and what isn’t healthy within the brain itself — and then engaging in activities, like meditation, that help us make the critical transitions from unhappiness to well-being. A brief introduction to mindfulness Mindfulness meditation involves the non-avoidant awareness of the thoughts, emotions, and sensations that arise in one’s immediate experience. No particular thoughts are emphasized. All are related to in the same way. Attention is first directed to breathing sensations until a thought, image, emotion, or sensation is perceived. Then that thought, image, emotion, or sensation is noted, and attention is redirected back to breathing sensations. This simple process continues for 10 or 15 or 30 minutes, or for as long as a person wishes. One can be in a seated position (recommended) or lying down. The technique can be summarized in the following way: * Attention is directed to breathing sensations * Awareness arises of a thought, image, emotion, or sensation * Practice detachment from this awareness * Attention is redirected to breathing sensations * Awareness arises of the next thought, image, emotion, or sensation * Practice detachment from this awareness * Attention is redirected to breathing sensations Harm Reduction Approaches Harm reduction programs entail reducing the worst dangers of drug and alcohol use by programs that don’t aim for or require complete abstinence but instead reduce use-associated risks. For example, if a teen with drinking problems can’t abstain, she can still relinquish a driving license and, in doing so, reduce the risks associated with driving under the influence. Perhaps the most recognizable harm reduction programs are those relating to opiate addictions that include needle exchange programs (which ensure reduced use of dirty needles that transmit infectious diseases like HIV/AIDS and Hepatitis C) and methadone maintenance programs. These methadone programs provide controlled, midway steps between total abstinence from opiates and the dangers of street use. Methadone programs provide a regular dose of opiates that don’t produce a high or a deficiency leading to craving and re-engagement with street use. (See Chapter 10 for more information on methadone treatment.) Although these are concrete examples, the principles of harm reduction are widely applicable. The other noticeable example of harm-reduction programs in North America and parts of Europe are the introduction of decriminalized marijuana programs. Such programs don’t encourage use but do reduce the legal penalties that are sometimes much more damaging than actual use. The following principles are important to understanding what harm reduction is: * Accept for better and worse that licit and illicit drug use is part of our world and work to minimize the harms rather than simply ignoring or condemning them. * Understand that drug and alcohol use is a complex phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledge that some ways of using drugs and alcohol are clearly safer than others. * Establish quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies. * Call for provision of services and resources to people who use drugs and to the communities in which they live in order to assist them in reducing attendant harm. * Ensure that drug users and those with a history of drug use routinely have a voice in the creation of programs and policies designed to serve them. * Affirm that drug users themselves are the primary agents of reducing the harms of their use, and seek to empower them to share information and support each other in strategies that meet their actual conditions of use. * Recognize that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other inequalities affect people’s vulnerability to and capacity for effectively dealing with drug-related harm. What is difficult about harm reduction is deciding where to draw the line between reducing the harm of abuse and making it easier for abusers to keep abusing. This boundary is best understood in terms of each individual’s situation and how he or she responds to harm reduction efforts. If you feel that someone’s exploiting a harm reduction program, the situation must be dealt with as effectively and as immediately as possible. Exploitation threatens the harm reduction program and enables the addicted individual to avoid confronting the necessity of limiting or stopping use.