Mental Health: Mindfulness can change impulsive behavior towards substance use

The practice of mindfulness can decrease the impulsivity of patients living in therapeutic communities undergoing treatment for substance abuse disorders, such as alcohol and other drugs, research shows.

Mindfulness, or “mindfulness,” is a state of mind in which a person turns their attention to the present.

With origins in Buddhism and Eastern traditions, mindfulness arrived in the West as a secular meditation practice used as a complementary treatment for various clinical conditions, such as chronic pain, stress, depression and anxiety. Mindfulness applied to health was developed by physician Jon Kabat-Zinn in the 1970s in the United States.

Research developed by psychologist Ana Paula Donate during her master’s degree in psychobiology at Unifesp (Federal University of São Paulo) analyzed the effect of mindfulness-based relapse prevention. The study was funded by Fapesp (Fundação de Amparo à Pesquisa do Estado de São Paulo) and was guided by Professor Ana Regina Noto, from Unifesp’s Escola Paulista de Medicina (EPM).

Donate was part of Nepsis (Health and Substance Use Research Center), which is part of Unifesp’s Department of Psychobiology, which conducts several studies on mindfulness.

The protocol used in the research was MBRP (Mindfulness-based Relapse Prevention), developed by Canadian psychologist Alan Marlatt in 1985.

According to Donate , “there are different mindfulness protocols in the world, which can be grouped into mindfulness-based interventions, with each of the protocols having specific practices, such as the MBRP, which was developed for people with substance use disorder”.

From a neural point of view, it is believed that meditation practices for chemical dependence can be seen as behavioral strategies that contribute to the development of cognitive functions mediated by the prefrontal cortex in the brain.

Studies have shown that the prefrontal region of the cortex is impaired by chronic substance use, which contributes to the maintenance of compulsive and impulsive behavior. Researchers have shown that as cognitive management is restored through meditation practices, there is an increase in connectivity between the top-down systems of the prefrontal cortex and the bottom-up of the limbic-striatal circuits involved in the processing of reward and reward. motivated behavior, respectively.

“The increased connection between top-down and bottom-up systems offers support for shifting the automated pattern of behaviors towards substance use, such as reward reassessment, cue reactivity, as well as reorganization of executive functions and, therefore, , control of impulsivity”, says the researcher.

There are several studies on mindfulness conducted around the world, considering clinical and non-clinical groups. These studies have shown that the practice can help to reduce not only stress and anxiety, but also depression and cravings caused by the lack of the drug.

Donate explains that there are two types of meditation practices: formal and informal. Informal practices are exercises that can be performed during routine activities, such as washing hands, eating or walking, without necessarily being in a meditation posture, as in formal practices.

“From a practical point of view, practicing mindfulness involves paying attention to the steps that involve a certain activity or action, in addition to choosing to have an attitude of openness to observe sensations, thoughts and emotions. In this case, the invitation is to bring the quality of attention, awareness and openness to a day-to-day activity”, he details.

The research included people with substance use disorder, including alcohol, cocaine, marijuana and crack, who were undergoing treatment in a therapeutic community in Campinas, in the interior of São Paulo.

Participation was voluntary and took place while they were inside the institution. Before starting the study, people were interviewed in order to verify if they met the inclusion criteria, such as being substance-free for at least 15 days, speaking Portuguese and not having a severe neurological condition. At the end of the initial interview, 86 people were selected to be part of the study, of which 45 received the meditation intervention.

At least five different formal meditation practices were performed, such as sound meditation, thought meditation and breath meditation. Practices were conducted over eight consecutive weeks by two facilitators who are trained in the MBRP protocol.

The meetings took place once a week, lasting two hours. The group consisted of a fixed number of people from start to finish, and new participants were not allowed. The remaining participants received the control intervention, that is, the collaborators of the therapeutic community offered activities that included techniques of the 12 steps of relapse prevention, which are interventions usually offered in therapeutic communities.

The study results showed a slight decrease in impulsivity among people who received the meditation compared to those who received the control intervention. According to Donate, this was the first study that investigated the effects of MBRP for eight weeks in a therapeutic community in Brazil. The experience pointed out the need for protocol adaptations for this population, including the flow of new participants into the group and the duration of the meditation session.

“We discussed the possibility of adapting to a protocol that is continuous and that allows new members to participate even after the group starts, as well as reducing the session time, which would be a maximum of one hour, extending so the number of encounters. From a practical point of view, this seems to make sense for our environment and for the characteristics of our population. It remains to be seen whether, from a neurobiological, cognitive and behavioral point of view, it will also have an impact on impulsivity. , new studies need to be elaborated”, says Donate.

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