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Home    >    Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain
Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain
Eric L. Garland
ISBN: 978-0-87101-445-0. 2013. Item #4450. 214 pages.
Book Type:

Human existence can be beset by a variety of negative mental states such that life seems devoid of meaning, but it can also be liberated - a meaningful life reclaimed and savored through cultivation of a higher kind of mind. This quality, mindfulness, refers to both a set of contemplative practices and certain distinct psychological states and traits, and it can be cultivated through intentional effort and training.


In Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain, Eric L. Garland presents an innovative program of intervention that can be put into practice by therapists working with people struggling with addiction and the conditions that underlie it. Unlike other substance abuse treatment modalities, which focus largely on relapse prevention, Mindfulness-Oriented Recovery Enhancement (MORE) concentrates on helping people to recover a sense of meaning and fulfillment in everyday life, embracing its pleasures and pain without avoiding challenges by turning to substance use.


Along with chapters on the biopsychosocial model underlying MORE and the current state of research on mindfulness, this book includes a complete treatment manual laying out for clinicians, step by step, how to run MORE groups - including adaptations to address chronic pain and prescription opioid misuse - and enhance the holistic recovery process for people striving to overcome addiction.


With addiction a widespread and growing problem in our society, Mindfulness-Oriented Recovery Enhancement could not be more timely or needed. It integrates the latest research on addiction, cognitive neuroscience, positive psychology, and mindfulness into a practice that has garnered empirical support and holds the promise of release and fulfillment for those who suffer from addiction.


Eric L. Garland's exciting book, Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain is a ground-breaking new contribution to addiction treatment literature. Dr. Garland, a licensed clinical social worker with more than a decade of experience in delivering evidence-based interventions based on contemporary cognitive-affective neuroscience, offers a clearly articulated 10-session model for intervening with substance dependent clients. The treatment approach presented in Garland's book is inexpensive, research based, broadly applicable to substance-dependent people of all types, and readily adopted by student and experienced practitioners. Although mindfulness interventions are rooted in ancient Buddhist traditions, psychophysiological and clinical assessments suggest that they are among the most efficacious treatments currently available for a range of modern-day maladies. I strongly encourage clinicians and therapists working with substance-dependent clients to read Mindfulness-Oriented Recovery Enhancement.


Matthew Owen Howard, PhD


Associate Dean for Faculty Development


University of North Carolina at Chapel Hill

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About the Author

Acknowledgements

Part I: Conceptual Foundations
1 Introduction

2 An Integrated Biopsychosocial Model of Automaticity, Allostasis, and Addiction and a Rationale for MORE

Part II: Treatment Manual
3 Conducting MORE

4 Mindfulness and the Automatic Habit of Addiction - Session 1

5 Mindful Reappraisal - Session 2

6 Shifting the Mind to Refocus on Savoring - Session 3

7 Seeing through the Nature of Craving - Session 4

8 Overcoming Craving by Coping with Stress - Session 5

9 Walking the Middle Way between Attachment and Aversion - Session 6

10 Mindfulness of the Impermanent Body - Session 7

11 Defusing Relationship Triggers for Relapse - Session 8

12 Interdependence and Meaning in Recovery - Session 9

13 Looking Mindfully toward the Future - Session 10

Part III: Evaluation of the Model
14 Research on MORE

Appendix A MORE for Chronic Pain and Prescription Opioid Misuse

Appendix B Client Handouts

What is Mindfulness?
Mindful Reappraisal Worksheet
Mindful Savoring
The Nature of Craving
Understanding Cravings Worksheet
Responding to Stress
Acceptance through Mindfulness
Mindful Walking
Mindfulness in Relationships
References

Index
Suffering and joy are ubiquitous. The sensitive heart yearns to bridge the chasm that hangs between the poles of this dichotomy. Yet the heart can be obscured by the mind, which may be torturer, taskmaster, or teacher. The magnitude of suffering inflicted by the mind is perhaps no more apparent than in the afflictions of addiction, stress, and pain. These interrelated forms of misery seem to arise from a deep psychological cling- ing or aversion to the conditions of life. However harsh one’s experience is in the moment, mental and physical pain are stoked into a conflagration of anguish when the mind craves or rejects the experience of the present moment. We frantically hold on to what we fear to lose, and we run from that which we fear to find. These reactions seem to be reflexive, automatic, and inherent in the human condition. But are they inevitable? Are we condemned to tread the well-worn grooves of self-destructive habits? The answer to this question arises in the depths of quiet contemplation, in the dawning light of self-awareness. Although human existence can be afflicted by negative mental states, so too can it be liberated by cultivating a higher kind of mind. This quality of mind, known as mindfulness, may be strengthened through intentional effort and training.

The word "mindfulness" may be applied to both a set of contemplative practices as well as to the distinct psychological states and traits cultivated by these practices. "Mindfulness" is an English term that has been imposed on a diverse set of cross- cultural traditions and techniques that most notably emerged in Asia over 2,500 years ago but also have manifestations in the mystical branches of Judaism, Christianity, and Islam as well as in numerous indigenous cultures around the world. In truth, no one culture can lay claim to mindfulness, for at its core, mindfulness is a fundamental aspect of human consciousness, an innate psychophysical operation that is garbed by language in cultural systems designed to impart a means of developing this naturalistic function. Various traditional and modern schools of thought offer scaffolding by which one may learn to develop and use mindfulness for the benefit of self and others.

There are numerous Western conceptualizations of mindfulness. Many of these conceptualizations stem from scientist-practitioners in medicine and psychology who have become interested in mindfulness because of its demonstrably salutary effects on both mental and physical health. These conceptualizations are, in turn, derived from reinterpretations of teachings from Theravada, Mahayana, Zen, and Tibetan Buddhist traditions, among others. Since at least the turn of the 20th century, these schools of Buddhism have influenced American and European culture, and hence it is not surprising that many modern conceptualizations of mindfulness originate from these philosophical-spiritual frameworks. Yet it must be clearly stated that mindfulness is truly nondenominational and nonreligious; it is a tool and function that may enhance sacred and everyday experience alike. In the West, mindfulness has been secularized, stripped of its religious-cultural trappings for use by non-Buddhists. Indeed, emerging research indicates that mindfulness has much clinical utility and may ease the forms of suffering and social ills that are part and parcel of modern life.

To understand mindfulness, it is helpful to use traditional concepts as the context within which to grasp the modern, academic definition. In Sanskrit, the ancient language of the Indo-Tibetan Buddhist traditions, the concept of mindfulness is associated with three terms: "manasikara," "smrti," and "samprajana" (Blo-bzan-grags-pa, 2000; Lutz, Dunne, & Davidson, 2007). Manasikara refers to the property of mind that attends to or turns toward the object of focus. In other words, it is manasikara that enables us to stay focused on reading each word on this page. Smrti refers to the property of mind that takes hold of or retains the object of focus. In other words, it is smrti that enables us to remember to stay focused on reading the words on this page when our mind wanders. Samprajanya refers to the metacognitive dimension of the mind - that is, the aspect of mind that monitors the content of consciousness while reflecting back on the process of consciousness itself (Nelson, Stuart, Howard, & Crowley, 1999). In other words, samprajana is the observing or witnessing faculty that allows us to be aware of when our mind has wandered, and, in the present example, when our mind is focused on read- ing. The practice of mindfulness is the practice of engaging these three naturally occur- ring faculties while tempering them with a sentiment of compassion and nonjudgment. Thus, the practice of mindfulness generates an open, kindly state in which the mind retains focus on the object of attention (for example, the sensation of the breath flowing into one’s nostrils) while simultaneously reflecting awareness back on itself. As the state of mindfulness deepens over time, it begins to take on an expansive, self-reflective quality, not unlike what one experiences when one stands between two mirrors and observes them reflecting an image to infinity. The distinction between the observer and the observed fades, the usually sharp division between the self and the world begins to soften, and a sense of all-pervading presence expands into space. Or, as it is said, "Mind is like space; it has the nature of space; equal to space, it encompasses everything" (Namgyal, 2006, p. 192). Awareness remains, pure, clear, vast, and undefiled, like the reflection of the sky in a mountain lake, unstained by the passage of clouds which are merely reflected, insubstantial, and ever-changing images.

At this point, the clinically minded reader may wonder what these abstract mental faculties, obscure concepts, and foreign metaphors have to do with the treatment of addiction, stress, and pain. Much of chapter 2 is devoted to answering this question. However, in brief, addictive behavior - as well as stress and chronic pain, which often trigger addictive impulses - involves an element of mindlessness (that is, the diametric opposite of mindfulness). Mindlessness refers to automatic habits or compulsions that are executed without conscious, willful intent. To be mindless is to be oblivious, unaware, unconscious. In contrast with focused attention, remembrance of the need to be aware, and meta-awareness itself, the state of mindlessness is characterized by a diffuse, wandering mind - one that is forgetful of its needs and intentions and that acts without awareness. Thus, people struggling to recover from addiction often want to remain sober yet find themselves unconsciously compelled to use drugs or alcohol. Similarly, in spite of people’s clear intentions to remain calm in the face of stress and pain, they may find themselves automatically lashing out in anger or yielding to hopelessness, only to suffer from pangs of guilt and shame at their uncontrolled reactions.

In this sense, addiction and the maladaptive mental states associated with it tend to operate in a context of mindlessness. Despite a substantial body of empirical evidence suggesting that mindless and maladaptive cognitive-emotional processes under- gird alcohol and drug dependence, the most common forms of addictions treatment do not directly target these mechanisms. To fill this gap, Mindfulness-Oriented Recovery Enhancement (MORE) offers promise as an innovative tool in the armamentarium of clinical social work.

MORE is innovative in the sense that it combines mindfulness techniques with principles drawn from cognitive therapy and the positive psychology literature. MORE unites complementary aspects of mindfulness training, cognitive restructuring, and positive psychological principles into an integrative treatment strategy, targeting the mindless or automatic cognitive and emotional processes implicated in addiction, stress, and chronic pain. These three therapeutic bases of MORE are fundamental means of addressing the self-destructive mechanisms that lead to human suffering. As such, they may be referred to as the "foundations of MORE." Specifically, the foundations of MORE are mindfulness, reappraisal, and savoring. Although the concept of mindfulness has been introduced already, the other two foundations deserve brief introductions. Reappraisal is the process by which a person reinterprets or reframes the meaning of a stressful event or experience. Hence, a challenging experience or event that was once held to be distressing and terrible might be reappraised as a learning opportunity or a source of personal growth. MORE promotes reappraisal by combining mindfulness skills with cognitive restructuring techniques adapted from cognitive therapy. Savoring is the process by which a person intentionally focuses awareness on beautiful, affirming, and rewarding events in the present moment. MORE promotes savoring by using mindfulness techniques to attend to, cultivate, and enjoy positive emotions stemming from the pleasant elements of our lives. All three foundations of MORE are discussed and expounded on in the chapters that follow.

Although these approaches form the foundation of the intervention, MORE is grounded in a particular philosophy and ethos that is just as essential as the techniques and principles taught in each session. Social work (as well as clinical psychology and counseling) may be distinguished as a heart-centered profession in that our efforts are impelled by a deep, abiding sense of compassion and a desire to right the wrongs of the world. These sensibilities impel us to act as advocates, activists, healers, and - ultimately - conduits to the empowerment of vulnerable and marginalized people. Thus, MORE is a strengths-based intervention focused on the cultivation of personal empowerment as a means of promoting recovery. Recovery may be defined as "a process of change through which individuals improve their health and wellness, live a self- directed life, and strive to reach their full potential" (Substance Abuse and Mental Health Services Administration, 2011). MORE was designed to enhance the holistic recovery process for people striving to overcome addiction. In other words, rather than being solely focused on relapse prevention, MORE is centered on helping individuals to recover a meaningful life from the clutches of addiction, stress, and pain. MORE is philosophically grounded in this recovery-enhancement perspective and in the recognition of the inherent capacity of individuals to transcend and transform their limitations into opportunities for growth and well-being. This philosophical perspective permeates MORE and serves as living core of the intervention from which its many concepts and techniques radiate. Thus, from the perspective underlying MORE, a per- son struggling with addiction, stress, or chronic pain has, like all people, the fundamental capacity to overcome obstacles and achieve the kind of personal transformation he or she wishes to achieve. However, this radical change does not come about by magic - it comes as a result of hard work, focused effort, and repeated practice. Each time a person intentionally challenges negative mental states and behaviors and replaces them with positive ones, he or she gradually transforms him- or herself for the better. Ultimately, MORE is founded on this notion of transformation through training. MORE is, at its heart, a form of mind training aimed at increasing freedom and purpose in the face of the endless round of suffering and joy that is human existence.


About the Author
Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain
Eric Garland, PhD, LCSW, is the developer of Mindfulness-Oriented Recovery Enhancement (MORE), assistant director of the Trinity Institute for the Addictions, and assistant professor at the Florida State University College of Social Work. His research agenda is focused on translating findings from cognitive and affective neuroscience into interventions that effectively target transdiagnostic mechanisms under- pinning stress-related conditions. He has a broad background in clinical research, with specific training and expertise in the design of randomized controlled trials of mind- fulness-based interventions and biobehavioral measurement protocols. Garland has received funding from multiple sources (including the National Institutes of Health) to conduct randomized controlled trials of MORE as a treatment for alcohol dependence, prescription opioid misuse, and chronic pain. Complementing his expertise in clinical research, he is a licensed clinical social worker with over a decade of experience providing cognitive-behavioral, solution-focused, and mindfulness-based therapies for people suffering from addiction, psychological distress, and chronic pain conditions. Ultimately, his life’s work is grounded in the existential philosophy that people have the power to transcend and transform their limitations into opportunities for growth and well-being.

Additional information about Dr. Garland and MORE is available at http://www.drericgarland.com.
In this work, Dr. Garland lays out a novel and timely behavioral approach for the treatment of substance abuse disorders. This treatment Mindfulness-Oriented Recovery Enhancement (MORE), is grounded in ancient philosophy and the most up-to-date, empirically driven models of drug addiction that stem from the social and neurobiological sciences. Dr. Garland successfully tackles the task of synthesizing the principles of these diverse fields, provides empirical support for MORE’s effectiveness, and delivers a concise and clear message that will surely appeal to clinicians, researchers, students, and the general public. Anyone who holds an interest in the dilemma of drug addiction and its treatment will benefit from reading Mindfulness-Oriented Recovery Enhancement for Addiction, Stress and Pain.

Brett Froeliger, PhD

Research Scientist
Health Behavior Neuroscience Research Program
Duke University Medical Center

-----------------------------

Eric L. Garland’s exciting book, Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain is a ground-breaking new contribution to addiction treatment literature. Dr. Garland, a licensed clinical social worker with more than a decade of experience in delivering evidence-based interventions based on contemporary cognitive - affective neuroscience, offers a clearly articulated 10-session model for intervening with substance dependent clients. The treatment approach presented in Garland’s book is inexpensive, research based, broadly applicable to substance-dependent people of all types, and readily adopted by student and experienced practitioners. Although mindfulness interventions are rooted in ancient Buddhist traditions, psychophysiological and clinical assessments suggest that they are among the most efficacious treatments currently available for a range of modern-day maladies. I strongly encourage clinicians and therapists working with substance-dependent clients to read Mindfulness-Oriented Recovery Enhancement.

Matthew Owen Howard, PhD

Associate Dean for Faculty Development
University of North Carolina at Chapel Hill

-----------------------------

Mindfulness-Oriented Recovery Enhancement for Addiction, Stress and Pain is a wonderful addition to the growing array of treatment manuals that are clinically informed, research - based, and focused on helping individuals who abuse substances to achieve long-term sobriety and improvements in overall life functioning. This book is written by an experienced psychotherapist who has developed and empirically evaluated the MORE model during the past decade. Dr. Eric L. Garland skillfully integrates mainstream cognitive-behavioral therapies with the much older spiritual traditions of meditative mindfulness to create a comprehensive treatment manual describing a semi-structured, 10-session approach to helping substance abusers. A later section of this book contains an eight-session protocol for using the MORE approach with patients experiencing chronic pain. Like the treatment model for substance abusers, the chronic pain protocol is thoroughly based in solid research findings, including clinical outcome studies. The book concludes with an array of client handouts for data collection and providing information. I highly recommend this treatment manual for therapists looking to learn more about the empirically-grounded research findings pertaining to mindfulness meditation and how they can be effectively used to help clients.

Bruce A. Thyer, PhD, LCSW, BCBA-D

College of Social Work
Florida State University