Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research

Eric L Garland, Matthew O Howard, Eric L Garland, Matthew O Howard

Abstract

Contemporary advances in addiction neuroscience have paralleled increasing interest in the ancient mental training practice of mindfulness meditation as a potential therapy for addiction. In the past decade, mindfulness-based interventions (MBIs) have been studied as a treatment for an array addictive behaviors, including drinking, smoking, opioid misuse, and use of illicit substances like cocaine and heroin. This article reviews current research evaluating MBIs as a treatment for addiction, with a focus on findings pertaining to clinical outcomes and biobehavioral mechanisms. Studies indicate that MBIs reduce substance misuse and craving by modulating cognitive, affective, and psychophysiological processes integral to self-regulation and reward processing. This integrative review provides the basis for manifold recommendations regarding the next wave of research needed to firmly establish the efficacy of MBIs and elucidate the mechanistic pathways by which these therapies ameliorate addiction. Issues pertaining to MBI treatment optimization and sequencing, dissemination and implementation, dose-response relationships, and research rigor and reproducibility are discussed.

Keywords: Addiction; Automaticity; Dissemination; Dose–response; Mindfulness; Review; Reward; SMART.

Figures

Fig. 1
Fig. 1
Hypothesized neural mechanisms by which mindfulness-based interventions ameliorate addictive behavior. Garland et al. [20] model of mindfulness-centered regulation posits that mindfulness-based interventions ameliorate the craving, negative affective states, and automatic habit behaviors underpinning addiction by enhancing functional connectivity (1) within a “top-down” brain network subserving metacognitive attentional (dlPFC, dACC, parietal cortex) and (2) between this metacognitive attentional control network and “bottom-up” brain structures implicated in automaticity, memory consolidation, interoception, and hedonic regulation. Enhanced functional connectivity within and between these neural circuits may allow individuals to self-regulate addictive impulses and restructure reward processes to support healthy, goal-oriented behavior. dlPFC dorsolateral prefrontal cortex, dACC dorsal anterior cingulate cortex, PCC posterior cingulate cortex, DS dorsal striatum, VS ventral striatum, Thal thalamus, HIPP hippocampus, Amy amygdala, OFC orbitofrontal cortex, MFC medial prefrontal cortex
Fig. 2
Fig. 2
Schema detailing the effects of mindfulness-based intervention components on mechanisms and outcomes implicated in the treatment of addictive behavior

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