Addiction almost always is the result of looking for all the right things in all the wrong places.
Addiction is a progressive, degenerative disease that has no cure, and is characterized by relapse. Statistics from the United States Substance Abuse and Mental Health Services (SAMHA) indicate that less than 2% of clients who received specialized addiction treatment in 2009, recovered for three months or more. A recovery rate of 2% or less suggests a deeper inquiry into the essence of the experience of addiction and relapse is needed in order to narrow this wide gap.
The focus of this phenomenological research design is on the fact that there is a need to develop understanding and awareness about individuals’ experiences in regards to addiction. In particular, this project aims to show that further research, collaborating the benefits associated with practicing mindfulness techniques with the emotional triggers often associated with relapse and addiction, is justified.
Almost everyone knows someone who has been affected by the disease of addiction. If the power of addiction could be neutralized, the social change implications would be staggering because addiction affects communities and individuals on untold levels. Mindfulness-based treatment models, which encourage the emergence of suppressed feelings, may affect the experience of addiction and relapse in individuals.
The disease of addiction is not sufficiently understood. Addiction treatment facilities, self-help groups, group and individual counseling, acupuncture, abstinence, and psychopharmacology are some of the current treatment models and options that are available to treat the disease of addiction. Nevertheless, the number of individuals with addiction related issues continue to rise.
The Substance Abuse and Mental Health Services (SAMHSA) is an agency under the U.S. Department of Health and Human Services and it is a Federal Government source for information concerning substance abuse. SAMHSA collects information so that quality and availability of informed treatments for individuals with addiction and mental health issues can be appropriately targeted. According to the Substance Abuse and Mental Health Services Administration, in the year 2009 an estimated 22.5 million persons aged 12 or older were classified with substance dependence or abuse in the United States.
I hope to further the understanding, meaning, and essence of the phenomenological experience of addictive patterns in the hope of improving patient outcomes. Mindfulness techniques are complimentary to the philosophy of modern mental health counseling theories and practices because the driving force of each paradigm is the belief that clients inherently know the answers to their life issues.
The problem that this research proposal identifies is exemplified by the fact that according to SAMHSA (2009), over 4.7 million people needed treatment for addictions. Yet, only 16.6 percent of these actually received treatment. Thus a gap exists, which suggests more research is needed. This gap is perhaps best represented by the fact that according to SAMHSA, an estimated 3.9 million people in the year 2000 or, 1.7 percent of the total population did not benefit from treatment. Due to the high numbers of people with addiction, including individuals struggling with relapse, this intention of this study is to demonstrate and justify there is a need for further development of effective treatments and models for the purpose of improving the individual’s experience of addiction and relapse.
Studies have identified that negative feelings such as stress, depression and grief often precede relapse (Pruett, Nishmura, & Priest (2007); Wada & Park (2008); Wong (2010). Concurrent research on the known value of mindfulness techniques was observed by Frame (2003) who earlier noted that developing mindfulness skills is beneficial for a variety of psychological issues such as stress, illness, anxiety and pain, which are emotional states also correlated with relapse. In the research it is generally agreed that the practice of mindfulness skills is efficacious in alleviating stress, which suggests that developing treatment modalities for mindfulness training as an adjunct to traditional addiction therapies may improve patient outcome.
Mindfulness training helps to improve one’s sense of wellbeing by increasing awareness and receptivity to the changing nature of life. Kong & Siew (2009) noted that the philosophy of Buddhism asserts change is natural and inevitable (p.123). Rothaupt & Morgen (2007) site dozens of studies that expose the numerous benefits and associated reductions in negative symptoms, which are specifically addressed in mindfulness training. Wada & Park (2009) observed life changing effects when mindfulness training is given as an adjunct to the current paradigms of counseling (p. 657). Segal, Williams, & Teasdale, 2002 (as cited in Wada & Park, 2009) draw attention to the fact that meditation and mindfulness practices are being integrated with positive outcomes into the treatment of a variety of mental health problems including mindfulness-based cognitive therapy for relapse prevention” (p.657). While stress and depression are correlated with relapse the way mindfulness can address these specifically in the field of addiction has yet to be formulated.
Although mindfulness practice appears simple, it represents a profound way of being through increasing personal awareness. This is due to the fact that the practice of mindfulness entails purposefully paying attention, being in the present moment, and simply observing without the use of judgment or attachment to outcome (Kabat-Zinn, et al., 2002).
Appel & Apple (2009) observed that despite increasing positive interest in the efficacy of mindfulness techniques in areas such as stress reduction, depression relapse, and other physical and mental conditions (p.507) more is required showing a direct link between behavioral changes such as in addiction recovery and practicing mindfulness techniques. Mindfulness training promotes a self-regulatory approach to wellbeing and health. In this regard it is consistent with the values and worldview of the counseling profession, which fully embraces the idea that the client possesses all the necessary insight and ability to eventually solve his or her issues. Yet, varying issues remain in the research.
Issues have been raised that involve how, and in what circumstances these techniques should be implemented (Proulx, 2003). Also, there is a lack of data showing effectiveness in the area of substance abuse and addiction (Appel & Appel, 2009). Carleson & Larkin (2009) suggest mindfulness meditation has both physical and emotional benefits including reducing blood pressure, improving mood and ability to process stress, feeling connected to one’s true nature, by increasing energy and feelings of well-being (p.389)
A need for building reliability could arise, because the phenomenological design involves small sample sizes, no random selection and there is an existence of doubt surrounding the accuracy of self-reporting. However personal change involves incorporating the meaning and structure of experience, and therefore the client’s experience of issues is reinforced by the phenomenological design.
Mindfulness training includes learning to separate s/he who is doing the perceiving from what it is that is being perceived and in doing so learns that thoughts are temporary. When the client learns that s/he is not the same as his or her thoughts, the associated stressors of painful attachments are also removed. This process has significance in the counseling profession because of its implications for stress reduction alone. Sue & Kong (2009) suggest that with the removal of the emotional attachments we characteristically place on our thoughts and feelings, what remains is the reality of the ebb and flow of the impermanent nature of thoughts and emotions.
Thus a simple act of observing one’s thoughts and feelings (without attachments) clears the way for deeper truths and potentially hidden self-limiting, and destructive beliefs to emerge.
The literature shows that with mindfulness techniques the client can learn to distance him or her self from the harmful beliefs and thoughts, which are partly responsible for driving the addiction. It seems there is a growing acceptance of the role of stress in addiction and relapse prevention. Vallejo & Amaro (2009) observed a strong relationship between stress and addictive behaviors (p.192-193). Researchers (Brewer, Catalano, Haggerty, Gainey, & Fleming, 1998; Dawes et al., 2000; Goeders, 2003; Kosten, et al., 1986; Kreek & Koob, 1998; Leiden University, 2007; National Institute on Drug Abuse, 2002; Sinha et al., 2000 (as cited in Pruett, et al., 2007) have indicated that the experience of stress is often associated with addictive behavior (p.193). Frame, 2003; Kabat-Zinn, 1990 (as cited in Pruett, Nishimura & Priest, 2007) have also observed that practicing mindfulness techniques has gained international recognition as an effective treatment for issues such as stress and blood-pressure reduction, anxiety and pain relief (p.72).
The mindfulness technique of meditation encourages clients to observe and allow all their thoughts as they appear in consciousness, and to simply mark them. Following this, the client releases them from consciousness awareness, while a new thought takes its place. This is process is repeated by more thoughts which are also observed and let go, and so on. Over time, practicing mindfulness encourages acceptance of the nature of one’s thoughts and being. The client soon deducts that if s/he is witnessing, then that means s/he cannot also be the observed emotion. Johanson (2006) noted: “When a person learns to become mindful of anger, sadness, jealousy, or joy rising, it is therapeutic in and of itself to know this is a part of me but it is not all of me” (p.21).
If addiction had a focus, it would be on unawareness. On the other hand, as pointed out by Pruett, J., Nishmura, N., & Priest, R. (2007) mindfulness techniques increase awareness, which is in essence, the opposite of addiction. The transition from addictive thinking to awareness naturally would require a significant change in thoughts and actions. Mindfulness exercises may help make the transition more meaningful. The mindfulness raising technique of meditation, for example, may be able to bridge the observer to its opposite, the behavior of denial and avoidance of the true nature of one’s perceptions.
The result of using pure observation without employing the use of judgment and/or reaction is the emergence of a fluid, unedited stream of thoughts and feelings. Neff (2004) observed how without trying to control, judge or interpret the experiences or outcome, mindfulness is intended to help an individual observe and accept the reality and true nature of his or her thoughts and feelings as they drift in and out of consciousness, (p.29).
As observed by Hunt (1971), the high incidence of relapse indicates that treatment methods as presently practiced make only a moderate impression on those who do manage to stop. He concludes that either the usual treatment period is too brief or the methods too inefficient to produce a lasting effect (p. 255). Hunt (1971) tracked the rate of relapse for individuals with three different addictions. He noted that treatment methods as presently practiced make only a moderate impression on those who do manage to stop. It is significant that since the three different addiction rates of relapse for the three different addictions displayed similar rates of occurrence, Hunt (1971) suggested that addiction research would benefit from researcher collaboration. Negative feelings such as stress and depression are commonly seen as triggers for addictive behavior and or relapse. Mindfulness training has been shown to alleviate these and other negative physical and emotional feelings. This suggests that mindfulness training might be efficacious in treating addiction.
The essence of phenomenological research, which entails the actual perception of an experience, is complimentary to the essence of mindfulness, in that through both methods the client is trained to become more aware of his or her thoughts and feelings. Rothaupt & Morgan (2007) observed that the mindfulness technique of meditation, for example, could help a client perceive his or her thoughts and feelings as they arise. This form of attention/awareness involves nonjudgmental observation, and eventual acceptance of the changing nature of thoughts and feelings. The very idea of imposing a method on phenomenological research would be inappropriate because an experienced phenomenon cannot be controlled without doing a great injustice to its authenticity and integrity.
Based on this view, and Creswell (1994) & Groenewald (2004) I choose the phenomenological model for my research design. This model is appropriate because it helps researchers identify meaningful patterns of behavior as the participants experience them. While the cause of relapse requires further understanding, several studies have identified that negative feelings such as stress, depression and grief often precede relapse (Pruett, J., Nishmura, N., & Priest, R. (2007); Wada, K. & Park, J. (2008); Wong, J. (2010).
Data collection will reflect typical phenomenological methods of observation, interviews and perhaps self-assessments. Observations enable researchers to record important details that become the basis for formulating descriptions from which stake holding groups produce their accounts. Although field notes are commonly used for observations, videotapes and photographs may also provide a powerful record of events and activities (Stringer, 2007). Of course, in order to gather the data, signed consent forms will be necessary in order to effectively implement the program. Observation can be cost-effective, however bias, prejudice, racial concerns, traditional values or standards, cultural differences, and stereotypical attitudes will have to be carefully considered in the evaluation of the observational data.
Unstructured and in-depth phenomenological interviews will be directed at obtaining experiences about relapse and the value of mindfulness techniques. Clients will be encouraged to speak in terms of real experiences with a focus on perceptions. Both researcher and client participate in the dialogue. According to Kruger (1988) the researcher seeks to understand the worldview of the client in order to reveal the less obvious, inherent meanings of the experience (p. 28).
The features and elements clarify the significant issues for stakeholders so that they can understand what is happening and the nature of the issue (Stringer, 2007). In-depth interpretations will provide and clarify new ways of considering and conceptualizing the issue. Therefore, the researcher’s task is to interpret and re-frame what has contributed to the development and perhaps pathology of the issue. It is the actual lived experience of the client, as described by the client that will help clinicians understand more profoundly because the phenomenology is rooted in the essence of experience.
In a phenomenological study, according to Hycner (1999) “the phenomenon dictates the method, not vice-versa, including even, the type of participants” (p.156). In this form of research it is essential that the researcher’s data be obtained as a result of his or her participation in the study.
The participants will include various stakeholders including the staff of caring professionals, social workers, team leaders, and administrators of the facility. Alternatively, a trained clinician could collaborate with program directors and counselors, who are also stakeholders and gatekeepers. The research takes place in a drug and alcohol treatment facility. There will be no needs assessment because the target group that I choose for this study is a population of patients who are voluntarily participating in an established residential drug and alcohol treatment facility. The key participants are the clients of the treatment center. Alternatively, a trained clinician could collaborate with program directors and counselors, who are also stakeholders and gatekeepers.
Permission will have to be acquired to enter the site. This could be in the form of a letter outlining the purpose, goals and consequences of the proposed study. In order to maintain ethical, research, Informed Consent agreement’ by participants will be signed. Additionally, at the start of each interview, Informed Consent will be reviewed. In accordance with Creswell (1998) long interviews and observation of the relatively small group of participants who will be at the facility center voluntarily is considered thorough for a phenomenological design (p. 65).
Recommendations & Social Change Implications
There is a need for understanding the essence and benefits of mindfulness-based skills in regards to addiction therapy. Mindfulness techniques have been developed in order to increase awareness and to become more deliberate. In contrast, addiction is driven by denial, with behaviors occurring outside of an individual’s awareness.
Mindfulness techniques encourage the individual to reconnect with his or her essential nature, and to foster a feeling of well-being and calm. Mindfulness techniques may influence the experience of addiction and recovery by leading the mindset of denial towards one of increased awareness with its intentional training Developing self-awareness (as opposed to that of addiction), is a process. It is not a once-only goal.
The social change implications are enormous and give pause for thought.The World Health Organization has defined health as the state of perfect physical, mental, and social well-being. Health is our natural state. Addiction and relapse have devastating effects on every level of life. As far as social change implications are concerned, the economic, health, education, justice system and policy implications alone are huge. A healthy system operates functionally on all levels and therefore affects all levels of life socially and personally. If each and every individual of a society enjoyed the creation and experience of good health society and life itself, as we know it would change.
A challenge incorporating mindfulness techniques into traditional drug and alcohol rehabilitation programs is that it is relatively unknown and not all patients will want to explore the mindfulness techniques for a variety of reasons. These techniques do not provide a quick fix. The client may not understand that this involves not just a behavioral change, but it is also a cognitive change. The effect evolves the person’s understanding evolves. It is possible to want to change, but also want everything else to stay the same. Mindfulness training skills are necessary in order to avoid merely having knee-jerk reactions to life’s events.
Awareness involves growth and will affect the entire person in both indirect and direct ways. Lack of awareness can cause clients to have misconceptions and fears about the implications of mindfulness. Clients seeking relief from addiction may not realize how the addictive mindset biases thoughts and beliefs by sabotaging the intended change. Without raising personal awareness the addictive behavior is naturally inclined to avoid, not face the issues.
As a solution to this challenge effort in the form of client education about the benefits of mindfulness training is needed in order to dispel cultural bias and untrue views about the practice prior to introducing the actual techniques (O’Connell, 2009). The advantage to educating clients is that without education, many will be unsure and hesitate due to mistrust of change. Researchers have discovered that adaptations of various mindfulness skills need to be individually catered to the participant’s diversities and sensitivities in order to successfully implement this paradigm.
American Psychiatric Association. (2000). DSM-IV-TR. Arlington, VA: Author.
Appel, D., & Appel, J. (2009). Mindfulness: Implications for substance abuse and addiction. International Journal of Mental Health Addiction (7), pp.506-512.
Creswell, J. W. (2009). Research design: Qualitative, quantitative and mixed methods approaches. Thousand Oaks, CA: Sage Publications, Inc.
Dali, Lama & Cutler, H.C. (1998). The Art of Happiness: A Handbook for Living. New York: Riverhead Books.
Groenewald, T. (2004). A phenomenological research design illustrated.
International Journal of Qualitative Methods, 3(1). Article 4. Retrieved from http://www.ualberta.ca/~iiqm/backissues/3_1/pdf/groenewald.pdf
Hanson, W. B., Creswell, J. W., Piano Clark, Y. L., Petska, K. S., & Creswell, D. (2005). Mixed Methods Research Designs in Counseling Psychology. Journal of Counseling Psychology, 52(2), 224-235.
Holloway, I. (1997). Basic concepts for qualitative research. Oxford: Blackwell Science.
Hunt, W., Walker, B., Branch, G. (1971). Relapse rates in addiction programs. Journal of Clinical Psychology, (27) 4, pp. 455-456.
Hycner, R. H. (1999). Some guidelines for the phenomenological analysis of interview data. In A. Bryman & R. .G. Burgess (Eds.), Qualitative research (Vol. 3, pp. 143-164). London: Sage.
Johanson, G. (2006). A survey of the use of mindfulness in psychotherapy. Annals of the American Psychotherapy Association, Vol. 9(2), pp.15-24.
Kabat-Zinn, Jon. 1994. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life , New York: Hyperion.
Khong, B. (2009). Editor’s introduction to special issue on mindfulness in psychology. The Humanist Psychologist, (37), pp.109–116. Taylor and Francis Group.
Krech, P. (2006). Development of a state of mindfulness scale. Thesis: Arizona State University.
Kruger, D. (1988). An introduction to phenomenological psychology (2nd ed.). Cape Town, South Africa: Juta.
Langer, E. (1989). Mindfulness. Reading, MA: Addison Wesley.
Lasker, R. D., & Weiss, E. S. (2003). Creating partnership synergy: The critical role of community stakeholders. Journal of Health & Human Services Administration, 26(1), 119–139.
Lau, M., & McMain, S. (2005). Integrating mindfulness meditation with cognitive and behavioral therapies: The challenge of combining acceptance and change-based strategies. Canadian Journal of Psychiatry (50),13, pp. 863-870.
Laureate Education, Inc. ; Executive Producer(2008). Prevention, Intervention, and Consultation. Baltimore: Author.
Mental Health: A Report of the Surgeon General, Overview of Prevention
McIntosh, W. D. (1997). East meets west: Parallels between Zen Buddhism and social psychology. The International Journal for the Psychology of Religion, 7(1), pp. 37-52. Lawrence Erlbaum Associates, Inc.
Neff, K. (2004). Self –compassion and psychological well-being. Constructivism in Human Sciences, 9(2), 27-37.
O’Connell, O. (2009). Introducing mindfulness as an adjunct treatment in an established residential drug and alcohol facility. The Humanist Psychologist, (37), pp. 178-191. Taylor and Francis Group.
Ogden, Jane, (2008). How consistent are beliefs about the causes and solutions to illness? Psychology, Health & Medicine, 13(5), pp. 505-515. United Kingdom: Taylor & Francis.
Onwuegbuzie, A. J., & Teddlie, C. (2003). A framework for analyzing data in mixed methods research. In Tashakkori & Teddlie (Eds.), Handbook of mixed methods in social and behavioral research (pp. 351–383). Thousand Oaks, CA: Sage.
Patton, M. Q. (2002). Table 3.6. In Qualitative Research and Evaluation Methods pp. 132–33). Thousand Oaks, CA: Sage Publications, Inc. Reprinted by Permission of Sage Publications, Inc.
Pruett, J., Nishimura, N., & Priest, R., (2007). The role of meditation in addiction recovery. Counseling and Values (52), pp. 71-84. APA.
Rothaupt, J. (2007). Counselors and counselor educator’s practice of mindfulness a qualitative inquiry. Counseling and Values. APA
Siegel, Daniel J. (2009). The Humanistic Psychologist, (37), pp. 137–158. Taylor and Francis Group.
Stevens, P., & Smith, R. L. (2009). Substance abuse counseling: Theory and practice (4th ed.). Upper Saddle River, NJ: Pearson Education, Inc.
Stringer, E. T. (2007). Action Research (3rd ed.). Thousand Oaks, CA: Sage Publications, Inc.
Substance Abuse and Mental Health Services Administration (SAMHSA) (2009).
The NHSDA is an annual survey of the civilian, non-institutionalized population of the United States who are 12 years old or older. The U.S. population considers it a primary source of statistical information on the use of illegal drugs. Conducted by the Federal Government since 1971, the survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence. The Substance Abuse and Mental Health Services Administration (SAMHSA) sponsor the survey, and RTI of Research Triangle Park, North Carolina carries out data collection. The project is planned and managed by SAMHSA’s Office of Applied Studies (OAS). This chapter contains a summary of the survey methodology.
Wilber, K. (2000). Integral Psychology: Consciousness, Spirit, Psychology, Therapy. Boston, USA: Shambala Press.