https://www.asam.org/resources/publications/asam-weekly/asam-weekly-editorial-comment
Editor-in-Chief: William Haning, MD, DFAPA, DFASAM
Topic – Meditation and derivatives
A link is featured this week to a Journal of Addiction Medicine piece by Sean Grant and co-authors, reviewing the efficacy of mindfulness-based relapse prevention (MBRP) for substance use disorders, through a review of nine randomized controlled trials with 901 participants. The conclusions were not convincing.
Variations on mindfulness meditation (MM) have been employed in several settings. A brief review of recent studies includes one on smoking cessation effect by Margaret Maglione and colleagues (2017), in which MM “…did not have significant effects on abstinence or cigarettes per day…” [http://www.sciencedirect.com/science/article/pii/S030646031730031X]. In 2013, Lauce et al. performed a systematic review and meta-analysis centering on a mindfulness approach to fibromyalgia; they concluded “…only a weak recommendation can be made” for Mindfulness-Based Stress Reduction (MBSR). While pain, nicotine use, and general substance use disorders may be said to represent different therapeutic targets, a common denominator in these reviews and others have been the lack of truly robust findings and the paucity of well-structured placebo-controlled clinical trials.
I am inclined to want mindfulness meditation to prove useful, in fact anyform of meditation. If there is a trait that is remarkable in its deficiency among those with substance use disorders, it is surely serenity. But just as I may have found meditation useful for myself, and have heard others in my field advocating it with vigor, that is not the same thing as saying that we have a solid platform on which to predicate a general application of this approach. One counter-argument to this view is – exempting those with active psychosis – “It can’t hurt!” Yet it can, just not in the usual sense of a direct impact on the patient’s well-being. Addiction medicine, more than most any other specialty with the possible exception of those that are chronic and involve lethality, such as cancer, is subject to hucksterism and snake-oil salesmanship. The desperation of families has caused some addiction physicians to put wishful thinking ahead of scientific rigor, at a time when we strive to earn public trust. But rather than raising an obstacle, it would seem like the interim approach should consist in obtaining consent through information, advising the patients that if they choose to engage in meditation, the evidence for its benefit has not quite reached the threshold of scientific proof; but it is well-rooted in other principles of recovery: rest, self-soothing, and for many, spirituality. All that is necessary is to be honest with the patient. And then it truly can’t hurt.
Editor-in-Chief: William Haning, MD, DFAPA, DFASAM
Comment;
Addiction is a lethal disease that kills people. Acudetox is a form of acupuncture using 5 points in each external ear (auricle) that is said to rebalance the flow of chi of life-force energy in the brain. It’s been shown to DOUBLE the rate of long-term sobriety/recovery from addiction.
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