New Paper Published! “Mindfulness Is Inversely Associated with Alcohol Attentional Bias Among Recovering Alcohol Dependent Adults”

An article written by my colleagues Charlotte Boettiger, Susan Gaylord, Vicki West Chanon, and Matthew Howard and I was recently published in the journal Cognitive Therapy and Research. This article describes the relationship between the tendency to be mindful in everyday life and the alcohol attentional bias among people in recovery from alcoholism. As described in the post below, attentional bias is the phenomena in which a person’s attention may be automatically captured by or fixated on an emotionally-significant object or event. Among alcoholics, cues associated with drinking tend to have a strong emotional importance – the sight of a bottle of liquor, an old drinking buddy, or familiar bar can automatically grab their attention and trigger the urge or craving to drink. This alcohol attentional bias can be measured in the laboratory using a dot probe task very similar to the one pictured in the post below, by asking participants to press a button to indicate the location of a target that replaces either an alcohol-related or neutral photo.

In the study described in our paper, we tested 58 people in long-term treatment for alcoholism with a dot probe task to measure their alcohol attentional bias. We also gave them questionnaires assessing their former drinking behavior, their level of craving, and the extent to which they reported to be mindful. These people had never received formal mindfulness training, but instead had received standard substance abuse treatment services. We found that individuals who classified themselves as having higher mindfulness actually had less attentional bias towards alcohol cues than people who classified themselves as being less mindful, regardless of how much they drank in the past or how much they craved alcohol.

Why is this important? The trait of mindfulness, that is, the tendency to be mindful in everyday life, is thought to involve being less reactive to difficult thoughts and feelings, less judgmental of yourself and others, more in touch with your emotions, more observant of sensory experiences (like the feeling of the wind in your hair or the sun on your face), and being aware of when you are acting out of habit or on “auto-pilot.”  What makes the study findings so compelling is that the recovering alcoholics who thought they were more mindful (i.e., more aware of their habitual responses and less reactive to strong emotions) were the ones who were best able to shift their attention away from alcohol cues. In other words, they were better able to “disengage” their attention from addictive temptations and refocus on other things.

If people in recovery who are more mindful are less perturbed by addictive triggers, would explicit mindfulness training help them to overcome addiction? It’s not a wild stretch of the imagination to make this supposition. Indeed, my research on Mindfulness-Oriented Recovery Enhancement shows that mindfulness has great promise as a treatment for alcoholism and other forms of addiction. But more research is needed!

New Research Study Accepted for Publication! “Attentional bias for prescription opioid cues among opioid-dependent chronic pain patients”

I am excited to announce that a scientific article I wrote with my colleagues Brett Froeliger (Duke University), Steven Passik (Vanderbilt University), and Matthew Howard (University of North Carolina at Chapel Hill) was recently accepted for publication in the Journal of Behavioral Medicine. This article details the first evidence of an attentional bias toward prescription opioid cues ever documented in the scientific literature! We found that among a sample of people with chronic pain who were prescribed opioid painkillers, those individuals who met diagnostic criteria for opioid dependence paid significantly more attention to opioid-related images than opioid-users in chronic pain who were not dependent on opioids. To measure attention to opioids, we used a neurocognitive task that looked something like this:

Participants were shown two pictures (displayed either for 200 ms, or 2000 ms), side by side, on a computer screen, and were asked to “choose the side with the dot” by clicking a button on a keypad. The computer recorded their reaction times down to the millisecond. We found that, compared to non-dependent opioid users, opioid dependent people were significantly faster to choose the side with the dot when the dot replaced an opioid photo than when it replaced a neutral photo.  This reaction time difference indicated that their attention was captivated by opioids. Also, the more they reported craving their opioid medication, the more their attention was biased towards the opioid photos. This effect was evident for cues presented for 200 ms (that’s one-fifth of a second!), suggesting that this attentional bias occurred automatically, unconsciously, and before participants even had time to think about what they were doing.

So what does this research mean in terms of helping people with addiction and chronic pain? The study findings suggest that people who take opioids for chronic pain may develop an automatic tendency to be fixated on their medication, even when they don’t want to be. This tendency might make it difficult to stop thinking about opioids, causing craving, distraction, or other kinds of disruption in life. It might even lead to taking more medication than is necessary, although the current research study cannot answer that question.

If future studies replicate these findings, the opioid attentional bias may be an important treatment target for people struggling with prescription opioid misuse and addiction. Mindfulness-Oriented Recovery Enhancement (MORE) is designed to address attentional bias and may be particularly helpful in that regard. My preliminary research on MORE as a treatment for alcoholism found that MORE had a significant effect on attentional bias for alcohol cues. Research is currently underway to determine if MORE can have a similar effect on the opioid attentional bias.

Recovery from Addiction, Stress, and Pain through Mindfulness and Social Support

I am honored to have the opportunity to discover new ways of helping people heal and recover from the challenges in their lives. For the past several years, I have been busily engaged in developing a new therapy for people struggling with chronic pain and problems with prescription opioid painkillers through a study funded by the National Institute on Drug Abuse. I first developed this new therapeutic approach, which I call Mindfulness-Oriented Recovery Enhancement, for an earlier study I conducted on alcoholism that was funded by a Francisco Varela Award from Mind and Life Institute. Mindfulness is an expansive and fundamental concept that has been pursued for millennia as a means of ameliorating suffering – look for more posts here soon about it. I am studying how this new treatment compares to a conventional support group. Support groups are a widely-used form of psychological support for people dealing with health and mental health issues that can be extremely helpful.

My approach to helping people is focused on promoting the basic goodness and inherent capacity for growth that lies within each person. I have a lot to say on this topic, but my latest thoughts can be summed up with an image:

In a way, this upward spiral of mindfulness, meaning, and positive emotion may be viewed as the converse of the downward spirals of addiction, stress, and pain that have become a modern day epidemic.

Downward Spiral of Pain and Prescription Opioid Misuse, Abuse, Dependence, and Addiction