Mindfulness and Substance Abuse

  • Elisa Harumi Kozasa
  • Isabel Cristina Weiss de Souza
  • Víviam Vargas de Barros
  • Ana Regina Noto


Metacognition, or cognition about cognition, one of our highest brain functions, involves attention, conflict solving, error correction, inhibitory control, and emotional regulation being therefore fundamental in learning processes. These aspects of cognition are presumably mediated by frontal brain areas (Shimamura in Conscious Cognit 9(2 Pt 1):313–323, 2000). By contributing to the development of awareness of one’s own thoughts and actions, mindfulness practices (full awareness or attention) are related to the development of the ability of metacognition. According to Baer (Clin Psychol Sci Pract 10(2):125–143, 2003), mindfulness practices are those in which the subject becomes intentionally attentive to the internal and external experiences that are happening in the present moment, without judgment. There have been several researches in this area that suggest such practices lead subjects to a state of aware observation of their own perceptions, rather than being dragged by the turmoil of their emotions and thoughts.


Mindfulness Meditation Anxiety Craving Withdrawal 


  1. Analayo, V. (2006). Mindfulness in the Pali Nikayas. In D. K. Nauriyal, D. K. Drummond, & Y. B. Lal (Eds.), Buddhist thought and applied psychological research: Transcending the boundaries (pp. 229–249). London: Routledge.Google Scholar
  2. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143.Google Scholar
  3. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45.CrossRefPubMedGoogle Scholar
  4. Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facets mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342.CrossRefPubMedGoogle Scholar
  5. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215.CrossRefPubMedGoogle Scholar
  6. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology, 11(3), 230–241.Google Scholar
  7. Black, D. S. (2014). Mindfulness-based interventions: An antidote to suffering in the context of substance use, misuse, and addiction. Substance Use and Misuse, 49(5), 487.CrossRefPubMedGoogle Scholar
  8. Bowen, S., Chawla, N., Collins, S. E., Witkiewitz, K., Hsu, S., Grow, J., et al. (2009). Mindfulness-based relapse prevention for substance use disorders: A pilot efficacy trial. Substance Abuse, 30(4), 295–305.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Bowen, S., Chawla, N., & Marlatt, G. A. (2011). Mindfulness-based relapse prevention for addictive behaviors: A clinician’s guide. New York: The Guilford Press.Google Scholar
  10. Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., et al. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: A randomized clinical trial. JAMA Psychiatry, 71(5), 547–556.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Bowen, S., Witkiewitz, K., Dillworth, T. M., Chawla, N., Simpson, T. L., Ostafin, B. D., et al. (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of Addictive Behaviors, 20(3), 343–347.CrossRefPubMedGoogle Scholar
  12. Brefczynski-Lewis, J. A., Lutz, A., Schaefer, H. S., Levinson, D. B., & Davidson, R. (2007). Neural correlates of attentional expertise in long-term meditation practitioners. Proceedings of the National Academy of Sciences of the United States of America, 104(27), 11483–11488.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Breslin, F. C., Zack, M., & McMain, S. (2002). An information-processing analysis of mindfulness: Implications for relapse prevention in the treatment of substance abuse. Clinical Psychology: Science and Practice, 9(3), 275–299.Google Scholar
  14. Brewer, J. A., Elwafi, H. M., & Davis, J. H. (2013). Craving to quit: Psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychology of Addictive Behaviors, 27(2), 366–379.CrossRefPubMedGoogle Scholar
  15. Brewer, J. A., Sinha, R., Chen, J. A., Michalsen, R. N., Babuscio, T. A., Nich, C., et al. (2009). Mindfulness training and stress reactivity in substance abuse: Results from a randomized, controlled stage I pilot study. Substance Abuse., 30(4), 306–317.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: The role of mindfulness in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.CrossRefPubMedGoogle Scholar
  17. Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: Are they all the same? Journal of Clinical Psychology, 67(4), 404–424.CrossRefPubMedGoogle Scholar
  18. Chiesa, A., & Serretti, A. (2014). Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence. Substance Use and Misuse, 49(5), 492–512.CrossRefPubMedGoogle Scholar
  19. Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosom Medicine, 65(4), 564–570.CrossRefGoogle Scholar
  20. Davis, J. M., Mills, D. M., Stankevitz, K. A., Manley, A. R., Majeskie, M. R., & Smith, S. S. (2013). Pilot randomized trial on mindfulness training for smokers in young adult binge drinkers. BMC Complementary and Alternative Medicine, 13, 215.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Elwafi, H. M., Witkiewitz, K., Mallik, S., Thornhill, T. A, 4th, & Brewer, J. A. (2013). Mindfulness training for smoking cessation: Moderation of the relationship between craving and cigarette use. Drug and Alcohol Dependence, 130(1–3), 222–229.CrossRefPubMedGoogle Scholar
  22. Fiore, M., Jaén, C. R., Baker, T. B., Bailey, W. C., Bennett, G., Benowitz, N. L., et al. (2008). A clinical practice guideline for treating tobacco use and dependence: 2008. American Journal of Preventive Medicine, 35(2), 158–176.CrossRefGoogle Scholar
  23. Gross, C. R., Kreitzer, M. J., Reilly-Spong, M., Wall, M., Winbush, N. Y., Patterson, R., et al. (2011). Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: A randomized controlled clinical trial. Explore (NY), 7(2), 76–87.CrossRefGoogle Scholar
  24. Hajek, P., Stead, L. F., West, R., Jarvis, M., & Lancaster, T. (2009). Relapse prevention interventions for smoking cessation. The Cochrane Database of Systematic Reviews, 25(1), CD003999. Google Scholar
  25. Instituto Nacional de Câncer. (2004). Deixando de fumar sem mistérios. Rio de Janeiro: Ministério da Saúde.Google Scholar
  26. Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.Google Scholar
  27. Kenford, S. L., Fiore, M. C., Jorenby, D. E., Smith, S. S., Wetter, D., & Baker, T. B. (1994). Predicting smoking cessation: Who will quit with and without the nicotine path. Journal of the American Medical Association, 271(8), 589–594.CrossRefPubMedGoogle Scholar
  28. Kozasa, E. H., Sato, J. R., Lacerda, S. S., Barreiros, M. A., Radvany, J., Russell, T. A., et al. (2012). Meditation training increases brain efficiency in an attention task. Neuroimage, 59(1), 745–749.CrossRefPubMedGoogle Scholar
  29. Lazar, S. W., Kerr, C. E., Wasserman, R. H., Gray, J. R., Greve, D. N., Treadway, M. T., et al. (2005). Meditation experience is associated with increased cortical thickness. NeuroReport, 16(17), 1893–1897.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Leshner, A. I. (1999). Science is revolutionizing our view of addiction—and what to do about it. American Journal of Psychiatry, 156(1), 1–3.CrossRefPubMedGoogle Scholar
  31. Lustyk, M. K. B. (2012). Hemodynamic response to a laboratory challenge in substance abusers treated with mindfulness-based relapse prevention. Paper presented at the International Research Congress on Integrative Medicine and Health, Portland, OR.Google Scholar
  32. Lutz, A., Greischar, L. L., Rawlings, N. B., Ricard, M., & Davidson, R. J. (2004). Long-term meditators self-induce high-amplitude gamma synchrony during mental practice. Proceedings of the National Academy of Sciences of the United States of America, 101(46), 16369–16373.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Marlatt, G. A. (2002). Buddhist philosophy and the treatment of addictive behavior. Cognitive and Behavioral Practice, 9(1), 44–50.CrossRefGoogle Scholar
  34. Marlatt, G. A., & Donovan, D. M. (2009). Prevenção de Recaída: estratégias de manutenção no tratamento de comportamentos aditivos. Porto Alegre: Artmed.Google Scholar
  35. Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.Google Scholar
  36. Marlatt, G. A., & Marques, J. K. (1977). Meditation, self-control, and alcohol use. In R. B. Stuart (Ed.), Behavioral self-management: Strategies, techniques, and outcomes (pp. 117–153). New York: Brunner/Mazel.Google Scholar
  37. Marlatt, G. A., Pagano, R. R., Rose, R. M., & Marques, J. K. (1984). Effects of meditation and relaxation training upon alcohol use in male social drinkers. In D. H. Shapiro & R. N. Walsh (Eds.), Meditation: Classic and contemporary perspectives (pp. 105–120). New York: Aldine Press.Google Scholar
  38. Morone, N. E., Lynch, C. S., Greco, C. M., Tindle, H. A., & Weiner, D. K. (2008). “I felt like a new person.” The effects of mindfulness meditation on older adults with chronic pain: Qualitative narrative analysis of diary entries. The Journal of Pain, 9(9), 841–848.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Newberg, A. B., & Iversen, J. (2003). The neural basis of the complex mental task of meditation: Neurotransmitter and neurochemical considerations. Medical Hypotheses, 61(2), 282–291.CrossRefPubMedGoogle Scholar
  40. Niaura, R., Abrams, D. B., Shadel, W. G., Rohsenow, D. J., Monti, P. M., & Sirota, A. D. (1999). Cue exposure treatment for smoking relapse prevention: A controlled clinical trial. Addiction, 94(5), 685–695.CrossRefPubMedGoogle Scholar
  41. Penberthy, J. K., Konig, A., Gioia, C. J., Rodríguez, V. M., Starr, J. A., Meese, W. et al. (2013). Mindfulness-based relapse prevention: History, mechanisms of action, and effects. Mindfulness. Acesso em 00 de mês por extenso de 2014, em.
  42. Rapgay, L., & Bystrisky, A. (2009). Classical mindfulness: An introduction to its theory and practice for clinical application. Annals of the New York Academy of Sciences, 1172(1), 148–162.CrossRefPubMedGoogle Scholar
  43. Robinson, T. E., & Berridge, K. C. (1993). The neural basis of drug craving: An incentive-sensation theory of addiction. Brain Research Reviews, 18(3), 247–291.CrossRefPubMedGoogle Scholar
  44. Schroevers, M. J., & Brandsma, R. (2010). Is learning mindfulness associated with improved affect after mindfulness-based cognitive therapy? British Journal of Psychology, 101(Pt 1), 95–107.CrossRefPubMedGoogle Scholar
  45. Segal, Z. V., Bieling, P., Young, T., MacQueen, G., Cooke, R., Martin, L., et al. (2010). Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression. Archives of General Psychiatry, 67(12), 1256–1264.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Shimamura, A. P. (2000). Toward a cognitive neuroscience of metacognition. Consciousness and Cognition, 9(2 Pt 1), 313–323.CrossRefPubMedGoogle Scholar
  47. Spinella, M., Martino, S., & Ferri, C. (2013). Mindfulness and Addictive behaviors. Journal of Behavioral Health, 2(1), 1–7.CrossRefGoogle Scholar
  48. Stefano, G. D., Fricchione, G. L., & Esch, T. (2006). Relaxation: Molecular and physiological significance. Medical Science Monitor, 12(9), HY21–HY31.PubMedGoogle Scholar
  49. Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623.CrossRefPubMedGoogle Scholar
  50. Teasdale, J. D., Segal, Z., Williams, J., & Mark, G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33(1), 25–39.CrossRefPubMedGoogle Scholar
  51. Vidrine, J. I., Businelle, M. S., Cinciripini, P., Li, Y., Marcus, M. T., Waters, A. J., et al. (2009). Associations of mindfulness with nicotine dependence, withdrawal, and agency. Substance Abuse: Official publication of the Association for Medical Education and Research in Substance Abuse, 30(4), 318–327.CrossRefGoogle Scholar
  52. Wallace, R. K. (1970). Physiological effects of transcendental meditation. Science, 167(3926), 1751–1754.CrossRefPubMedGoogle Scholar
  53. Wallace, R. K., Silver, J., Mills, P. J., Dillbeck, M. C., & Wagoner, D. E. (1983). Systolic blood pressure and long-term practice of the transcendental meditation and TM-Sidhi program: Effects of TM on systolic blood pressure. Psychosomatic Medicine, 45(1), 41–46.CrossRefPubMedGoogle Scholar
  54. Weber, B., Jermann, F., Gex-Fabry, M., Nallet, A., Bondolfi, G., & Aubry, J. M. (2010). Mindfulness-based cognitive therapy for bipolar disorder: A feasibility trial. European Psychiatry, 25(6), 334–337.CrossRefPubMedGoogle Scholar
  55. Westbrook, C., Creswell, J. D., Tabibnia, G., Julson, E., Kober, H., & Tindle, H. A. (2013). Mindfull attention reduces neural and self-reported cue-induced craving in smokers. Social Cognitive and Affective Neuroscience, 8(1), 73–84.CrossRefPubMedGoogle Scholar
  56. Witkiewitz, K., & Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 78(3), 362–374.CrossRefPubMedPubMedCentralGoogle Scholar
  57. Witkiewitz, K., Bowen, S., Douglas, H., & Hsu, S. H. (2013a). Mindfulness-based relapse prevention for substance craving. Addict Addictive behaviors, 38(2), 1563–1571.CrossRefPubMedGoogle Scholar
  58. Witkiewitz, K., Bowen, S., & Lustyk, M. K. B. (2013b). Retraining the addicted brain: A review of the hypothesized neurobiological mechanisms of mindfulness-based relapse prevention. Psychology of Addictive Behaviors, 27(2), 351–365.CrossRefPubMedGoogle Scholar
  59. Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy: An International Quarterly, 19, 211–228.CrossRefGoogle Scholar
  60. Zamarra, J. W., Schneider, R. H., Besseghini, I., Robinson, D. K., & Salerno, J. W. (1996). Usefulness of the transcendental meditation program in the treatment of patients with coronary artery disease. The American Journal of Cardiology, 77(10), 867–870.CrossRefPubMedGoogle Scholar
  61. Zgierska, A., Rabago, D., Chawla, N., Kushner, K., Koehler, R., & Marlatt, A. (2009). Mindfulness meditation for substance use disorders: A systematic review. Substance Abuse, 30(4), 266–294.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Elisa Harumi Kozasa
    • 1
  • Isabel Cristina Weiss de Souza
    • 2
  • Víviam Vargas de Barros
    • 2
  • Ana Regina Noto
    • 2
  1. 1.NeurociênciasHospital Israelita Albert EinsteinSão PauloBrazil
  2. 2.Departamento de PsicobiologiaUniversidade Federal de São PauloSão PauloBrazil

Personalised recommendations