How do addictions form, and how we can we use mindfulness to escape the “habit loop” that entraps us? These important questions are addressed by University of Massachusetts psychiatry professor and author Judson Brewer in his 2017 book, The Craving Mind: From Cigarettes to Smartphones to Love — Why We Get Hooked & How We Can Break Bad Habits.
Round and Round
As research director of the Center for Mindfulness at UMass Medical School, Dr. Brewer examines the neuroscience of addictive patterns of behavior. The first chapter of The Craving Mind, “Addiction, Straight Up” provides the following definition of the “all-consuming obsession”:
[A]ddiction is continued use, despite adverse consequences . . . the degree to which [a particular substance or a specific behavior] turned our lives and those of around us upside down helps determine the level of severity. In this way, we can view addictions along a spectrum calibrated as much on the degree to which our behaviors affect our lives as on the behaviors themselves.
Brewer described what he learned about addictive patterns as an outpatient psychiatrist at a VA Hospital in Connecticut. Some veterans got hooked on opioids due to chronic psychical pain. Others sought to suppress their emotional pain with alcohol and other drugs.
Brewer noticed a “common theme” in their stories of how the vets became addicted: a “reward-based learning process” he calls “the habit loop”: Trigger. Behavior. Reward. “Addiction rides an evolutionary juggernaut,” Brewer writes. “Every abused drug hijacks the [brain’s] dopamine reward system.”
For the veterans in Brewer’s care, the reward of self-medication frequently stemmed from “negative reinforcement,” defined as “making something unpleasant [e.g., emotional distress, “trauma related or otherwise,” or the “trigger”] go away.” Even more often, the reward was derived from the momentary relief provided by succumbing to cravings: “Scratching that damn itch.”
What is Mindfulness?
A study Brewer conducted examined the effectiveness of mindfulness practice upon smoking cessation. To define mindfulness Brewer quotes his UMass colleague Jon Kabat-Zinn: “The awareness that arises from paying attention, on purpose, in the present moment, and non-judgmentally.” The scientifically-based, secular mindfulness techniques established by Kabat-Zinn in the late 1970s known as Mindfulness-Based Stress Reduction (MBSR) have their roots in Buddhist meditation.
Subjects in Brewer’s study inhabited each moment of their nicotine craving fully. They embraced their thoughts and reactions and examined them (“How does that feel?”), rather than replacing these thoughts with another thought considered to be more constructive. This put the craving under a different microscope than the “gold standard” behavioral modification approach, Cognitive Behavior Therapy (CBT). Certainly mindfulness provided more awareness than the usual compulsive “itch-scratching” of submission to craving. Brewer’s study held that mindfulness was equally as effective as CBT.
Dr. Brewer has made the application of mindfulness to the cessation of craving his life’s work. In fact, earlier this year, Brewer’s Craving to Quit app won a global technology challenge seeking potential innovative methods to address the opioid crisis. You could say Dr. Brewer’s career has come full circle from his VA days, when he treated vets for opioid addiction.
A Wide Net
Even those of us who are already in recovery may yet be saddled with other addictive behaviors. In Part One, “The Dopamine Hit,” The Craving Mind devotes entire chapters to addictions to technology, ourselves, distraction, thinking, and love. It’s a wide net that Brewer casts, and most 21st Century humans are likely ensnared by it.