1. Mindfulness-Based Stress Reduction as a Treatment for Addiction Rachel Fintzy, M.A. David Geffen School of Medicine at UCLA, Semel Institute for Neuroscience and Human Behavior

2. What Do We Know About Methamphetamine Addicts? Active Users show impairments in:  Response inhibition  Mental flexibility  Problem solving  Abstract thinking

3. What Do We Know About Methamphetamine Addicts? Abusers in abstinence show impairments in:  Inhibitory control  Verbal learning  Decision making VIG

4. Hippocampal Atrophy is Associated with Impaired Vigilance London et al, 2005, Biol Psychiatry 58: 770-778 MEM

5. Hippocampal Atrophy in MA Abusers is Linked With Poorer Memory Performance (Thompson et al., 2004; J. Neurosci. 30: 6028-36) IMAG

6. Experiential Index is Lower in Subjects with Hippocampal Damage Hassabis et al, 2007, PNAS, on-line SPAT

7. Hippocampal Damage Impairs Imagination Hassabis et al, 2007, PNAS, on-line IFG

8. MA Abusers Exhibit Gray Matter Deficit in Inferior Frontal Gyrus (Thompson et al., 2004; J. Neurosci. 30: 6028-36) SST

9. MA Abusers Impaired on Stop-Signal Monterosso et al., 2005, Drug Alcohol Depend. 79: 273-77 MA Use

10. Inhibitory Deficits Related to MA Use Monterosso et al., 2005, Drug Alcohol Depend. 79: 273-77 RETENT

11. Cognitive Deficits Predict Retention in Cocaine Users Aharonovich et al., 2006, Drug Alcohol Depend. 81: 313-22 N=56, coc-dependent IMPULS

12. High Impulsivity Associated with Poor Retention in Cocaine Users Moeller et al., 2001, J. Substance Abuse Treatment 21: 193-198 SUM

13. Summary Active and newly abstinent MA abusers exhibit deficiencies in cognition, decision making, impulse control, and abstract thinking. These behavioral changes have been linked to brain abnormalities. Pharmacotherapies are being investigated, but non-pharmacotherapies may also work. What Is Being Done About This? WHY

14. Why Mindfulness Training For Addiction? Hippocampal atrophy: Connection between methamphetamine addicts in early abstinence, depression, and anxiety. Mindfulness training has demonstrated effectiveness in treating depressive and anxiety disorders. WHAT

15. What Is Mindfulness?  a receptive attention to and awareness of present events and experiences. (Brown & Ryan, 2003)  a way of being that combines increased alertness with an optimal state of physical, emotional, and mental equilibrium (Kabat-Zinn)  “going with the flow” or adaptation to the situation at hand with a minimum of excessive stress and/or volatility (Kabat-Zinn) NOT

16. Mindfulness is not…..  relaxation  sleeping  fantasizing Med. & DA

17. Dopamine Increased During Meditation Kjaer et al, 2002, Cognitive Brain Research 13:255-259 MA & DA 65% Attn to Speech

18. DA D2 Receptors Reduced in MA Abusers 1.51.5 22 2.52.5 33 3.53.544 Caudate (p < 0.0002) 1.51.5 22 2.52.5 33 3.53.544 Putamen (p < 0.02) Controls Meth [ 11 C] Raclopride Volkow et al. AJP 2001 CortThck

19. Meditators Have Thicker Cortical Regions Lazar et al, 2005, Neuroreport 16(17):1893-1897 Age & CT Frontal Cortex Insula

20. Meditators Maintain Cortical Thickness While Aging! Lazar et al, 2005, Neuroreport 16(17):1893-1897 Insula Frontal Ctx InsSm

21. Insular Damage Stops Smoking Bechara and colleagues 2007, Science 315, 531-4 VM

22. Meditation Decreases Substance Use Bowen, 2006, Psychology of Addictive Behaviors 20(3):343-347 MBCT

23. Ma, SH & Teasdale, JD, 2004, J Consulting & Clinical Psych 72(1):31-40 MBCTGr Mindfulness-Based Cognitive Therapy Improves Outcomes for Treatment-Resistant Depression

24. Ma, SH & Teasdale, JD, 2004, J Consulting & Clinical Psych 72(1):31-40 MBSR

25. Mindfulness-Based Stress Reduction Improves Outcomes for Anxiety Disorders Miller et al, 1995, General Hospital Psychiatry 17:192-200 ADHD

26. Self-report ADHD Symptoms Reduced After Mindfulness Training Zylowska et al 2006, Amer Acad Child Adolsc Psychiatry, Poster Presentation BPD

27. Dialectical Behavior Therapy Decreases Drug Use In Patients with BPD Linehan et al, 1999, American Journal on Addictions 8:279-292 CurrTrt

28. Substance Abuse and Affective Disorders: Current Mindfulness Treatments  Mindfulness-Based Stress Reduction  Dialectical Behavioral Therapy  Mindfulness Based Cognitive Therapy  Acceptance and Commitment Therapy  12-Step Programs  Cognitive Control Training/Attention Training StrEf

29. Affects of Chronic Stress on Body, Mind, and Behavior habituation to stress and subsequent down- regulation low cortisol levels associated with long- term chronic physiological and/or psychological stress subsequent need to “re-boot” system (SSRI’s = neurogenesis, reversal of hippocampal atrophy)

30. Summary of Mindfulness Training FutDir practice of nonjudgmental awareness of one’s thoughts, feelings, and environment increases endogenous dopamine release increases cortical thickness effective for depression, anxiety, ADHD, and apparently substance use

31. Future Directions 8-week mindfulness training weekly two-hour group sessions 15-30 minute/day home practice thrice weekly urine testing weekly cognitive assessments weekly BDI, SUI, VAS evaluate effect of mindfulness practice on abstinence, cognition, and mood retention in treatment

32. Acknowledgments Thomas Newton, M.D. Richard De La Garza, II, Ph.D. Lidia Zylowska, M.D. Gilles Fleury, M.D. J. David Creswell

33. Life is not the way it’s supposed to be. It’s the way it is. The way you cope with it is what makes the difference. Virginia Satir