Running head: MINDFULNESS, AND SUBSTANCE-RELATED ADDICTION

MINDFULNESS, SUBSTANCE-RELATED ADDICTION, AND THE
IMPLICATIONS FOR SOCIAL WORK
by
William M. Tomlinson
Bachelor of Social Work, University of Victoria 2011

MAJOR PAPER SUBMITTED
IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF

MASTER OF SOCIAL WORK
in the
School of Social Work and Human Services

© William M. Tomlinson 2020
UNIVERSITY OF THE FRASER VALLEY
Spring 2020

All rights reserved. This work may not be
reproduced in whole or in part, by photocopy
or other means, without permission of the author.

MINDFULNESS AND SUBSTANCE-RELATED ADDICTION
Approval
Name: William M. Tomlinson
Degree: Master of Social Work
Title: Mindfulness, Substance Related Addiction, and the Implications for Social Work
Examining Committee:
Lisa Moy, BA, BSW, MSW, PhD, RSW
Primary Supervisor
Associate Professor, School of Social Work and Human Services
Leah Douglas, BSW, MSW, PhD, RCSW
Second Reader
Associate Professor, School of Social Work and Human Services

Date Approved:

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MINDFULNESS AND SUBSTANCE-RELATED ADDICTION
Table of Contents
Table of Contents ......................................................................................................................... iii
Abstract .......................................................................................................................................... v
List of Acronyms .......................................................................................................................... vi
Acknowledgments ....................................................................................................................... vii
Introduction ................................................................................................................................... 1
Research Questions ......................................................................................................... 1
Working Definition of Mindfulness and Substance-Related Addictions ....................... 2
Critical Reflexivity .......................................................................................................... 4
Methodology .................................................................................................................................. 5
Theoretical Perspectives .................................................................................................. 5
Research Methods ........................................................................................................... 9
Literature Review ....................................................................................................................... 10
Theme 1: What Is Mindfulness? ................................................................................... 10
The Effects of Mindfulness Practices to Reduce Substance-Related Addictions ......... 12
Theme 2: Impact of Mindfulness on Alcohol Addiction .............................................. 19
Theme 3: Impact of Mindfulness on Smoking population ............................................ 21
Theme 4: Impact of Mindfulness on Addiction to Illicit Drugs .................................... 25
Individuals With Opioid Addiction Issues ................................................................. 25
Male Methamphetamine Substance Users ................................................................. 26
Thematic Findings From The Literature Review - Common Findings ................................. 28
Gaps in the Literature ............................................................................................................... 33
Literature Review Implications for Social Work Practice ...................................................... 35
Benefits of Mindfulness and Social Work .................................................................... 35
Barriers to Mindfulness and Social Work .................................................................... 36

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MINDFULNESS AND SUBSTANCE-RELATED ADDICTION
Practice Implications for Mindfulness and Social Work .............................................. 39
Conclusion ................................................................................................................................... 44
References .................................................................................................................................... 45

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MINDFULNESS AND SUBSTANCE RELATED ADDICTION
Abstract
This research paper is a thematic analysis of various studies on mindfulness-based
intervention (MBI) strategies, and the effectiveness of MBIs in assisting individuals in reducing
or ending their substance use issues. The paper begins with a general examination of the
evidence-based findings concerning the effectiveness of MBIs, including an analysis of how
MBIs are theorized to work in helping with addiction. Following this, the paper examines
research that looks at various substance-using populations and the effectiveness of MBIs. Critical
theory is integrated into this paper in terms of how mindfulness could be utilized as a
consciousness-raising modality which offers the potential to connect individual issues with larger
socio-structural concerns. The findings highlight mindfulness as an effective modality for those
dealing with substance-related addiction issues.

MINDFULNESS AND SUBSTANCE-RELATED ADDICTION
List of Acronyms
ADHD - Attention-Deficit Hyperactivity Disorder
CBT - Cognitive-Behavioural Therapy
DMN - Default Mode Network
EMA - Ecological Momentary Assessment
MAAS - Mindful Attention Awareness Scale
MBAT - Mindfulness-Based Addiction Treatment
MBCT - Mindfulness-Based Cognitive Therapy
MBGT - Mindfulness-Based Group Therapy
MBI - Mindfulness-Based Intervention
MBRP - Mindfulness-Based Relapse Prevention
MBSR - Mindfulness Based Stress Reduction
MBT - Mindfulness-Based Therapy
MORE - Mindfulness-Oriented Recovery Enhancement
MTS - Mindfulness Training for Smokers
RP - Relapse Prevention
RR - Reward Responsiveness
SUD - Substance Use Disorder
TAU - Treatment As Usual
UC - Usual Care

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Acknowledgments
I would like to thank my most loving, intelligent and beautiful wife Fara, my dad Ron
(who passed away recently and is greatly missed), and my mom Miriam for their tremendous
support for me throughout this program. I would also like to express my appreciation to all the
University faculty who provided feedback and supervision, especially Dr. Lisa Moy, and Dr.
Leah Douglas as my primary and secondary readers.

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Introduction
This research paper will focus on mindfulness-based intervention (MBI) strategies for
individuals who are dealing with substance-related addictions. In addition, I will define and
explore approaches to mindfulness, review the historical background of mindfulness, as well as
review and summarize the various therapeutic applications of this practice in relation to
substance-related addictions. Another area that will be investigated is how mindfulness practices
could potentially be harnessed to connect individual oppressions and concerns with larger sociostructural issues. Finally, I will review the benefits and barriers of mindfulness in the context of
social work practice.
Research Questions
There are important reasons for studying mindfulness in relation to those who live with
substance-related addictions. I think the primary reason this topic should be researched is simply
because those who are addicted to substances deserve love, respect, dignity, and freedom from
suffering. In other words, I am motivated by the BC Association of Social Workers’ Code of
Ethics which states that “A social worker shall respect the intrinsic worth of the persons she or
he serves in her or his professional relationships with them” (BC Association of Social Workers,
2011).
I have four overarching research questions which underpin this paper. First, how does
mindfulness work? In answering this question, I will examine findings related to the unique
aspects of mindfulness which can assist individuals in reducing or quitting their substancerelated addictions. Second, in what ways is mindfulness useful as a strategy in reducing or
ending substance-related addictions for those within various substance using populations? Third,
what are the broader practice implications of mindfulness for the field of social work? In

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answering this question, I will analyze how mindfulness could be used as a therapeutic tool for
substance use treatment. Additionally, I will also examine the potential that mindfulness offers
as a consciousness raising modality which could allow people to connect their individual
concerns with the larger socio-structural environment. Finally, my fourth research question asks
what the potential benefits are of mindfulness treatment, as well as some of the barriers that
individuals might encounter in accessing and/or receiving treatment.
Working Definition of Mindfulness and Substance-Related Addictions
I will employ the following working definitions of mindfulness and substance-related
addiction. Researchers Goldberg, Davis, and Hoyt (2013) write that mindfulness is a practice
which can be defined as focusing or paying attention, in certain ways, to the present moment in a
non-judgmental manner. This practice has been demonstrated to improve one’s abilities in
moment-to-moment awareness, non-reactivity to detrimental emotions, sensations and thoughts,
as well as increased levels of acceptance (Goldberg et al., 2013). Another definition by authors
Hick and Furlotte (2009)—a definition of mindfulness often used in the field of social work—
consists of two parts:
(a) self-regulation of attention so that it is maintained on immediate experience, thereby
allowing for increased recognition of mental events in the present moment, and (b)
adopting a particular orientation toward one’s experiences in the present
moment…characterized by curiosity, openness, and acceptance. (p. 8)
According to authors Brewer, Elwafi and Davis (2014), mindfulness training, in theory,
offers the advantage of providing individuals with a simple concept that involves an individual
paying attention to momentary experiences rather than resisting these same experiences.
Mindfulness training is a practice which can be applied broadly to various links within the

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addictive loop. Over time, effective mindfulness training may cause a dampening as well as an
eventual dismantling of an individual’s associative learning process regarding one’s use of
substances (Brewer, Elwafi & Davis, 2014); this differs from merely removing the stimuli. For
instance, Brewer and colleagues (2014) argue that through the attentional focus offered by
mindfulness training, individuals can improve their awareness of habit-linked bodily sensations
and affective states of which they were minimally conscious (ex. low-level craving). In so
doing, mindfulness training causes a “de-automating” process that is largely habitual in nature
(p. 78).
Brewer, Elwafi and Davis (2014) further write that teaching people mindfulness allows
individuals to simply observe their aversive physical and mental states instead of reacting to
them. Evidentiary findings have suggested that mindfulness training may provide one with the
ability to replace affect and stress induced habitual reactions with responses that are more
adaptive. In addition, mindfulness training may also assist people in being able to change their
relationships towards mentally or physically unpleasant states.
There are a variety of practical ways in which mindfulness exercises can be carried out.
According to Vidrine et al. (2016), the two most prominent mindfulness-based treatments are
mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).
According to these authors, MBSR was initially used to treat stress as well as pain-related
disorders, whereas MBCT was developed for the treatment of reoccurring and chronic depressive
disorders. The principal means utilized by each of these approaches to teach mindfulness is
meditation (Vidrine et al., 2016).
In considering a definition of substance-related addictions, authors Zou et al. (2017) write
that it can be defined as a neuropsychiatric disorder which can be characterized by causing a

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recurring desire within an individual to continue taking a substance(s) despite suffering harmful
consequences. In adding to this definition I would like to state that I take a bio-psycho-social
perspective on substance-related addiction. In terms of the causes of substance-related
addictions numerous research studies have demonstrated that one’s social environment, mental
health state and in some cases one’s genetic predisposition are factors that have bearing upon one
becoming addicted to substances.
Critical Reflexivity
I have been interested in the topic of mindfulness for several years. When I first learned
about mindfulness, it struck me not only as an interesting concept but also as something that
could be used in a variety of ways to not only improve the mental health of individuals but also
assist people in reducing or quitting their substance usage. Furthermore, I have worked as a
mental health worker with many individuals who frequently have both mental health and
substance-related addictions. My observations and experiences have led me to believe that there
is a lack of research in this area.
I believe that the largest potential bias and blind spot in carrying out this research is my
personal socio-economic position. I mention this because many of the individuals with whom I
have worked come from less socio-economically stable and often abusive backgrounds. Due to
this, these individuals have faced great stressors in their lives, which may often be a factor
causing and maintaining their substance usage. In addition, living in a stressful and abusive
environment also often plays a part in stimulating the onset of mental illness for many of these
individuals. In contrast, I have had a higher socio-economic status and greater socio-economic
stability than most people with whom I have worked, and have not faced addictions or practised
the mindfulness techniques discussed in this paper.

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As a result, the questions I have chosen for this literature review are guided both by gaps
in the literature and my own desire to increase my understanding of subjects that could benefit
my practice. In other words, since I have not had the same lived experience as most of my
clients, I must rely on the evidence-based findings of the most rigorous and recent research in
this area.
Methodology
Theoretical Perspectives
Although it may not be immediately evident, mindfulness shares a number of
congruencies with critical theory. According to Bohman (2019), critical theory has both a
narrow and a broad meaning within philosophy and social science history. In the narrow sense,
critical theory refers to the perspective of several generations of German social theorists and
philosophers who arose out of a Western-European Marxist intellectual tradition which came to
be known as the Frankfurt School (Bohman, 2019). According to this school of thought, a
“critical” theory can be distinguished from “traditional” theory in that its purpose is specific and
practical in its aim and must seek to emancipate humans from slavery in some manner (Bohman,
2019, Critical Theory section). Thus, the overarching goal of critical theory is to function as a
liberating influence which aims to create a world which can satisfy both the needs and powers of
human beings (Bohman, 2019).
Bohman (2019) continues by saying that since such theories intend to explain and
transform all the circumstances which enslave people, many critical theories that exist within a
broader theoretical milieu have been developed. These theories have arisen in conjunction with a
variety of social movements which identify multiple dimensions of domination over individuals
in modern societies (Bohman, 2019). However, in terms of both its broad and narrow senses,

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critical theory offers a basic framework for social inquiry which is descriptive and normative as
well as having the aim of increasing all forms of freedom by decreasing domination (Bohman,
2019).
Moreover, critical theorists argue that their theoretical perspective not only has a practical
emphasis but also a distinctively moral (rather than instrumental) focus (Bohman, 2019). Thus,
in order to accomplish such a task, it is essential that there be an interplay between social science
and philosophy that utilizes interdisciplinary empirical social research (Bohman, 2019). In
another article, Wellmer (2014) summarizes what distinguishes critical and traditional social
theory in the following sentences:
What distinguishes a critical theory from traditional forms of social theory is that critical
theory conceives of itself as part and parcel of a struggle for an “association of liberated human
beings, in which everybody would have an equal chance of self-development”. The theory
asserts that the “real possibility” of such an association exists, given the current level of human
productive forces, and it asserts, at the same time, the practical necessity of a struggle for the
realization of this possibility. (p. 706)
Hick and Furlotte (2009) write that mindfulness itself does not posit any social theory.
However, that being said, these authors demonstrate how critical theory can be closely connected
with many of the aspects of mindfulness practice. To these researchers, mindfulness is a process
through which an individual can uncover how oppression can be perpetuated without the
individual being consciously aware of it. In other words, mindfulness is a technique that allows
one to perform an internal examination of their perceptions, thoughts, emotions, and
consciousness which in turn endows a greater ability to recognize harmful systems and

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institutions in the external world. Mindfulness can lead to insight about existing oppressive
relationships and, through this work, society can be transformed (Hick & Furlotte, 2009).
Hick and Furlotte (2009) go on to suggest that mindfulness practice offers one a
technique to experience “felt” oppression within the reality of the present moment (p. 19). Even
though mindfulness does not promote any sort of constructed view of the future in terms of
social organization, it is not antithetical to arrangements which produce more peaceful and
egalitarian relations (Hick & Furlotte, 2009). Thus, one potential intention or benefit of
mindfulness practice is that it enables individuals to see how everyone is unconsciously
participating in the perpetuation of existing social relations (Hick & Furlotte, 2009).
Hick and Furlotte (2009) suggest that, in time, a theory may develop out of a mindfulness
practice itself. However, they write that it would be a theory grounded in concrete conditions and
experiential learning rather than a theory based upon relations between various pre-existing
concepts. Building upon experiential learning, this knowledge would be gained through an
individual examination of feelings, thoughts, and body in connection with the socio-economic
and political realms of one’s everyday grounded experience of life (Hick & Furlotte, 2009).
Another similarity between critical theory and mindfulness highlighted by Hick and
Furlotte (2009) is that neither philosophy is metaphysical in orientation. Rather, they write that
each practice focusses on examining, understanding, and change making. In other words, both
mindfulness and critical theory are practices that are focused on assisting people in changing
themselves as well as the larger world around them (Hick & Furlotte, 2009).
Rowe (2016) refers to post-Nietzschean political theorists William Connolly and Michel
Foucault. Rowe (2016) posits that, according to these authors, power relations exist everywhere,
including within our embodied habits and thought processes. Thus, in order to achieve a

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liberation that is deep and sustained, social movements which tackle the intimate and embodied
way power shapes and sculpts individuals are required, thereby making mind/body practices
politically crucial in their significance. In and of themselves, mind/body practices will not power
any political revolutions on their own. However, if they are connected with actual
revolutionaries, what they can offer is an expansion in the realm of possibilities for freedom
(Rowe, 2016).
In a similar vein to Rowe, Hick et al. (2009) argue that many of the foundational tenets of
social justice approaches connected with social work have their roots within the critical theory
conception concerning human nature. An example of this would be classic critical approaches
aimed at addressing the socio-economic forces which fuel oppression and are crucial to radically
oriented social justice frameworks within the field of social work (Hick et al., 2009). Likewise,
Hick et al. (2009) argue that mindfulness challenges the concept that any social institution within
capitalist society or otherwise is not only natural but also the only way of being. This feature of
mindfulness provides a congruent link between itself and critical theory. In essence, a social
work theory, which incorporates a social justice approach that is rooted in critical theory,
suggests that differential or inequitable access to wealth is the source of social problems (Hick et
al., 2009). Hick et al. (2009) go onto write that mindfulness is also critical of societal practices
such as materialism, over-consumption, and the equating of such ideas with happiness. Instead,
mindfulness suggests that peace or happiness cannot be provided by wealth or even a lack of
poverty. For mindfulness approaches, inner and external levels of ease and peace are necessary
for social justice (Hick et al., 2009).

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Research Methods
The primary research method used here is a thematic review of the literature in relation to
the research questions and themes analyzed. In searching for appropriate research materials, the
resources for this research paper were obtained through the University of the Fraser Valley’s
(UFV) list of various library databases in order to find relevant and appropriate qualitative and
quantitative research studies. In total, I reviewed fifty-seven articles and selected thirty-three of
these articles to include as sources in this research paper. I searched terms such as: addiction and
mindfulness, social work and mindfulness, mindfulness and social justice approaches,
mindfulness treatment barriers and other search terms that I found to be beneficial in answering
my research questions. In searching through these articles, I selected ones which contained
relevant information on the effectiveness of mindfulness and substance-related addictions.
Additionally, I also selected articles that discussed how mindfulness could be more effectively
utilized in social work in a manner that would allow individuals to make connections between
their personal lives and the surrounding socio-structural environment. I also accessed other
available online resources which met the accepted academic standards of UFV’s Master of
Social Work program. This was necessary in my search for additional information on critical
theory and for constructing a definition of substance-related addictions. In selecting journals,
research studies, books and any other sources, I only used academic peer-reviewed sources since
I consider these sources to be trustworthy because of the peer review oversight process and
rigorous research methods employed. I only used sources from the last seven years except for
when I was able to justify the use of an older source. I did include three older sources in the
research paper. In a paper by Hick and Furlotte (2009), the authors discussed critical theory
which is still currently used in the field of social work as well as other social science disciplines.

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Another source by Dakwar, Mariani, and Levin (2011) was used because the researchers
analyzed the effects of mindfulness upon mono-drug and poly-drug using individuals. Finally, I
included an article by Garland, Schwarz, Kelly, Whitt, and Howard (2012) because the this
study argued that mindfulness was helpful for individuals who had experienced significantly
stressful events in their lives.
Literature Review
Theme 1: What Is Mindfulness?
According to authors Shonin and Gordon (2016), mindfulness is a Buddhist meditation
technique that is approximately 2600 years old. Although there are a variety of contemplative
techniques which are practiced by many of the world’s spiritual and religious traditions, the one
utilized in mental health settings is primarily grounded in the Buddhist tradition (Shonin and
Gordon, 2016).
In examining some of the history and concepts of Buddhist mindfulness, Lee (2018)
writes that the term mindfulness is derived from a Pali (a language of the Indian subcontinent)
term “sati,” which translates as “memory” or “recollection”. According to core Buddhist
teachings, known as the Noble Eightfold Path, mindfulness is a key aspect of “awakening” which
is viewed as being a specific mental state or mode of recollection that allows those in such a state
or mode to know and observe the truth behind the nature of causes, conditions, and effects (Lee,
2018, p. 220). Put another way, Lee (2018) writes that Buddhist mindfulness is meant to sharpen
one’s observation skills in relation to all mental processes, one’s ability to discern between
skillful and unskillful mental qualities, and one’s memory elicitation quality to vividly recollect
details concerning any experience. Lee states that the overall goal of Buddhist mindfulness is to
refine and train one’s mind in order to build a foundation to practice Buddhist teachings. Thus,

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Buddhist mindfulness is meant to be used as a tool to aid practitioners in their cultivation of
these teachings rather than as a goal in and of itself (Lee, 2018).
According to Lee (2018), Buddhist mindfulness is viewed as a crucial practice which
liberates a practitioner from dukkha (suffering). Lee goes on to write that the ability to liberate
oneself from suffering is the primary aspect of Buddhist teachings. As a result, all major
concepts in Buddhism connect with the understanding and ceasing of dukkha. In achieving this
new level of understanding, consciousness is reshaped into a nongrasping view of worldly
phenomena. This transformation allows for a state of experience through which all suffering as
well as the origins of that suffering are extinguished (Lee, 2018).
Yi (2017) posits that the utilization of mindfulness as a clinical intervention can be traced
historically and culturally to Jon Kabat-Zinn, who became inspired to develop MBSR. While at
a retreat, Kabat-Zinn experienced an inspirational moment which lasted approximately fifteen
seconds. This moment provided Kabat-Zinn with the insight as to how he could bring the
Buddha Dharma into the larger world. This Dharmic aspect of Buddhism was a central feature of
Kabat-Zinn’s inspiration, describing it as “lawfulness in a similar vein to ‘the law of physics’ or
as ‘the way things are’ as is the case in the Chinese concept of Tao” (Yi, 2017, p. 212). He
emphasises that Dharma offers a coherent description of the nature of the human mind, emotion,
and suffering as well as its potential release based upon highly refined practices aimed at
cultivating various aspects of the heart and mind through a process of mindful attention (Yi,
2017). With this in mind, Kabat-Zinn formulated a way to incorporate mindfulness that would
not dilute, distort, or profane the practice, whilst simultaneously not locking on to a tradition and
culture-bound framework which would make the practice totally impenetrable to the individuals
who may find it to be extremely useful and liberative (Yi, 2017).

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Given that mindfulness is meant to assist one in developing their overall mental skills I
believe that this technique could be utilized by social workers in a variety of ways. Since the
purpose of Buddhist mindfulness is meant to allow one to observe the truth behind the nature of
causes, conditions, and effects one can see how it could be a useful skill for those dealing with
substance-related addictions. Many individuals who have substance-related addictions often lack
insight into how these addictions are detrimentally affecting them from a bio-psycho-social
perspective. Like in Buddhism, those dealing with substance-related addictions usually need to
arrive at a moment of “awakening”. For individuals with substance-related addictions this
“awakening” is akin to insight. Gaining insight is a major step in the journey of one either
reducing or quitting their use of substances. Mindfulness appears to be a promising modality
which could be utilized by social workers to assist individuals in gaining such insight.
The Effects of Mindfulness Practices to Reduce Substance-Related Addictions
Mindfulness practice has been shown to help individuals quit or reduce their substance
usage. For example, Brewer, Elwafi, and Davis (2014) write that humans suffer greatly from
substance-related addictions as well as other addictions, and that despite tremendous effort by the
bio-medical research community to understand the processes and mechanisms of addiction,
strategies for treatment have remained at suboptimal levels over the last number of decades
(Brewer et al., 2014). Brewer and colleagues go on to write that mindfulness training which, as
previously discussed, is founded in ancient Buddhist concepts of human suffering, has
demonstrated preliminary success in the treatment of addictions. Mindfulness-based
interventions MBIs could potentially provide more information about craving as well as the
underlying neurobiological processes that might be active within an individual (Brewer et al.,
2014).

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As another example, in more recent years, mindfulness has been employed as a way of
targeting individual’s cravings with the intention of causing clinically relevant changes to the
behaviour of those utilizing mindfulness techniques (Tapper, 2018). Tapper reviewed thirty
experimental studies on the effects of different modalities of mindfulness practice on cravings
for cigarettes, alcohol, and food. Cravings are frequently viewed as an appropriate target
intervention for MBIs with the aim of reducing cravings or instead changing one’s craving
response. However, Tapper writes that researchers are currently limited in their understanding of
how these various applications of mindfulness may influence the final craving-related outcomes.
As such, researchers lack a complete understanding of how mindfulness practices could
influence cravings. Thus, for effective mindfulness-based addiction treatments to be created, a
sound theoretical basis needs to be developed (Tapper, 2018). Tapper (2018) explains that a key
question about the advantage of mindfulness-based strategies over other strategies is that they
could be sustained over a longer timeframe. For example, the technique of focusing on the
present moment while experiencing cravings could be more flexibly and easily applied within a
wide variety of different settings when compared with a more traditional visualization strategy
that might seem more effortful and become rather repetitive. Another question that Tapper
(2018) asks is whether the amount of experience with meditation moderates the effects of
mindfulness strategies. The majority of studies testing the immediate effects of techniques
related to present moment awareness and craving were carried out in a context that did not
require intensive training in meditation (Tapper, 2018). Thus, more longitudinal research, as well
as research that examines user viewpoints regarding different strategies, would be helpful in
addressing these questions. Researchers Szeto, Schoenmakers, van de Mheen, Snelleman, and
Waters (2019) argue that an improved understanding of relapse through the use of mindfulness

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exercise could assist in the development of new interventions. This study used an ecological
momentary assessment model (EMA). In contrast, the majority of mindfulness studies have
examined the relationship between substance use and MBIs via laboratory assessments.
However, an EMA model takes an approach that allows for analysis from both within and
between-subject associations with the natural environment. For instance, the EMA model has
been used to determine subjects’ associations to emotional outcomes and mindfulness (Szeto et
al., 2019).
Garland, Roberts-Lewis, Kelley, Tronnier, and Hanley (2014) examine the increasingly
large body of research that positions mindfulness as a trait-like construct which may have
relevance to substance use disorder (SUD) treatment. Garland and colleagues (2014) examined
mindfulness as a naturally occurring trait. They found it to be roughly normally distributed and
characterized by an individual’s propensity to demonstrate a present-oriented awareness. This
present-oriented awareness was nonjudgmental and is the culmination of one’s perceptions,
emotions, cognitions and habitual behavioural reactions of one’s daily life.
Sala, Rochefort, Lui, and Baldwin (2019) separate trait mindfulness from state
mindfulness. They write that trait mindfulness reflects individual differences within one’s
general level of mindfulness when viewed across situations and time. In comparison, state
mindfulness describes to what extent an individual is experiencing mindfulness at any particular
moment (Sala et al., in press). For example, Sala et al. (in press) use the following distinction to
highlight the difference between these two states of mindfulness:
Individuals in a mindful state would be actively attending to the present moment rather
than being preoccupied, distracted, or acting without awareness to their actions or internal
experiences. State and trait mindfulness are related but distinct constructs; they have been shown

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to be positively correlated with each other, but also predict other outcomes above and beyond
each other. Garland et al. (2014) purport that individuals vary in the extent to which they exhibit
mindful dispositions. However, one’s dispositionality towards exhibiting mindfulness behaviour
may be strengthened by participating in mindfulness training as well as other kinds of
interventions. By practicing mindfulness, individuals have been shown to significantly increase
their overall level of trait mindfulness which has in turn led to high increases in the level of this
mode of mindfulness (Garland et al., 2014). The research by Garland and colleagues (2014)
demonstrated a positive correlation amongst optimism, attentiveness, emotional intelligence,
mental health, awareness of internal states, well being, and a negative correlation with anger,
anxiety, self-consciousness, depression, and impulsivity. Thus, indices relating to not only one’s
general mental health but also their psychosocial flourishing can be linked to trait mindfulness
(Garland et al., 2014).
Garland and colleagues (2014) used a moderately large sample of individuals who were
substance users, and who have also been living in residential treatment facilities. The researchers
identified a significant inverse association between substance craving and trait mindfulness
which was partly statistically mediated by reappraisal and negative affect, but not by a readiness
for change. Given that the data from this study is cross-sectional, it cannot be used to identify
causal relationships conclusively between the examined variables. The findings of this study
supported the notion that individuals who were in recovery due to SUDs and who also reported
increased levels of trait mindfulness may be less susceptible to addictive urges. This was seen as
a result of their enhanced ability to downregulate distressing emotions and their heightened
capacity for the reappraisal of the meaning of life’s challenges (Garland et al., 2014).

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Researchers Dakwar and colleagues (2011) analyze what they term mindfulness deficits.
They define mindfulness deficits as being a characteristic of individuals who are tested according
to requirements of the mindful attention awareness scale (MAAS) testing process and found to
have particular mindfulness-related attentional impairments. What these findings suggest is that
mindfulness-related attentional impairments might be common within individuals seeking SUD
treatment. Furthermore, these impairments may vary depending upon the variety and types of
substances used, thereby, making this a suitable focus of care within substance use treatment
(Dakwar et al., 2011).
Dakwar and colleagues (2011) believe that attentional difficulties could have a role in
causing or maintaining SUDs. This possibility has received a great deal of attention in the area of
attention-deficit hyperactivity disorder (ADHD) research, as there is a high comorbidity between
ADHD and SUDs (Dawkar et al., 2011). This connection has been attributed to ADHD-related
heightened impulsivity, recklessness, impaired self-regulation, increased delay discounting,
sensation seeking, as well as self-medication attempts (Dawkar et al., 2011). Implicated in
conjunction with many of these deficits is impaired attention, which mindfulness could help
with. These mindful attention impairments could lead to increases in vulnerability in relation to
SUDs in a similar way to ADHD, even though such impairments may be too mild or subtle to be
diagnostic of the disorder (Dawkar et al., 2011).
Dakwar and colleagues (2011) emphasize that moment-to-moment attention as a
protective factor in relapse prevention (RP) is well-recognized in the field of substance use
treatment. This form of therapy emphasizes the development of one’s awareness of triggers and
cues so that these factors are more easily navigated. Thereby encouraging individuals to remain
cognizant of the consequences of their intentions and decisions even though such intentions and

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decisions may initially seem irrelevant to substance use (Dakwar et al., 2011). Although this
study occurs prior to the seven-year cut off mark for selected research articles that I tried to
adhere to in this literature review, it is significant in that it compares the effects of MBIs between
mono-drug and poly-drug using individuals, and suggests mindfulness deficits amongst
populations of substance users.
Garland (2016) discusses a new mindfulness intervention for addiction issues called
mindfulness-oriented recovery enhancement (MORE), which has empirical support. Not only is
MORE innovative, it is distinct from extant MBIs because it combines traditional mindfulness
meditation through strategies of reappraisal and savoring to reverse the downward salient shift of
natural rewards in relation to substance use rewards. Creating such a shift in an individual
represents a crucial tipping point in disrupting the pattern of substance use (Garland, 2016).
Garland (2016) argues that these unique strategies combine mindfulness, reappraisal and
savoring techniques to restructure the reward processes. If neural reward circuits offer a basic
logic for the selection of goals sustained, training selective attention to strengthen natural
rewards rather than substance use rewards may provide the necessary learning signal to reverse
one’s substance-related addiction (Garland, 2016).
Garland (2016) writes that MORE may represent a sizeable advance in terms of applying
clinical interventions within the arena of contemplative science. While there are numerous
currently existing MBIs which utilize mindfulness to disrupt maladaptive associative learning
patterns, they nonetheless eschew an explicit focus upon promoting evaluative processing but do
not intentionally or directly engage individuals in the restructuring of learned responses. In
comparison, the aim of MORE is to restructure drug cue reactivity through the enhancement of
an individual’s natural reward responsiveness (RR) (Garland, 2016).

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A significant finding of this study by Garland et al. (2012) was that those individuals who
participated in the MORE intervention process experienced a substantial positive impact on their
lives. The participants in this study had experienced many years of trauma, homelessness,
poverty, violence, low levels of education, a lack of political capital, and more. The results of
this study are especially interesting as the researchers state that the majority of prior studies on
mindfulness have focussed their attention upon people who are living in less stressful, more
stable situations (Garland et al., 2012). Not only does the MORE modality appear to hold much
promise as a therapeutic intervention, but the findings of this study demonstrated that it was
helpful for individuals who had experienced significant stressors in their lives.
According to the findings of these studies it seems clear that MBIs are effective at
assisting individuals in helping them to reduce or quit their substance usage. I believe that social
workers who are dealing with individuals with substance-related addictions are well suited
through their education and work experience to assist individuals by learning and utilizing
mindfulness modalities like MORE to assist those with substance-related addictions in
restructuring their natural RR, as a way to direct them away from substance use. In doing this,
social workers could utilize various individualized and group exercises to assist people through
the process of restructuring their natural RR. Due to the flexibility of MBIs there are a variety of
ways in which they could be applied. Social workers could teach MBI techniques to those whom
they are assisting so that individuals could utilize them when not attending a session with their
social worker or group activity. Additionally, MBIs could be incorporated into counselling
sessions that one might have with their social worker when discussing their substance-related
addiction issues. Such sessions could also be used as an opportunity to review, refine and
analyze the MBI modality itself.

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In the next few sections, I will review in detail through the literature review the effect of
MBIs on individuals with addictions to alcohol, smoking, and illicit substances. In having
examined the general effectiveness of mindfulness practice and substance-related addictions, I
will more specifically analyze a literature on the effectiveness of mindfulness practices
concerning specific substance using populations to determine its efficacy for each population. I
reviewed the findings regarding the different MBIs such as mindfulness-based relapse prevention
(MBRP), MORE, mindfulness-based group therapy (MBGT), mindfulness-based addiction
treatment (MBAT), and, via a literature review, compared these modalities with one another in
relation to techniques such as cognitive-behavioral therapy (CBT) and treatment as usual (TAU).
While it is not the intention of this literature review to describe these models in detail, it is
important to broadly note that the models are similar in that they all utilize mindfulness-based
techniques to help with a variety of substance-related addiction issues. Moreover, they also
differ in their goals and objectives in terms of the specific area(s) for which one needs assistance.
I reviewed how these techniques were practiced with different substance using populations and
explain my findings below.
Theme 2: Impact of Mindfulness on Alcohol Addiction
The study by Szeto and colleagues (2019) focussed on alcohol dependent patients from
Holland who carried personal digital assistants, otherwise known as a handheld computer, on
them for a period of four weeks while participants tried to abstain from using alcohol. The
participants completed random assessments three times a day and when they experienced a
strong urge towards having a drink or were on the brink of drinking but did not succumb to this
urge. At each assessment point, categories such as stress level, craving, negative affect, recent
drinking, as well as attentional or approach bias were assessed. At baseline, the researchers used

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MAAS to assess the participant’s mindfulness. The results revealed that the more mindful
individuals (who reported higher MAAS scores) also reported lower cravings than the less
mindful individuals (Szeto et al., 2019). Furthermore, the study showed no evidence that
negative affect, stress, approach or attentional bias mediated any association between craving
and MAAS (Szeto et al., 2019). However, this study did offer evidence of an indirect path
between MAAS and drinking which demonstrated that a higher level of mindfulness related to
lower craving levels; this in turn, produced a lower level of drinking (Szeto et al., 2019).
A paper by Garland, Schwarz, Kelly, Whitt, and Howard (2012) discusses how MBIs can
reduce addictive behaviours while also increasing one’s ability to have nonreactivity to stressors.
This study utilized a qualitative methodology to increase understanding of the effects of
mindfulness-related treatments. The participants in this study were eighteen adults with alcohol
addiction issues who had all utilized MORE as an intervention strategy. Researchers conducted
interviews to elicit participant narratives as well as open ended questions, which were then
analyzed through a grounded theory lens as well as a constant comparison methodology.
Narrative accounts indicated to the researchers that MORE was able to enhance one’s selfawareness while also helping clients to cope with addictive impulses and emotional stressors
more effectively (Garland et al., 2012). It was determined that MORE not only appears to be an
acceptable therapeutic intervention strategy according to participants but also functions well in a
residential treatment environment (Garland et al., 2012).
There were several limitations in this study by Garland and colleagues (2012). First, the
researchers needed to more carefully distinguish between the MORE related effects of treatment
and those therapies which are more generally associated with community treatment. Also, the
researchers needed to more systematically assess therapist factors as well as nonspecific

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treatment variables so that the variables associated explicitly with mindfulness can be more
easily differentiated from common factors (Garland et al., 2012).
Theme 3: Impact of Mindfulness on Smoking populations
Another research article which utilized the EMA methodology focused on individuals
who were dealing with smoking addiction. Spears and colleagues (2019) used an EMA model to
investigate the mechanisms of mindfulness on smoking cessation, building on findings that those
with greater mindfulness (non-judgmental and present-focused) are more likely to quit smoking.
In total, three hundred and fifty-five smokers received the smoking cessation treatment.
Participant’s states of mindfulness were assessed at baseline and then again on their quit date.
For four days prior to quitting and one week after quitting the study, participants completed up to
four EMAs each day revealing negative affect levels, positive affect levels, smoking urges, as
well as affect regulation expectancies (Spears et al., 2019).
Individuals who demonstrated a higher level of mindfulness in the study also appeared to
have emotional profiles (psycho-emotional characteristics) which were beneficial to them when
in the earlier stages of quitting smoking (Spears et al., 2019). As a result, these individuals were
also more likely to achieve early cessation milestones (Spears et al., 2019). The researchers
found that one’s key emotional processes may be targeted by mindfulness, thereby weakening
patterns of negative reinforcement which are hypothesized to underlie addictions. These findings
have implications in terms of understanding MBIs and the fostering of emotional profiles that
offer greater levels of adaptability when in the pre-quit period. The pre-quit period was a four
day period in which a participant’s baseline level of mindfulness was assessed and four EMA
assessments per day were carried out. During this pre-quit period, having a lower stress level
due to mindfulness practice could be a primary mechanism in enhancing the smoking cessation

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process. Within this first week of quitting, stress level may be lowered by the stimulation of
certain emotional states such as decreased levels of sadness, boredom, anger in conjunction with
greater levels of relaxation and happiness as a result of mindfulness (Spears et al., 2019).
De Souza et al. (2015) conducted a systematic literature review aimed at analyzing the
effectiveness of mindfulness-based practices on people trying to quit smoking. The majority of
the articles were connected to randomized controlled feasibility trials or pilot studies, which had
a low bias risk in relation to attrition, random sequence generation, and reporting. De Souza et al.
(2015) concluded that mindfulness seems to affect one’s mental health in a positive manner,
which in turn may contribute towards one’s ability to refrain from the use of tobacco.
Witkiewitz, Bowen et al. (2014) offer a review of mindfulness-based addiction treatment
models as well as a number of hypothesized causes of change. Witkiewitz, Bowen et al. (2014)
hypothesize that training in mindfulness may have a direct impact in preventing the occurrence
of high-risk situations as well as a reduction in phasic risk. Mindfulness may also aid individuals
in substance use prevention by increasing one’s awareness of automatic non-mindful responses
and judgemental thinking. Additionally, mindfulness has also been shown to increase one’s
levels of self-compassion, kindness, and relapse resistance. According to neurobiological
perspectives regarding mindfulness meditation and addiction, there are several plausible
mechanisms through which MBIs could affect an individual’s cravings and substance use
(Witkiewitz, Bowen et al., 2014).
In attempting to integrate both mindfulness practices as well as perspectives into a
treatment that is both deliverable and replicable for those dealing with addictive behaviours,
Witkiewitz, Bowen et al. (2014) refer to a study that was structured as an eight-week manualized
outpatient aftercare program. This program incorporated CBT skills such as the recognition of

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common relapse antecedents, effective coping skills, and self-efficacy. Mindfulness-based
practices were employed to reduce the likelihood of relapse by increasing participant’s
awareness and flexible responding when faced with substance use triggers. To date, Witkiewitz,
Bowen et al. (2014) discovered that MBRP was effective in treating those with substance use
issues in relation to the TAU control group within the outpatient treatment environment.
Furthermore, MBRP’s efficacy was also demonstrated when compared with a program for RP at
a residential women’s treatment centre, as well as an intervention for a smoking cessation
program called Freedom from Smoking (Witkiewitz, Bowen et al., 2014).
Spears et al. (2017) analyzed the cognitive and affective mechanisms that underlie
MBAT in comparison to CBT and the usual care (UC) treatment for smoking cessation. Spears et
al. (2017) go onto write that even though mindfulness-based treatments demonstrate promise
regarding smoking cessation, there is a limited amount of data on mindfulness’s differential
effects in relation to the specific hypothesized mechanisms of other active treatments. Also, the
parent trial uncovered that treatment type did not have any impact when it came to overall
abstinence rates. However it was discovered that MBAT greatly increased lapse recovery levels
in relation to UC and CBT (Spears et al., 2017). As hypothesized, individuals receiving MBAT
perceived themselves as having more volitional control over their smoking along with lower
levels of anger volatility than did the participants utilizing the other treatments offered (Spears et
al., 2017).
Davis et al. (2014) reviewed the differences between a mindfulness-based treatment
program for smokers called mindfulness training for smokers (MTS) and the usual type of
therapy, which consisted of nicotine patches and the tobacco quit line. The participants of this
study were randomized into either the telephone support service or to MTS. Treatment indicators

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showed that there were significant differences between the two groups: the success rate was
20.6% for the telephone support group, and for the MTS group, it was 38.7% (Davis et al.,
2014).
Researchers Goldberg et al. (2013) set up a randomized controlled trial that examined the
lack of consensus around how MBIs affect change. One of the plausible explanations which
remains underexplored is the therapeutic connection that clients have between themselves and
their mindfulness instructors. This study suggested that when measured at the mid-treatment
point, the therapeutic alliance between the client and the instructor did not have much bearing on
predicting primary smoking outcomes (Goldberg et al., 2013). Improvement was predicted in
this alliance on several variable outcome scores in the posttreatment phase. However, the
alliance did predict an improvement in the posttreatment scores in relation to several outcome
variables connected to mindfulness practice (Goldberg et al., 2013). The areas which showed
improvements due to this alliance were treatment compliance, negative affect, mindfulness, and
emotional regulation (Goldberg et al., 2013). These findings hold significance for social work
since the quality of the therapeutic connection between social work practitioners of mindfulness,
and their clients can affect these particular areas.
Even though the study by Goldberg et al. (2013) uses a sample size that is relatively
small, the data nonetheless suggests various tentative conclusions. First, there are important prepost changes that were observed via several measures, which indicate that MTS was effective as
an intervention in the development of emotional regulation and mindfulness (Goldberg et al.,
2013). This is significant because MTS incorporates mindfulness training in conjunction with
smoking cessation intervention. These findings support self-reported improvements connected

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with other MBIs not aimed at smokers, thereby supporting the generalizability of these findings
(Goldberg et al., 2013).
Theme 4: Impact of Mindfulness on Addiction to Illicit Drugs
Individuals With Opioid Addiction Issues
Garland, Froeliger, and Howard (2014) examined how MORE affected RR on opioid
cue-reactivity in connection with a sample of patients who had been experiencing chronic pain as
well as opioid use problems. The findings of this study indicate that the MORE intervention
process was not only able to reduce opioid cue-reactivity but was also able to enhance one’s
natural reward processing ability. These results support the hypothesis that RR and therapeutic
enhancement are linked to a reduction in opioid cravings within this particular sample of drugdependent individuals. However, a connection of causal directionality in this study was not able
to be conclusively established amongst the findings (Garland, Froeliger, & Howard, 2014).
In a research study by Dakwar, Mariani, and Levin (2011), the researchers used the
MAAS in order to examine mindfulness levels within individuals who had presented themselves
for drug addiction treatment. This study compared mono-drug with poly-drug users and
compared the two groups for differences based upon the substances used. The results of this
study discovered that the average MAAS scores of the majority of drug populations were lower
than the national average. Furthermore, poly-drug individuals obtained a lower score on the
MAAS in comparison to the mono-drug individuals. The results of this study indicate that
mindfulness deficits could be commonplace within populations of substance users and that there
could also be sub-groups of people who have even more pronounced deficits in this area. Such
findings lend validity to the idea that mindfulness-based treatments for individuals dealing with
SUDs require continued development (Dakwar et al., 2011).

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Fahmy et al. (2019) focussed on opioid dependence and the effectiveness of mindfulness.
Here, the authors write that mindfulness training has already demonstrated counter-addictive
properties by supporting individuals’ habit modification, emotional regulation, restoration of
natural RR, as well as stress reactivity and cognitive appraisal. Furthermore, neuroimaging
studies analyzing structural changes in the brains of those who have practiced mindfulness have
demonstrated increases in the cortical thickness in the insula, the prefrontal cortex as well as the
somatosensory cortex (Fahmy et al., 2019). Moreover, functional imaging studies have found
neural similarities in expert meditators’ brain activity while meditating and while at rest. (Fahmy
et al., 2019). Like studies of other types of cognitive training, these findings demonstrate long
lasting and stable brain changes connected to the duration of one’s practice. A consistent
outcome of those who practice mindfulness meditation is a modulatory activation pattern within
regions of the brain known as the default mode network (DMN) (Fahmy et al., 2019).
Fahmy et al. (2019) aimed to detect decreased DMN connectivity changes in the brains of
opiate-dependent patients who were also receiving mindfulness-based therapy (MBT) over the
first treatment month. Using resting state functional magnetic resonance imaging (fMRI), Fahmy
et al. (2019) looked for treatment-related changes in the anterior and posterior DMN subsystems
in thirty-two participants who either received MBT or TAU control. The authors found decreased
levels of impulsivity and lowered negative urgency scores (the tendency to behave rashly when
in a negative emotional state) in the MBT group. In comparison, the TAU control showed only
improved tolerance of distress and regulation (Fahmy et al., 2019).
Male Methamphetamine Substance Users
Shareh, Gholami, and Jafari (2018) carried out a study to determine how effective MBGT
can be for RP in male methamphetamine substance users. This study indicated that MBGT was

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more beneficial for RP than was common group therapy (Shareh et al., 2018). Shareh and
colleagues go onto write that their results were consistent with several other similar studies. The
first of these studies was by researchers Witkiewitz, Marlatt, and Walker (2005, as cited in
Shareh et al., 2018). Their findings suggested that MBRP is effective as a coping strategy when
one is facing high-risk situations in terms of substance usage. According to these researchers,
this is because mindfulness assists in creating awareness and acceptance of emotions, feelings
and thoughts (Witkiewitz et al., 2005, as cited in Shareh et al., 2018). The second study
mentioned by Shareh et al. (2018) was by researchers Zemestani, Babamiri, and Sepyani (2016).
Their findings indicated that mindfulness is effective regarding the improvement of anxiety,
depression, reduced substance cravings as well as relapse (Zemestani et al., 2016, as cited in
Shareh et al., 2018).
In a third study analyzed by Shareh and colleagues (2018), researchers Kiani et al. (2012)
investigated the effects of acceptance and commitment therapy in conjunction with MBT on the
lowered rate of cravings in methamphetamine substance users. These researchers proposed that
both treatments provide effective results due to common shared mechanisms. These common
treatment mechanisms allow individuals to only be an observer, rather than making decisions
based on one’s feelings and thoughts through momentary mindfulness and separation of such
feelings and thoughts from one’s self. This process also provides one with an understanding of
one’s emotional and physiological sensitivities and the impact they have on their behaviour
(Kiani et al., 2012, as cited in Shareh et al, 2018).
This study by Shareh and colleagues (2018) was a clinical trial that employed a control
group pretest-post test design configuration. After a period of detoxification, forty individuals
were selected via convenience sampling and were later assigned randomly to either an

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experimental group or a control group. While the subjects who were assigned to the experimental
group participated in nine sessions of MBTs oriented towards RP, the control group of subjects
took part in the group therapy program already used by the treatment centre. MBGT reduced
drug cravings, the likelihood of substance use, depression, and produced an overall improvement
level within individuals. Moreover, no major differences were observed between either group in
relation to treatment satisfaction. However, the number of control group members who
experienced relapses was over twice as high as those in the experimental group (Shareh et al.,
2018).
Thematic Findings From The Literature Review - Common Findings
In analyzing the literature on mindfulness and substance usage, I offered evidence for the
effectiveness of mindfulness-based practises for several substance use issues and contexts.
Evidence suggests that MBIs could also be beneficial for individuals who are members of a
variety of substance using populations. The literature review revealed that mindfulness-based
strategies have proven themselves to be effective for many people with substance-related
addictions.
MBIs may hold an advantage over other strategies such as more traditional visualization
strategies in sustaining their effects over a greater length of time. This seems to be in large part
due to their greater level of flexibility and applicability to a wide variety of settings and contexts.
Additionally, traditional visualization strategies may require more effort and have a greater
degree of repetitiveness to them.
Various researchers also found that key emotional processes may be targeted by MBIs,
which may weaken patterns of negative reinforcement within people. Such emotional processes
are hypothesized to underlie addictions.

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Davis, Berry et al., (2018) focus on whether MBRP is an appropriate and viable treatment
for individuals in young adulthood who are participating in residential substance use and
disorder treatment programs. Each participant in this study had an initial baseline assessment
which evaluated each individual’s behavioural, psychological, and social domains. Afterwards,
test subjects were assigned randomly to receive either TAU or MBRP. All people receiving these
treatments completed bimonthly assessments over six-months after their baseline evaluation
(Davis, Berry et al., (2018).
The results of this study by Davis, Berry et al., (2018) suggest that MBRP is a viable and
useful intervention for young adults who are in residential treatment and who fit the criteria of
having been marginalized. Those who received MBRP had reduced substance use, cravings, and
stress levels six months after beginning their treatment. This is significant because young adults
who have been marginalized often deal with greater stressors and traumas due to their life
circumstances, such as involvement in the criminal justice system or the child welfare system,
not having attended some type of higher education, and being at greater risk for mental, physical,
and substance use addiction (Davis, Berry et al., (2018) ). The fact that MBRP was beneficial for
this population speaks to the effectiveness of this intervention.
An article by Witkiewitz et al. (2014) utilized MBRP in comparison to the TAU RP for a
residentially based treatment program aimed at helping incarcerated women. During an intensive
phase of treatment in this program, MBRP was found to offer a modest level of support as an
effective intervention strategy in relation to RP. However, those participants who were selected
randomly to receive MBRP treatment reported significantly fewer days of substance use as well
as fewer medical and legal issues at the fifteen-week follow-up period when compared with the
individuals who received RP. The substance use relapse rate was low in terms of both MBRP

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and RP, which indicated that the RP program was effective at RP. However, while the RP
program had a substance use relapse rate of 10%, the MBRP program had a relapse rate of only
1.8%. Moreover, the relapse rates of each approach were low in comparison to what the
researchers uncovered in the literature (Witkiewitz et al., 2014).
The primary goal of Witkiewitz et al. (2014) was to assist individuals in identifying their
“automatic-pilot” state and its connection to substance use relapse as well as recognizing
cravings and triggers (p. 538). The researchers also wanted to provide ways in which
mindfulness practices could be integrated into one’s daily life by practicing the skills participants
had learned for usage in high-risk situations, along with the specific role that one’s thoughts play
in relapse. Each of the mindfulness treatment sessions began with a short-guided meditation,
such as a sitting or body scan meditation. Included with these exercises were several experiential
activities that allowed participants to utilize their mindfulness-based skills to lower their
reactivity when in high risk situations. Afterwards, these sessions were followed by discussions,
and group members were also assigned exercises to practice outside of the groups’ sessions and
given handouts to follow (Witkiewitz et al., 2014).
In reviewing all these articles, it seems that mindfulness is useful as a strategy in reducing
or ending substance-related addictions for the various substance using populations reviewed in
the previous sections. In analysing the previous research about individuals with alcohol
addiction issues and individuals with opioid addiction issues, researchers discovered that MORE
was helpful for individuals who were trying to reduce or quit their alcohol and opioid substancerelated addiction. Their findings also reveal that the current evidence suggests that MBIs can
assist individuals in reducing their usage of substances such as opiates, cocaine, alcohol,

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cigarettes, amphetamines and marijuana. The results of these studies also offered preliminary
evidence that MBIs can also reduce one’s substance related cravings.
Regarding individuals with smoking addiction issues, authors Spears et al. (2017)
discovered that MTS had a high success rate for those dealing with smoking addiction issues.
Moreover, MBRP was found to be beneficial in relation to the TAU program as well as a RP
program for a residential women’s treatment centre. Also, these researchers discovered that
MBAT significantly increased lapse recovery levels in relation to the UC and CBT treatment.
Additionally, study participants who received MBAT training also perceived themselves as
having a greater level of volitional control regarding their smoking, as well as lower anger
volatility levels.
According to researchers Chiesa and Serretti (2014) all MBIs share two fundamental
features. The first characteristic of mindfulness is the development of a mental state that allows
individuals to focus their full attention upon their internal and external experiences at any given
moment. The second characteristic is the development and cultivation of a non-judgemental
attitude of openness towards such experiences. Chiesa and Serretti (2014) continue by listing
three main reasons as to why MBI’s might be useful for those dealing with substance use and
misuse (SUM) issues. The first reason is because MBIs allow for the fostering of a nonjudgemental attitude within individuals towards distressing phenomena that could reduce the
associated distress. Secondly, MBIs lead to the development of adaptive changes within one’s
thought patterns or may stimulate attitudinal changes towards their thoughts. Thirdly, MBIs
allow individuals to enhance their ability to accept distressing present moment experiences.
Thus, by enhancing this ability this could also allow individuals to lessen their substance using
behaviors as a way to suppress painful emotional experiences.

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Overall, according to the research is seems that by utilizing MBIs individuals are able to
create within their minds a mental state that enhances their self awareness. In developing this
state of greater self awareness one then becomes better able to recognize and cope with addictive
and emotional impulses more effectively. Another extremely beneficial feature of mindfulness
seems to be that it enables individuals to cultivate a non-judgemental and present focused
awareness which allows one to examine their thoughts, emotions and actions in an accepting and
non-judgemental manner. In utilizing mindfulness one can act as an observer in order to learn
how to recognize which thoughts, emotions and actions are detrimental to their substance-related
addiction recovery process. According to authors Chiesa and Serretti (2014) MBIs are becoming
an increasingly recommended approach for what the authors term substance use and misuse
(SUM) issues. Chiesa and Serretti (2014) report that the suggestion by the current evidence is
that MBIs reduce the intake of a variety of substances such as opiates, cocaine, alcohol,
cigarettes, amphetamines, and marijuana. Some of the preliminary evidence also supports a
connection between MBIs and the reduction of cravings along with increased mindfulness
(Chiesa & Serretti, 2014).
In relating these thematic findings more specifically to social work practice MBIs have
proven themselves to be useful for a variety of issues and contexts other than just substancerelated addictions. Due to the broadly applicable nature of MBIs it seems clear that there are
other areas of one’s life to which they could be applied. Initially, mindfulness arose out of
Buddhism as a way to allow Buddhist monks to more easily cultivate the teachings of Buddhism.
However, a key aspect of Buddhist mindfulness as well as all of its derivative forms is to
understand and learn how to put an end to whatever form(s) of suffering an individual may be
experiencing. Moreover, within Buddhism mindfulness is considered to be a key aspect of

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“awakening” which is viewed as a specific mode of recollection or mental state that allows one
to understand the truth behind the nature of conditions, causes and effects.
Similarly, critical theory shares commonalities with mindfulness. Both critical theory
and mindfulness approaches have as their focus the alleviation of suffering. For instance, one
can distinguish between critical theory and traditional theory by virtue of the fact that critical
theory has as its practical aim the emancipation of humans from some form of slavery.
Buddhism on the other hand seeks to alleviate suffering from one’s life by allowing one to
reshape their consciousness into one that takes a non-grasping view of worldly phenomena
through which one’s suffering is extinguished along with its origins. The field of social work
certainly shares the goal of the elimination of human suffering. Due to the commonalities shared
by mindfulness and critical theory, it would seem that these approaches could be used in
conjunction with each other to develop a broader analysis. Those who are dealing with
substance-related addictions are also often affected in a detrimental manner by larger sociostructural forces and institutions within society. An analysis that integrates both approaches may
provide individuals with a greater ability to deal with their suffering and develop better solutions
for overcoming it.
Gaps in the Literature
I note several gaps in this literature review. Some of the following areas were lacking in
content. Having more information on how to carry out MBIs regarding specific substance using
populations would be very useful. Overall, the literature seemed to provide more information
relating to the efficacy of MBIs rather than how to perform such activities. Amongst the
majority of the articles I reviewed there was a limited amount of step-by-step instructional

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information which social workers could draw upon in order to practice the MBI activities being
analyzed with their own clients.
Furthermore, I did not find much information regarding the use of computer software
applications and mindfulness. I believe that such information could be beneficial in this current
age of various smartphone applications, and I know that such applications exist and that many
people are using them. Having such options available makes mindfulness an even more flexible
alternative for those dealing with substance-related addiction or for any other issues for which
mindfulness is beneficial.
The majority of the studies that I reviewed were usually small scale in design, thereby,
lacking large enough sample sizes for their findings to be very generalizable. Some studies
lacked generalizability of the analyzed findings due to methodologies that lacked details, had
small scale sizes, and lacked replicated findings.
In creating a stronger evidence base for the effectiveness of MBIs, I believe that what is
required are research projects with larger sample sizes, a greater variety of participants and
contexts, as well as studies that are more longitudinal in design. In addition, I believe that
including a more significant amount of training in mindfulness for research participants would
improve the quality and findings of any future research studies.
Another area where knowledge seems to be lacking is the area of substance addiction
cravings. According to some of the most recent studies, researchers still seem to lack a complete
understanding of how mindfulness practices influence craving related changes. It would seem
that more research in this area is needed.

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Literature Review Implications for Social Work Practice
Benefits of Mindfulness and Social Work
Due to the broad macro-oriented theoretical scope that social work education entails in
conjunction with a micro-oriented therapeutic approach, I believe that this could allow social
workers to make the most of mindfulness modalities. Mindfulness interventions are already
being successfully applied to several individually based issues such as mindfulness-based stress
reduction, mindfulness-based cognitive therapy, mindful body scanning meditation etcetera.
Social workers are well suited to assisting individuals with such issues due to their microtherapeutic knowledge and skills. However, if social workers can find ways to link mindfulness
approaches to larger socio-structural concerns as well this could allow for a more transformative
experience for their clients.
In terms of those with substance-related addictions social workers might be able to utilize
or develop MBI interventions that will instil within individuals an awareness of how larger
socio-structural issues may have played, or may continue to play a part, in their ongoing
substance-related addiction(s). Such an approach may allow individuals to consider other factors
unrelated to their own actions that they may not have considered previously. Often factors such
as guilt, shame, low self-esteem, loneliness, stress, trauma, mental health issues etcetera can
cause one to develop a substance-related addiction(s). These issues are often individualized by
those who have them. However, such issues are often connected to wider socio-cultural concepts
that unfairly encourage an individualizing approach to such matters. In taking approaches that
integrate a micro as well as a macro focus this could allow individuals to view the causes and
continuation of their substance-related addictions within a wider context. This wider view could

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allow people dealing with substance-related addictions to be better able to make changes in their
lives that allow them to either reduce or end their substance-related addiction(s) usage.
Authors Banerjee, Cavanaugh, and Strauss (2018) write that there is a substantial amount
of evidence for the effectiveness of group based MBIs. These authors suggest that if social
workers were to utilize more group based MBIs in their practice that this could greatly widen
access to MBIs for the individuals whom they serve. Utilizing such group based MBIs would
not only allow social workers to teach and treat a greater number of individuals more easily but
would probably be better venues for making socio-structural connections. Since socio-structural
forces affect everyone as a group, albeit, not always in the same way due to issues of ethnicity,
class etcetera discussing and sharing one’s experiences in this realm could be beneficial. These
group sessions could operate not only as mindfulness sessions but could also function as
consciousness raising educational events.
Barriers to Mindfulness and Social Work
Many of the barriers that individuals might face in accessing mindfulness treatments are
centered around the ability of mental health and addiction professionals to offer people this
treatment. Edwards, Cohen, and Wupperman (2016) examined the rates of mindfulness modality
adoption by substance-treatment professionals and also explored the perceived barriers to the
adoption of such a treatment approach, including in social work contexts. This study revealed
that approximately one third of practitioners reported having incorporated mindfulness into their
treatment regimes (Edwards et al., 2016). Almost two thirds reported having some familiarity
with mindfulness in terms of its treatment applications for substance-related addiction and
respondents who had more familiarity with mindfulness were found to be significantly more
likely to utilize it within their treatment practices (Edwards et al., 2016). However, fewer than

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20% of those practitioners who were using mindfulness in their practice were doing so in a
research-supported manner via the use of formalized manuals (Edwards et al., 2016). Moreover,
reported familiarity with mindfulness and educational study completion dates did not
demonstrate a significant relationship (Edwards et al., 2016).
On average, Edwards et al. (2016) found only small to moderate barriers were reported
by practitioners in terms of being able to utilize mindfulness for treating substance use issues.
Notably, regardless of their discipline, familiarity, or usage of mindfulness as a treatment
modality, what was viewed by practitioners as the greatest obstacle was the need for further
training (Edwards et al., 2016). In comparison, religious and philosophical issues posed only
minor barriers (Edwards et al., 2016). Overall, when viewed from across all the disciplines
studied, the differences in the severity of the perceived barriers were minimal even amongst
individuals with varying years of experience in the field (Edwards et al., 2016).
Banerjee, Cavanaugh, and Strauss (2018) write that not much is known regarding what
factors are effective when it comes to increasing one’s engagement with MBIs. Moreover, the
authors posit that the basis through which engagement in mindfulness is usually defined is via
class attendance (physical engagement) only. In contrast to this way of defining an individual’s
engagement with mindfulness, recent psychotherapy literature has emphasized the importance of
measuring a participant’s level of involvement with MBIs (psychological engagement, Banerjee
et al., 2018). The authors of this study tested a research model which revealed that worry and
rumination can act as barriers to both physical as well as psychological engagement, which can
impede one’s ability to learn mindfulness (Banerjee et al., 2018).
Banerjee et al. (2018) write that the literature does not provide a clear definition of MBI
engagement. In terms of psychological therapies more broadly, the authors write that within the

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field, there is a lack of consensus on how engagement is defined in this area. For individuals to
become more mindful, these authors state that ‘psychological participation’ is required (Banerjee
et al., 2018). This means that one not only needs to engage with normal mindfulness practice but
also needs to develop a radically different ‘being’ or mode which can be entered into at any
moment, thus perhaps making MBI engagement somewhat different in comparison to
engagement with other psychotherapies. In highlighting this difference mindfulness is often
considered to be an ‘approach to life’ rather than as strictly a health behaviour (Banerjee et al.,
2018, p. 981).
In considering what psychological engagement would entail, Banerjee and colleagues
(2018) propose a definition of psychological engagement consisting of five factors: (1)
motivation – for putting aside the time to participate in an MBI course, (2) intention –
maintenance of one’s formal mindfulness practice while participating in an MBI course and
afterwards, (3) commitment – towards utilizing mindfulness within one’s daily life, (4) the belief
– that in practicing mindfulness it will be beneficial for one’s well-being or mental health, (5) the
therapeutic relationship - between an MBI participant and their instructor and/or group (p. 981).
This study by Banerjee, Cavanaugh and Strauss (2018) utilized one hundred and twentyfour participants who were provided with access to a two-week-long online mindfulness-based
self-help (MBSH) intervention. The participants used self-reporting measures regarding
mindfulness, worry, rumination, and positive beliefs concerning rumination, as well as worry and
positive beliefs concerning psychological and physical engagement. This study revealed that
what can increase one’s chances of disengagement from MBSH are rumination and worry and, in
so doing, hinder one’s cultivation of mindfulness (Banerjee et al., 2018).

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Practice Implications for Mindfulness and Social Work
Dylan and Coates (2016) write that there has been an increasing amount of interest in
mindfulness within the social work field due to its applicability to a wide variety of human
endeavors and issues. Dylan and Coates (2016) state that since mindfulness is so multifaceted
and ever evolving, it has quickly become an important methodology across a variety of academic
disciplines, helping professions, health sectors, geographic regions, as well as ethnocultural
groups within North America. However, despite the increasingly significant amount of evidence
demonstrating the efficacy of mindfulness as a strategy to alleviate a multiplicity of specific
human concerns, several issues have arisen.
Dylan and Coates (2016) also reaffirm that mindfulness is a core aspect of the Eightfold
Noble Path of Buddhism, and thus, is derived from a particular philosophical and religious
tradition. However, within North America, mindfulness is often de-coupled from this Buddhist
tradition and is frequently taught in a secularized manner that risks cultural appropriation. A
secularized approach may allow mindfulness to be more easily accessed by a greater number of
individuals as well as increase its adaptability to a larger variety of applications. However, such
changes also have the potential to weaken the robustness, wholeness and integrity of the practice.
In applying mindfulness in this broader manner, there is a risk that its defining characteristics or
meaning could become diffused (Dylan & Coates, 2016).
Furthermore, Dylan and Coates (2016) write that it is particularly important for the
profession of social work to consider how mindfulness can be incorporated into their practice.
For instance, to utilize mindfulness in their professional practice, a practitioner must also be
experienced in practicing it themselves. Connected to this question are the additional questions
of how one applies mindfulness, for what purpose, and with what degree of effectiveness. These

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authors posit that in operating from a position of mindfulness and time, practitioners might come
to recognize the impact of systemic and structural realities upon their lives. Thus, what is needed
is research directed towards how mindfulness can be employed in advancing the social work
profession’s radical and social justice objectives (Dylan & Coates, 2016).
I did not encounter very much discussion on how to carry out specific MBI practices. As
a way to promote the incorporation of mindfulness into one’s practice I believe that social
workers should at least be introduced to the practice of mindfulness when in social work school.
Perhaps mindfulness could be offered as an elective course. I think that one of the easiest ways
for social workers to introduce mindfulness into their practice would be by incorporating it into
counselling sessions with their clients. Social workers could begin and/or end each counselling
session with some sort of a mindfulness practice. One mindfulness-based practice modality that
could be useful within this context which was initially used to treat stress as well as pain-related
disorders is mindfulness-based stress reduction (MBSR). Since counselling sessions often
involve the discussion of stressful issues the utilization of MBSR before and/or after each
counseling session could allow one to more easily discuss and process emotionally difficult
issues and experiences. Additionally, another mindfulness modality that could be helpful with
counselling sessions could be mindfulness-based cognitive therapy (MBCT) since this modality
can assist individuals in dealing with negative thought patterns. In moving beyond
individualized sessions, social workers could also apply mindfulness-based modalities to groups
sessions. Some of these group sessions could involve discussions amongst clients regarding their
journey towards overcoming their substance-related addictions. Social workers could also
facilitate educational discussion sessions around the effects of societal dynamics upon peoples
lives and work collaboratively with group attendees to develop solutions to overcoming societal

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obstacles that they might be dealing with. Mindfulness modalities meant to assist individuals in
recognizing how socio-structural issues were affecting their lives could be utilized in such a
group.
In examining how social workers could promote and employ mindfulness techniques in
order to affect systemic change, Rowe (2016) writes that Kabat-Zinn likened mindfulness to a
form of “institutional aikido” (p. 207). Kabat-Zinn (as cited in Rowe, 2016) stated that
mindfulness could not only change organizations from within but could also allow practitioners
to heighten their awareness and progressively become more aware of issues related to hatred,
greed, and delusion that cause a great deal of collective suffering within society. Furthermore,
Rowe (2016) also cites a philosopher and activist named Angela Davis who, after debating with
Kabat-Zinn, recognized that mindfulness has the potential of becoming a revolutionary force if it
is embedded within social movements which target oppressive systems. Such movements also
offer political and ethical analyses which can serve as a way of utilizing mind/body practices
towards the service of creating radical social change.
I believe that mind/body practices do have the potential for assisting people involved in
creating large scale macro-changes within society. For instance, I can see how mindfulness could
be used as a method to bring people together. Besides meeting to practice mindfulness, such
sessions could also be used as an opportunity to develop and maintain social connections and
create a broader sense of group solidarity. I agree with the perspective that mindfulness practices
alone will not power any revolutions unless they are paired with goals that further the revolution.
In order to further such goals, I believe that a socio-structural analysis of the social changes
being pursued would need to be incorporated into an individual’s mindfulness practice.

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It would appear that both mindfulness and critical theory can be utilized in conjunction
with each other. Individuals can use mindfulness strategies to analyze their internal state in terms
of thoughts, emotions, and body sensations. This practice can then be linked with critical theory
approaches which focus on the overarching socio-economic system and structures responsible
for creating and perpetuating unfairness and oppression. Hick et al. (2009) write that since
mindfulness enables a sustained awareness of thoughts, emotions, and physical sensations, this
practice can also be used to delve into societal dynamics. As one’s sense of interconnectedness
increases, so will one’s sense of compassion for the world. In strengthening this sense of
interconnectedness, practitioners of mindfulness begin to understand how their actions could be
influencing and perpetuating injustice (Hick et al., 2009).
Hick et al. (2009) state that two elements, which are key to practicing social justice
approaches in social work entails viewing economic and social structures as having a major
influence on how social justice and oppression is perpetuated. These elements also focus on the
dialectical interaction between societal and individual influences regarding social problems.
Moreover, each of these elements could fit with mindfulness practice goals. Mindfulness
practices mirror the structural tendency to analyze social and economic structures. It elucidates a
vision of our unsustainable and fast-paced economic system, as maintaining oppressive social
relations by perpetuating mindlessness or being on “autopilot” (Hick et al., 2009, p. 14). In this
way, Hick et al. (2009) demonstrate that mindfulness is change-oriented since it allows one to
develop a sense of awareness of when they are on autopilot, and in so doing, cultivates an
awareness of the present moment. Once one can learn to develop a sustained level of awareness,
individuals can start to link their personal lived experiences in relation to broader social
structures. Thus, mindfulness practices could be of assistance to social justice approaches in

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cultivating an awareness of how power inequities are reinforced through well-worn practices.
Having this critical awareness of the functioning of dominant institutions reveals possibilities in
terms of their dismantling, thereby suggesting a vision of social transformation (Hick et al.,
2009).
As a social worker, I believe that utilizing mindfulness strategies to assist individuals in
reducing or ending their substance usage would be helpful. However, as a larger long-term goal,
I believe that integrating mindfulness practices with educational discussion sessions to elucidate
the connection between individuals’ personal lives and socio-structural issues of oppression
could generate actions towards larger socio-economic changes within society.
Hick et al. (2009) posit that, in identifying key broad ways through which mindfulness
and social justice approaches to social work are congruent, mindfulness approaches could be
integrated into one’s practice. In particular, concepts such as self-reflection, social relations and
consciousness provide guideposts as to how such a co-mingling might occur. Social justice
approaches offer skillful methods to social work in uncovering, analyzing, and changing unjust
social institutions and structures (Hick et al., 2009). Hick et al. (2009) propose that mindfulness
introduces a skillful method for not only cultivating but also sustaining awareness about
ourselves, as well as our everyday experience and overall experience in the world. When taken
together, this can allow social workers to consciously understand both their inner and outer
experiences along with the dialectical relationship between these experiences and society (Hick
et al., 2009).
Hick et al. (2009) argue that by developing an awareness of social relations, one can
become aware of unconscious participation in reproducing social structures. Through this
understanding, one can increase their choices regarding future actions in terms of how one

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chooses to live within society and the approach one might adopt in changing it. Hick et al. (2009)
write that this consciousness raising can create an awareness that can allow one to see how
everyday activities could be organized and articulated in a manner that reduces or remedies
oppressive social relations. Within this self-reflective realm, the goal of each approach is to
develop an understanding of oneself in relation to how one operates in the world. Thus,
mindfulness offers a comprehensive modality for examining inner experiences in a manner that
does not cause one’s inner experience(s) to be viewed as a pathology or personal fault(s) (Hick et
al., 2009).
Conclusion
In conclusion, in having analyzed the efficacy of mindfulness as a modality to treat substancerelated addictions as well as a potential consciousness raising modality, it appears as though
mindfulness is beneficial for both of these pursuits. Mindfulness is being increasingly applied to
a variety of issues and contexts due to its usefulness and flexibility. Moreover, mindfulness can
also be used in conjunction with a number of other therapeutic approaches and modalities
making it especially useful when working towards client outcome goals. As a social worker, I
intend to utilize mindfulness techniques in all applicable areas when working with individuals.

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