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Mindfulness-Oriented Recovery Enhancement: A review of its theoretical underpinnings, clinical application, and biobehavioral mechanisms


In 2006, Eric Garland began to contemplate developing a mindfulness-based intervention (MBI) for the treatment of addiction. At the time, there were no empirically supported mindfulness-based treatments for addiction, and few studies of mindfulness for addictive behavior had been published in the literature. As one key exception, a quasi-experimental study of traditional Vipassana meditation (Buddhist insight meditation) for incarcerated dsubstance abusers had been published that year (Bowen et al., 2006).

Inspired by this study, Garland was motivated to develop a secular mindfulness program to treat addiction that was founded on mechanistic insights from basic biobehavioral research and neuroscience. To inform the treatment development process, Garland reviewed the literature on the cognitive, affective, and psychophysiological mechnisms underpinning addiction. This review identified two key addictive mechanisms that might be effectively targeted by mindfulness: (1) automaticity and (2) allostasis.

With regard to the first mechanism, empirical data suggested that addiction was largely governed by unconscious cognitive and behavioral habits (Tiffany, 1990) -- a conclusion echoed in first-person accounts of individuals with substance use disorders that describe feeling automatically compelled to use substances even in the absence of the conscious desire or will to do so. As a result of such addictive automaticity, persons with substance use disorders exhibited an attentional bias, or hyperfixation of attention, towards exteroceptive and interoceptive cues (i.e., external and internal stimuli, respectively) associated with past drug use episodes, which "trigger" cue-elicited craving for substances (Field & Cox, 2008). With regard to the second mechanism, neurobiological research indicated that addiction, emotion dysregulation, and chronic pain involve a downward spiral of allostatis (ie., the process by which the body responds to stress in order to maintain internal equilibrium), in which prolonged exposure to drugs and chronic stress results in heightened sensitivity to threat and decreased sensitivity to natural reward. 


Garland, E.L., Baker, A.K., Riquino, M.R. & Priddy, S.E. (2019). Mindfulness-Oriented Recovery Enhancement: A review of its theoretical underpinnings, clinical application, and biobehavioral mechanisms. Ivtzan, I. (Editor). Handbook of Mindfulness-Based Programmes: Mindfulness Interventions from Education to Health and Therapy. Psychology, Routledge.

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Last Updated: 12/12/23