Mind and Body Approaches for Substance Use Disorders: What the Science Says
Clinical Guidelines, Scientific Literature, Info for Patients:
Mind and Body Approaches for Substance Use Disorders
To date, there is not enough consistent data to support the use of acupuncture for substance use outcomes; however, there are some findings that suggest acupuncture may have positive effects as an adjunctive therapy for withdrawal/craving and anxiety symptoms. Only a few high-quality studies on acupuncture for smoking cessation have been conducted, so firm conclusions about its effectiveness cannot be drawn
What Does the Research Show?
- A 2016 systematic review and meta-analysis of 41 studies involving 5,227 participants found no consistent differences between acupuncture and comparative treatments for substance use. There were some findings in favor of acupuncture for withdrawal/craving and anxiety symptoms; however, those findings are limited by low quality evidence.
- A 2014 Cochrane review of 38 randomized trials concluded that although pooled estimates suggest possible short-term effects there is no consistent, bias-free evidence that acupuncture, acupressure, or laser therapy have a sustained benefit on smoking cessation for 6 months or more. However, lack of evidence and methodological problems mean that no firm conclusions can be drawn.
- A 2014 randomized controlled trial of 67 military veterans in recovery from substance use disorder found that participants’ craving and anxiety levels decreased significantly after a single session of acupuncture or relaxation response intervention, suggesting there may be some value in attending regular acupuncture or relaxation response intervention sessions.
- A 2016 systematic review of four trials found that auricular acupuncture was not effective in reducing acute opiate craving or withdrawal, it may be useful as an adjunct treatment to increase treatment retention and decrease methadone detoxification and maintenance dosages in opioid use disorder.
- Relatively few complications from the use of acupuncture have been reported to the FDA, in light of the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments.
- When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.
There is some evidence to suggest that hypnotherapy may improve smoking cessation, but data are not definitive.
What Does the Research Show?
- A 2014 randomized controlled trial of 164 patients hospitalized with cardiac or pulmonary illness compared the efficacy of hypnotherapy alone, as well as hypnotherapy with nicotine replacement therapy, to conventional nicotine replacement therapy alone. The study found that hypnotherapy patients were more likely than nicotine replacement therapy patients to be nonsmokers at 12 weeks and 26 weeks after hospitalization.
- A 2010 Cochrane review of eleven studies compared hypnotherapy with 18 different control interventions. The authors found that hypnotherapy did not have a greater effect on 6-month quit rates than other interventions or no treatment. They concluded that there is not enough evidence to show whether hypnotherapy could be as effective as counseling treatment.
- A 2012 meta-analysis of randomized controlled trials found that acupuncture, hypnotherapy, and aversive smoking increased smoking abstinence, but the patient population in the analysis was small and reports of smoking cessation were not validated by bio-chemical means.
- Hypnosis is considered safe when performed by a health professional trained in hypnotherapy.
- Self-hypnosis also appears to be safe for most people. There are no reported cases of injury resulting from self-hypnosis.
Available data suggest that mindfulness-based interventions may help significantly reduce the consumption of several substances including alcohol, cigarettes, opiates, and others compared to control groups; however, many studies have had small sample sizes, methodological problems, and a lack of consistently replicated findings.
What Does the Research Show?
- A 2016 review found that mindfulness-based interventions effectively reduce pain intensity, improve functional status, improve pain-related psychological consequences, and improve quality of life; they can also be used as adjunct therapy aimed at improving health-related quality of life in individuals with substance use disorders interested in self-management strategies. (Strength of Recommendation: B) Further, in smokers, mindfulness training used as adjunct therapy with pharmacotherapy shows efficacy in maintaining abstinence comparable to standard of care. (Strength of Recommendation: B)
- A 2014 systematic review of 24 studies found evidence suggesting that mindfulness-based interventions can reduce the consumption of several substances including alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates to a significantly greater extent than waitlist controls, non-specific educational support groups, and some specific control groups. The review also found preliminary evidence suggesting that mindfulness-based interventions are associated with a reduction in cravings. However, the findings are limited due to small sample sizes of the studies and lack of methodological details.
- Relapse is common following substance abuse treatments. In a 2014 randomized controlled trial involving 286 individuals who successfully completed initial treatment for substance use disorders, mindfulness-based relapse prevention (MBRP), a group-based psychosocial aftercare that integrates evidence-based practices from mindfulness-based interventions and a cognitive-behavioral relapse prevention (RP) approaches was compared to a 12-step programming and psychoeducation (treatment as usual (TAU)). Compared with TAU, participants assigned to MBRP and RP reported significantly fewer days of substance use and heavy drinking at the 6-month follow-up. Cognitive-behavioral RP showed an advantage over MBRP in time to first drug use. MBRP participants, however, reported significantly fewer days of substance use and significantly decreased heavy drinking at the 12-month follow-up, compared with RP and TAU. These results suggest that mindfulness practices may help reduce the risk of substance abuse relapse by strengthening the ability to monitor and cope with discomfort associated with drug craving or negative affect.
- A 2014 randomized controlled trial involving 286 individuals who successfully completed initial treatment for substance use disorders found that compared with treatment as usual, participants assigned to receive mindfulness-based relapse prevention (MBRP) and cognitive-behavioral relapse prevention (RP) approaches reported significantly lower risk of relapse to substance use and heavy drinking. Further, among those who used substances, those in the MBRP and RP groups had significantly fewer days of substance use and heavy drinking at the 6-month follow-up.
- A 2011 randomized controlled trial comparing mindfulness training with a standard behavioral smoking cessation treatment found that individuals who received mindfulness training showed a greater rate of reduction in cigarette use immediately after treatment and at 17-week follow-up.
- Several studies have used functional magnetic resonance imaging to examine the effects of mindful attention on the anterior cingulate and prefrontal cortex in smokers, the areas of the brain associated with cravings and self-control. In a 2017 study of 23 participants who completed either mindfulness training or cognitive behavioral treatment for smoking cessation, the researchers found that stress reactivity in several brain regions including the amygdala and anterior/mid insula was related to reductions in smoking after treatment. These same regions also differentiated between treatment groups such that the mindfulness training group showed lower stress-reactivity compared to the cognitive behavioral treatment group. The findings suggest that reduction in stress reactivity may be one of the underlying mechanisms of mindfulness-based treatments. In a 2013 study, participants’ self-reported results demonstrated that mindful attention reduced cravings. In addition, the brain imaging results indicated that mindful attention reduced neural activity in a craving-related region of the subgenual anterior cingulate cortex. In another 2013 study, a 2-week course of meditation (5 hours in total) produced a significant reduction in smoking, compared to a relaxation training control. Results of brain imaging showed increased activity for the meditation group in the anterior cingulate and prefrontal cortex.
- Meditation is considered to be safe for healthy people.
- There have been rare reports that meditation could cause or worsen symptoms in people who have certain psychiatric problems, but this question has not been fully researched.
Although there is some evidence that music therapy may have an effect on emotional and motivational outcomes and perceived helpfulness, the efficacy of music therapy for substance abuse disorders is unclear.
What Does the Research Show?
- A 2017 systematic review of 34 quantitative and 6 qualitative studies found beneficial effects of music therapy and music-based interventions on emotional and motivational outcomes, participation, locus of control, and perceived helpfulness, but results were inconsistent across studies. Efficacy of music therapy for substance abuse disorders is unclear.
Only a few studies have been conducted on the effects of yoga for smoking cessation. Although preliminary results have been positive, larger, high-quality studies are needed to determine rigorously if yoga is an effective treatment.
What Does the Research Show?
- A 2013 systematic review of 14 clinical trials concluded that yoga and meditation-based therapies hold promise in assisting with smoking cessation; however, larger, high-quality studies are needed to determine rigorously if yoga and meditation are effective treatments.
- A 2012 study examined the effect of yoga on smoking cessation. Results of this study provide preliminary evidence that yoga may be an effective adjunctive treatment for smoking cessation in women.
- A 2011 study examined the effects of physical activity, including cardiovascular exercise and Hatha yoga, on craving to smoke and smoking withdrawal. Participants who engaged in physical activity reported a decrease in craving to smoke, an increase in positive affect, and a decrease in negative affect.
- Yoga is generally low-impact and safe for healthy people when practiced appropriately under the guidance of a well-trained instructor.
- Overall, those who practice yoga have a low rate of side effects, and the risk of serious injury from yoga is quite low. However, certain types of stroke as well as pain from nerve damage are among the rare possible side effects of practicing yoga.
- Women who are pregnant and people with certain medical conditions, such as high blood pressure, glaucoma, and sciatica should modify or avoid some yoga poses.
- Baker TE, Chang G. The use of auricular acupuncture in opioid use disorder: a systematic literature review. Am J Addict. 2016;25(8):592-602.
- Barnes J, Dong CY, McRobbie H, Walker N, Mehta M, Stead LF. Hypnotherapy for smoking cessation. Cochrane Database of Systematic Reviews. 2010;10:CD001008.
- Bock BC, Fava JL, Gaskins R, et al. Yoga as a complementary treatment for smoking cessation in women. J Womens Health (Larchmt). 2012;21(2):240-248.
- Bowen S, Witkiewitz K, Clifasefi SL, et al. Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA Psychiatry. 2014;71(5):547-556.
- Brewer JA, Mallik S, Babuscio TA, et al. Miindfulness training for smoking cessation: results from a randomized controlled trial. Drug Alcohol Depend. 2011;119(1-2):72-80.
- Carim-Todd L, Mitchell SH, Oken BS. Mind-body practices: an alternative, drug-free treatment for smoking cessation? A systematic review of the literature. Drug Alcohol Depend. 2013;132(3):399-410.
- Chang BH, Sommers E. Acupuncture and relaxation response for craving and anxiety reduction among military veterans in recovery from substance abuse. Am J Addict. 2014;23(2):129-136.
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- Elibero A, Janse Van Rensburg K, Drobes DJ. Acute effects of aerobic exercise and Hatha yoga on craving to smoke. Nicotine Tob Res. 2011;13(11):1140-1148.
- Grant S, Kandrack R, Motala A, et al. Acupuncture for substance use disorders: a systematic review and meta-analysis. Drug Alcohol Depend. 2016;163:1-15.
- Hasan FM, Zagarins SE, Pischke KM, et al. Hypnotherapy is more effective than nicotine replacement therapy for smoking cessation: results of a randomized controlled trial. Complement Ther Med. 2014;22(1):1-8.
- Hohmann L, Bradt J, Stegemann T, et al. Effects of music therapy and music-based interventions in the treatment of substance use disorders: A systematic review. PLoS One. 2017;12(11):e0187363.
- Khusid MA, Vythilingam M. The emerging role of mindfulness meditation as effective self-management strategy: part 2: clinical implications for chronic pain, substance misuse, and insomnia. Mil Med. 2016;181(9):969-975.
- Kober H, Brewer JA, Height KL, Sinha R. Neural stress reactivity relates to smoking outcomes and differentiates between mindfulness and cognitive-behavioral treatments. Neuroimage. 2017;151:4-13.
- Tahiri M, Mottillo S, Joseph L, et al. Alternative smoking cessation aids: a meta-analysis of randomized trials. Am J Med. 2012;125(6):576-584.
- Tang YY, Tang R, Posner MI. Brief meditation training induces smoking reduction. Proc Natl Acad Sci USA. 2013;110(34):13971-13975.
- Westbrook C, Creswell JD, Tabibnia G, et al. Mindful attention reduces neural and self-reported cue-induced craving in smokers. Soc Cogn Affect Neurosci. 2013;8(1):73-84.
- White AR, Rampes H, Liu J, Stead LF, Campbell J. Acupuncture and related interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2014;1:CD000009.
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