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Interviewer: Using mindfulness to overcome pain pill addiction. We'll tell you how, next on The Scope.

Announcer: Medical news and research from University of Utah Physicians and Specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: You or somebody you know suffers from chronic pain and as a result now has an addiction to the pain pills. Eric Garland is a clinical researcher and practicing licensed psychotherapist at the University of Utah, and there is a technique called mindfulness that could actually help get rid of the addiction and manage the pain as well. Tell me a little about that. First of all, does it really work?

Dr. Garland: It seems like it works. We have a body of research that's building that indicates that mindfulness is a really useful treatment for addiction. We're still actively studying this area, and really, it's an emerging research area, but there have been some pretty big well-controlled trials to show that it's helpful for this problem. I myself have done some of them.

Interviewer: I think sometimes people think of mindfulness and they think, "Oh, mind over matter. If it was only that easy." Right?

Dr. Garland: Right, and it's certainly not easy and I don't want to be flippant about it. This is tough stuff. We're talking about deeply entrenched habits. And it takes a lot of energy to change a deeply entrenched habit. But if you think about it, what mindfulness really is, it's a form of mental training.

So think of it this way. If you wanted to build up your bicep, you would curl a dumbbell and you have to put in a lot of energy, rep after rep, week after week, grueling workout after grueling workout to build the strength of your bicep. Well, if you want to build the strength of your mind to enhance your self-control over addictive habits, then you have to apply the same principle of repetition after repetition of mindfulness practice over and over again, day after day, week after week and you build up your mental strength through a very similar type of process.

Interviewer: So tell me, then, now. With somebody with pain pill addiction, how do they use mindfulness to overcome it? What would they do? Walk me through that process.

Dr. Garland: Yeah, let me walk you through the process. So let's assume that we have someone who's taking pain pills for a chronic pain condition but their use of the pain pills has sort of gotten out of control. One of the techniques we teach them is to practice mindful breathing before taking their opioid medicine. What that means is when the person is getting ready to take the opioids, instead of just popping the pill they stop, they pause, and they begin to focus on their breathing, and as they begin to focus on their breathing they begin to notice thoughts and feelings and urges, for example, the urge to take the pain medicine. In practicing mindfulness like this, the person may begin to realize whether their taking opioids is a means of alleviating pain or perhaps they're taking opioids as a means of getting rid of a craving, satisfying an urge as opposed to satisfying a genuine need for pain relief.

Interviewer: So then at that point what do you do? You just make the decision that wait, it is a craving. I'm not going to take this pill.

Dr. Garland: Well, in the case of somebody who is really dependent on opioids that would be dangerous to just stop taking the pill at that point, but by gaining that awareness the person might decide that they want to change their opioid use habit, so they might be able to work with their doctor to gradually decrease their dosage.

Now, if a person is really dependent and they start to decrease their dosage of opioids under a doctor's supervision, they may experience withdrawal or they may experience craving, and mindfulness techniques can be useful to help a person cope with the unpleasant feelings in their body and the unpleasant emotions in their mind during that process.

Interviewer: So it's really just kind of coming into touch with, "What am I feeling right now," and not just assuming that you're feeling pain or whatever, and then assessing that, and then deciding what you're going to do with that.

Dr. Garland: That's definitely a part of it. That's a big part of it. Another part of it is this process that we call mindful savoring, which is using your attention and your awareness to experience greater pleasure out of everyday activities and events. So again, as we discussed, from a neuroscience perspective addiction involves a process where the person becomes less sensitive to natural pleasure. When practicing mindfulness we can teach people to focus their attention on the positive and good aspects of their life so that they can actually enjoy it more. So let me give you an example of that.

In this mindfulness technique we have patients practice by focusing their attention on a bouquet of flowers. So they focus on the beautiful sights of the flowers, the colors, the textures, the touch of the pedals against their skin, the scent of the flowers, and whenever their mind wanders off to random thoughts they notice that their mind has wandered and they bring the focus of their attention back to the pleasant features of the flowers; the scent, the smell, the texture, the color. As they do this, they become aware of positive feelings in their mind and their body, and then the positive feelings and thoughts that arise in their mind and body become the focus of mindfulness practice. So we encourage the patient to focus their attention on any positive emotions or thoughts that come up.

This technique involves practice both in sessions with a therapist but also practice at home with other enjoyable things in the person's everyday life, and this technique is designed to help them to re-learn how to experience pleasure.

Interviewer: So with somebody with a pain pill addiction, the first thing that they would do is use mindfulness to just kind of become aware of, "Why am I popping this pill," and then if they've decided, "I want to do something different about that," you would recommend going to their physician and telling them, "I would like to get myself off these pain pills."

Dr. Garland: That's right

Interviewer: And a therapist would probably likely be involved as well with some mindfulness training.

Dr. Garland: That's right. So as the person goes to the process of reducing their use, they may experience craving for opioids, and mindfulness can be used to cope with the craving, again by first helping the person become aware of the sensations in their body, their craving-related thoughts and emotions. As the person becomes aware of the craving the feelings may start to get overwhelming, so they can use mindfulness techniques to focus on their breathing as a way to calm down the mind and relax the body to help the person to cope with the difficult thoughts and feelings without giving in to opioid use. And when this process is repeated over time, the craving can become weaker and weaker.

Interviewer: Any tips for somebody that's listening and they're convinced, "I want to do this". Do you have any tips for them, anything they should watch out for, anything they should absolutely do?

Dr. Garland: They should absolutely work with a trained and licensed therapist through this process. I don't think it's something that somebody could do so easily on their own in the beginning, but as a person learns these techniques with a skilled teacher they can begin to practice them at home alone by themselves, and that'll help them overcome the problem.

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