NCAD Spotlight: Practice of Mindfulness an Effective Complement to MAT

Mindfulness, says John Bruna, CADC, is not simply an added piece to one’s life, but rather a way of integrating the therapeutic process. Bruna, co-founder of the Mindful Life Program and Mindfulness in Recovery, will discuss the myths and benefits of mindfulness in the treatment of addiction and co-occurring disorders at NCAD West, Oct. 24-26 in Denver.

Ahead of his presentation at NCAD, Bruna spoke with Addiction Professional about mindfulness beyond the practice of meditation, misconceptions about mindfulness, and the role of mindfulness as a complement to medication-assisted treatment.

[Editor’s note: This interview has been edited for length and clarity.]

Can you explain how mindfulness meditation differs from the practice of mindfulness? Do you see these terms being used interchangeably, even by practitioners?

So often when people think about mindfulness, they immediately think about meditation. Mindfulness itself is being aware of what you’re doing. When we think about living mindfully, you’re not going to be meditating all day. Can you be mindful when you are talking to someone? Can you be present in a way that is healthy and meaningful? Can I be mindful of my deepest values and the person I want to be? Can I be mindful of whether I’m making a healthy choice or unhealthy choice? The practice of mindfulness permeates our way of living, and the more mindful we can be as we engage in our lives, the more opportunities we have to have a life we find meaningful.

Meditation helps us develop attention. Meditation is an incredible tool that helps me develop my attention so that I can be mindful when I’m not meditating. If I think of mindfulness as my meditation, if I do that every day in the morning for 20 minutes, if I’m 16 hours a day not mindful, it’s not going to be very successful to do a little meditation in the morning and then be mindless all day. So, if we learn the meditation piece is a tool to help us start living mindfully, then we can distinguish between the idea of meditation and living mindfully.

What is the biggest myth or misconception that you see today with regards to mindfulness?

One is this idea that if I am just aware in the present moment that I’m not going to have any problems. That’s a pretty fascinating concept, that mindfulness is this present-moment awareness in this non-judgmental way and if I start living this way without expectations, I will live a life with more freedom and less stress, and my best qualities will come about naturally. That’s an interesting take because, for example, the idea that mindfulness is a non-judgmental way of living without expectations, let’s just think about that. You need to make judgments every day. You wake up and have to decide what to wear. Try to go shopping without being judgmental. Is this food healthy for me or not? Often, this idea of “non-judgmental” gets confused. What they mean by that is without exaggeration or absolute right and wrong. There’s a lot of gray in the world. A lot of people misunderstand the idea of “non-judgmental.”

And then there are expectations. A lot of people say they have no expectations, but you can’t function in the world without expectations. If you go to the gas station, you expect there to be gas. If you go to college, you have an expectation your teacher will be there and if you turn in your assignments, you’ll get a grade. We have expectations all day long, and they help us function. Unrealistic expectations—my partner will never change, I’ll never have challenges in my life, there shouldn’t be traffic when I go to work—that is not healthy. When we think about mindfulness and myths, this idea of just being present in the moment and living non-judgmentally and this idea of living without expectations and allowing things to arrive as opposed to how about I come into this moment with an intention. I would like to be more patient. I would like to be a better partner or a better parent. Then I come into a moment not just responding to what is happening, I’m coming into the moment with the ability to bear in mind something that is meaningful to me, something I would like to grow and nourish in my life. Then, I can respond in a way that helps me to be a better parent or student. There is quite a bit of wise discernment there and the ability to make healthy choices.

For patients being treated for substance use disorders, do you see the practice of mindfulness as being an effective complement to medication-assisted treatment?  

The way I look at mindfulness is that it’s not something I do, it’s not some added piece to my life. It’s actually a way of integrating the therapeutic process into my life. I’m mindful of what’s healthy and what’s not. I’m mindful of the therapeutic tools I’m developing in my life and how to apply them. If we think of living mindfully as the ability to integrate healthy and meaningful choices and activities and be able to stop doing things that are unhealthy, we start to realize whatever my therapeutic process is, mindfulness is going to allow me the opportunity—and here’s where the science goes—say I’m on medication-assisted treatment, as I reduce that medication and start engaging in activities that support the ultimate reward system in my brain, not just the temporary feel-good, but the one that makes me feel good about who I am, I literally start rewiring myself. As we reduce one and increase the other, we can go from the fundamental problem in addiction and humanity in general, which is wanting to feel good instead of doing thing I feel good about, not just trying to find a feeling of being OK, but finding a deeper sense of purpose and doing things I feel good about.

With neuroplasticity, we rewire ourselves. In that process, we can include the opportunity now that I’m in less pain and getting some treatment and getting balance, I can focus on purposefully living. That is where we get to rewire our brain and fundamentally start recognizing a different reward system. The brain can adjust to the idea that when I do things I feel good about, I feel good about who I am, and I’m going to need less of that external substance or validation from somebody else, that this is the way of integrating any therapeutic process into your life better.