Substance Misuse – Mindfulness and Ecstasy

I noticed some recent newspaper reports suggesting that MDMA (aka the recreational drug Ecstasy) is effective in helping alcoholics to reduced their drinking.  The research was conducted at University College London by Professor David Nutt.  You may recall Professor Nutt was previously the government’s “Drugs Tsar” as chairman of the Advisory Council on the Misuse of Drugs.  He was fired from this post in 2009 after speaking out to suggest that there was a mismatch between lawmakers’ classification recreational drugs – suggesting that illicit drugs should be classified according to the actual evidence of the harm they caused.  To this end he presented an analysis which revealed that alcohol or tobacco were more harmful than LSD, ecstasy or cannabis.  Further, I have heard Professor Nutt talk about the opportunity to repurpose some drugs that are currently controlled in order to effectively treat mental illness and addictions.

The recent news reports centred on a study by Professor Nutt and his team at University College London showing that Ecstasy can be used to treat alcoholism – as it seems to enable addicts to confront their pasts.

In a trial, addicts were given doses of the Class A drug MDMA during two of eight psychotherapy sessions.  Before the therapy, they had been drinking an average of about 130 units a week – yet nine months later, 79 per cent of those who had taken the MDMA therapy were still consuming less than 14 units of alcohol per week, compared with just 25 per cent of people who had sought standard NHS care.

Prof Nutt’s work made me wonder about trials investigating the possibility of using Mindfulness to help people with substance abuse and addiction problems.

In fact, there are many published papers detailing research into the effectiveness of Mindfulness interventions to help reduced addictive behaviours – alcoholism, binge drinking smoking and drug addictions – to reducing cravings and dependency… and as a mollifiers for stress.  It took me a little longer to find studies looking at the long-term effect (where the effects lasted beyond the period of the study interventions) – but pleasingly there are a number of excellent random controlled trials that show such lasting impact.

One typical example is this 2014 paper “Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders A Randomized Clinical Trial (Sarah Bowden et al – from the Addictive Behaviors Research Center, Seattle, Washington – published in JAMA Psychiatry). (Here).

This research contrasted the use of “Mindfulness-based relapse prevention” (MBRP) with a “cognitive-behavioural relapse prevention program“ (RP)  and  also with “treatment as usual” (TAU)  – a 12 step counselling program. A total of 286 eligible individuals who had successfully completed initial treatment for substance use disorders were randomized to MBRP, RP, or TAU and attended eight weekly sessions for their given program.  They were then monitored for 12 months.

The trail showed that in comparison with TAU, both MBRP and RP significantly reduced risk of relapse risk to drug use and heavy drinking at 6 months; and at the 12-month follow-up, MBRP was more effective than both RP and TAU in reducing drug use and heavy drinking.  The researchers commented:

“Targeted mindfulness practices may support long-term outcomes by strengthening the ability to monitor and skilfully cope with discomfort associated with craving or negative affect, thus supporting long-term outcomes.”

This is just one example of many such research projects to show that Mindfulness interventions really can support people to reduce heavy drinking and drug use over the long term.

It will be interesting to see if Professor Nutt’s “ecstasy treatment” requires “maintenance sessions” to continue the progress made – my hope and expectation is that most of his subjects will have changed their habit for the long-term as a result of his program.

One final comment: most of the research I found was centred on the use of drugs, alcohol and/or tobacco – it would be interesting to look at the effectiveness of Ecstasy on other addictive behaviours like gambling, self-harm, eating disorders etc which have also shown a positive response to mindfulness interventions.

MBCT will reduce social anxiety and increase self-esteem in adolescent girls

I have written before about social anxiety: Social Anxiety Disorder is more than just shyness or nervousness.  While many people get nervous or self-conscious on occasions, Social Anxiety Disorder involves an intense fear of certain social situations — especially situations that are unfamiliar or in which people feel that they will be judged by others; and where they are afraid that they won’t “measure up” or that they will be exposed as inferior.  Just thinking about such situations may cause them to get anxious and they may go to great lengths to avoid them, disrupting their lives in the process.

And it is not unusual, nor confined to adults. Social anxiety is one of the most common psychological disorders amongst children and adolescents – and it has profound effects on their psychological states and academic achievements. The lifetime prevalence of Social Anxiety Disorder is 9.5% in females and 4.9% in males; the six-month prevalence rate is about 2% – 3%; yet and among high-school adolescents this rate increases to 5% – 10%.  Children and adolescents diagnosed with social anxiety are prone to academic problems, drug abuse, long periods of disability, and considerable pathologies in their daily lives and social relationships.

In summary, it’s a significant problem for adolescents… and especially for girls.

So, I was encouraged to read of a paper published in 2016 investigating the effectiveness of Mindfulness Based Cognitive Therapy (MBCT) to reduce social anxiety and to increase self-esteem in adolescent females diagnosed with social anxiety disorder. (Here.)

The research identified high school girls (mean age 14) as subjects by using the established  (DSM-VI-TR-Axis) criteria for Social Anxiety Disorder; and then randomly accolated them to an “intervention group” and a control group.  The Intervention group were given eight weekly MBCT sessions and asked to work on MBCT mediations at home.  The two groups were assessed before and after the intervention:  the Social Phobia Inventory was used to assess social phobia and social anxiety; and Rosenburg’s Self Esteem Scale was used to measure the self-esteem of the participants.

Social Phobia Inventory (SPIN) questionnaire was developed in order to assess social anxiety or social phobia. This inventory is a self-assessment scale with 17 items including three subscales of phobia (6 items), avoidance (7 items), and physiological distress (4 items). Rosenberg’s Self-Esteem Scale (RSES) is a 10-item scale is to measure self-esteem. Originally, the scale was designed to assess the self-esteem of high school students. However, since its development, the scale has been used with a wider variety of groups including adults.

So, what did the study show?  The results showed that the social anxiety scores of the intervention group showed a significant decrease compared to their pre-test results, and the mean of the self-esteem scores of the intervention group members showed an increase compared to their pre-test results. These changes were not observed in the control group.  For the intervention group the mean SPIN score was reduced from 26.07 to 21.50 and the RSES scored increased from 0.89 to 2.58.

The researchers concluded: “The results revealed that the MBCT sessions significantly decreased social anxiety and increased self-esteem among the female adolescents suffering from social anxiety.”

So, if you are o someone you know is feeling anxious in social situations and have low self-esteem then MBCT may well be beneficial.  Try it.