Introduction

1. A Qualitative Study on the introduction of Mindfulness-Based Relapse Prevention (MBRP) into a Therapeutic Community for substance abusers Presented by Anita Harris Research Assistant Coolmine Therapeutic Community

2. Introduction Overview of Mindfulness-Based Relapse Prevention Purpose of the study Methodology Findings Q&A

3. What is mindfulness? Jon KabatZinn describes Mindfulness as paying attention in a particular way; on purpose, in the present moment, and non-judgementally Emphasis is placed on the breath and teaching individuals to return to the present moment by focusing on the breath.

4. Mindfulness Meditation Traditionally rooted in ancient Eastern traditions, in particular Buddhism Recently adopted by the West in recent years as an effective therapeutic intervention for a number of psychological and medical problems Perhaps the most noted is mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn (1979) for individuals suffering with chronic pain and stress related disorders.

5. Mindfulness Based Interventions Other well researched and evidence based interventions by which mindfulness meditation is a core componenet include: Mindfulness-Based Cognitive Therapy(MBCT),proven to be effective for people with recurrent or relapsing depression. (Segal, Teasdale & Williams) Acceptance and Commitment Thaerapy (ACT) Diaclectical Behavioural Therapy (DBT) Mindfulness-Based Relapse Prevention (MBRP) for individuals with addictive behaviours. (Marlatt, Bowen, Chawla)

6. Mindfulness and Addiction Addiction is the repeated desire to avoid the present moment, which contributes to the urge to use.....(Larimer, 1999) Individuals with addictive behaviours have great difficulty accepting the present moment (Marlatt) Through cultivating mindfulness awareness it is suggested that individuals can create a space whereby they can respond skilfully instead of reacting automatically. Through the regular practise of formal and informal mindfulness practises, individuals can be fully in the present moment without being “wiped out by it”(Marlatt)

7. Mindfulness- Based Relapse Prevention An 8 week programme combining relapse prevention skills with mindfulness meditation A structured protocol with session by session agendas containing mindfulness practices/discussions and worksheets Inquiry process is a central component of mindfulness It is important that faciliators of the programme not only have experience with substance abuse treatment but are fully trained to deliver mindfulness training

8. Goals of MBRP 1. Help clients to developawareness of personal triggers and habitual reactions, and learn ways to create a pause in this seemingly automatic process. 2. Alter individualsrelationship to discomfort, learning to recognize challenging emotional and physical experiences and responding to them in skilful ways. 3. Help clients foster a non-judgmental, compassionate approach toward themselves and theirexperiences. 4. Build a lifestyle that supports both mindfulness practice and recovery (Marlatt)

9. Context/Background of the study In May 2011, Coolmine TC decided to introduce MBRP across its 3 main services, the men and women’s residentials and the drug free day programme Three Coolmine staff members were trained to deliver MBRP and acted as facilitators of the eight week programme. A pilot group was conducted prior to implementation to which I myself was a participant observer

10. Aims of the Study Aimof thestudy was to evaluate the impact of the newly introduced MBRP on the TC to which it was introduced and HOWit may be helpful to individuals with addictive behaviours

11. Objectives: Investigate how MBRP was perceived and received by both clients and staff at Coolmine TC Gain insight into the self perceived benefits/effects of MBRP Outline the mechanisms of how MBRP may be helpful to individuals with substance abuse problems Place in the broader context of a TC’ s approach to treatment

12. Methodology Aqualitative approach was deemed most appropriate. Methods Used include: Observation Focus Groups with clients only in each of the three settings immediately following the end of the 8 week programme Semi-structured individual interviews with both clients and Facilitators immediately following the end of the 8 week programme

13. Findings: Objective 1: Investigate how MBRP was perceived and received by both clients and staff at Coolmine TC Meditation as relaxation???. Largely well received by both clients and staff Better received by the clients in the residential programme than those in the day programme- Surprising giving that it is designed as an aftercare programme

14. Objective 1 contd..... No one particular reason for lack of enthusiasm in the day programme but facilitators lack of confidence in delivering the programme may have being a facto Facilitator stated she was not ready to deliver and felt she required more time and training before she could confidently deliver.

15. Objective 1 Contd...... In both residentials, it was received a lot more positively. Critical turning point for most clients was in week 3-4 of the programme-Got an understanding The majority of clients and staff perceived mindfulness to be a highly valuable and beneficial programme that could help them with their recovery process

16. Critical Turning Point something happened to me in that room in the third week. It was like I could feel it, all the tension andworry wash away from me just for that twenty minutes or whatever it was. I had relief from my head. I felt it, I felt relief for the first time since I’d been in here and since then I love it; I can say, hand on my heart, I love mindfulness, it gives me that relief; and I don’t think anyone would understand how much it means to have relief from your own head unless they had been tormented themselves with their head. (Marie).

17. Objective 2: Benefits/Effects of MBRP Benefits cited by many of the clients: To learn how to sit with youself and be okay Being taught how to return to the present moment Acceptance of uncomfortable thoughts and emotions Heightened awareness Practical and useful practices for triggers/cravings and high risk situations Reduced stress Anger management Increased retention/ Helped many clients stay in the community Heads slowed down

18. Objective 3:Outline the mechanisms of how MBRP may be helpful to individuals with substance abuse problems A highly beneficial technique cited by many was the Sober Breathing Space (a 3 minute mini meditation technique) Stop-stop right what your doing now Observe- what is going on with you right now in this moment, in your body, your thoughts, your emotions Breathe-bring your attention to breathing, keep your focus there Expand- your awareness to include a sense of the whole body and the situation you are in Respond-to whatever situation with awareness

19. Objective 3 Contd....How MBRP may be helpful • Formal practices helped many calm the mind • Thoughtsare just thoughts-a very powerful message to many of the clients • Able to verbalise how they are feeling-inquiry process really helped many clients put into words how they are feeling and locate it in their body • “It’ okay”- Strong message “It’s okay, it’s okay to feel this way. Really, really powerful; nearlychoked me up at one stage when I heard it in one session. I really felt like crying. But it’s something I tell myself a lot of the time now. That meant a lot to me”.

20. Objective 3 contd... • Acceptance of emotions/thoughts/situations • For many the inquiry process that follows the practises has helped them to talk about cravings-which many stated they would not have done in other groups • Interesting finding was how many, especially women struggled with the Loving Kindness practise. • Became very evident how self critical many clients are

21. Objective 4: Place in the broader context of a TC’ s approach to treatment Mindfulness as confrontational- Many clients described it as hard work and as the most confrontational work they have ever did The educative and therapeutic elements of MBRP appear o fit well with the TC approach Like the TC approach, it seeks to address the whole self by placing clients at the centre of their recovery It’s a self help approach which uses group as method For one staff member and a couple of clients the practise of “urge surfing” conflicted with the TC approach to treatment

22. Conclusion Significant changes have occurred at both staff and clients level- all largely positive about the introduction of MBRP Study would support the view that Coolmine as an organisation has changed significantly-open to change Some implementation issues in Day programme All in all, a programme viewed by the staff and clients as one with real perceived gains

23. Recommendations More thought exploring the differences between the day programme and residentials-so that future use will be based on a recognition of difference Closed groups more beneficial Further training for facilitators Facilitators to be mindful of the language used and spend more time on the introductory piece with clients

24. Thank You !Q&A