Children Who Experience Family Members’ Trauma at Twice the Risk for Substance Abuse as Adults

By Richard Taite

AbuseWe know the effects of childhood traumas like abuse and neglect on later substance abuse. But what impact does second hand trauma have? A study published in the August issue of the journal Addiction shows that when a child under age 15 is exposed to a family member’s trauma (e.g. a parent or sibling being the victim of violent assault or a parent’s cancer diagnosis), that child has approximately twice the risk of struggling with drug and alcohol problems 6 years later.

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Opioid Drug Deaths Cost Half a Million Years of Life in the U.S. Each Year

By Richard Taite

PillsIn 1991, the band Nirvana released the classic album Nevermind and Kurt Cobain was the face of the grunge scene that spread from Seattle across the United States. If you’re old enough, remember back: it was a gritty time that seemed defined by self-destructive heroin use. A new study on early view at the journal Addiction shows that, at least in terms of opioid-related deaths, 1991 was nothing compared to today. Between 1991 and 2010, opioid-related deaths increased 242 percent. Today, deaths related to opioid use account for one out of every eight deaths of people 25-34 years old.

The report, which uses coroner data from Ontario, Canada, blames the rise not on heroin itself, but on prescription opioid pain medications. The medical use of prescription painkillers is up; the recreational use of these same prescription painkillers is up; and deaths due to opioid use are up alongside use – from 127 deaths per year in 1992 to 550 deaths per year in 2010.

Interestingly, the study didn’t leave its description of the impact of opioids at the level of deaths alone. Inside this number is a statistic called years of life lost. If average life expectancy is 80 years and a person dies of an overdose at age 75, that person would have lost 5 years of life. If a person dies in the same way at age 30, that person would have lost 50 years of life. Because opioids tended to kill younger people (median age 42), not only is the overall number of deaths high, but the years of life lost to drugs is staggering.

Overall, the study found that opioid drug deaths cost the people of Ontario, Canada 21,927 years of life in 2010. These years lost were greater than the years of life lost to alcohol use (18,465 years of life lost). In fact, the years of life lost to opioids were greater than those lost to pneumonia, HIV/AIDS, or influenza.

The authors point out that if you extrapolate the data to the population of the United States, “where rates of opioid use, misuse and death are comparable to those in Canada,” the drugs would result in more than half a million years of life lost per year.

These drugs kill young people, taking not only lives but, tragically, many years of life with each death. The study writes, “The finding that one in eight deaths among young adults were attributable to opioids underlines the urgent need for a change in perception regarding the safety of these medications.”

**

Richard Taite is founder and CEO of Cliffside Malibu, offering evidence-based, individualized addiction treatment based on the Stages of Change model. He is also co-author with Constance Scharff of the book Ending Addiction for Good.



Does Food Addiction Really Exist?

By Richard Taite

Donuts.2When people use heroin, their brains become physiologically dependent on the drug and the behavioral patterns of use become written alongside this need. That’s addiction: both behaviorally and biologically, heroin addicts need the drug. When they don’t get it, they crave it, even though they may no longer like it and know the drug is bad for them. If the drug is withheld long enough, the addict experiences symptoms of withdrawal.

Now, an important review of food addiction in the Journal of Nutrition points out many parallels between heroin and food. First, drugs and food make us feel good in the same ways – we tend to think about drug addiction first and then wonder how food addiction might be like it, but, really, drugs take over reward pathways in the brain that were originally built for food. The high you get from a drug takes over a system in your brain that, way back in evolutionary time, made you leave your cave to look for vittles. And cravings for drugs are extreme versions of the feelings of hunger and satisfaction that come from eating.

Here’s a little more about how it works: As you probably know, drugs like cocaine create dopamine release in the brain – the longer you use the drug, the less sensitive your brain is to it, and so the more cocaine you need to create dopamine release. The same dopamine desensitization is true in obese people – food creates dopamine release in the brain, but people who chronically overeat require more and more food to create the same “good feeling” of dopamine release.

There’s another critical point in the definition of drug addiction: addicts continue to crave the substance long after they report liking it. With food, most of the foods “addicted” people crave are also foods they like…and continue to like. People who consider themselves food addicts are more likely to crave cake than cucumbers. But there are some exceptions: a study that put people on a bland, vanilla food replacement shake found that in the week after the study ended, some people reported craving the shake even though they also said they didn’t like it – making people accustomed to the “drug” and then taking it away produced cravings even when, like heroin for most long-term addicts, they no longer liked the drug.

So, according to the Journal of Nutrition review, here’s what we know: “Two of the criteria mentioned in the Diagnostic and Statistical Manual of Mental Disorders are tolerance and withdrawal and there is evidence for food withdrawal and tolerance.”

Another important criteria for addiction is consequences; part of the definition of drug or alcohol addiction is the negative consequences of this addiction. What are the negative consequences of food? The review points out a critical distinction: for healthy, normal-weight people, the consequences of food are generally positive; for obese people or people who control weight through unhealthy means like bulimia, the consequences of food can be negative, up to and including early death, just as with drug addiction.

“Just as some individuals can drink alcohol responsibly and others cannot, there are individual differences in reactions to food (due to genetic predisposition or to prior experience) and some people can consume food in moderation more easily than others,” the review writes.

In other words, food may be just like alcohol; for people who are addicted, the substances are “addictive”; for people who are not addicted, because the substances don’t really do harm, they are not “addictive”.

So you want to know if food is addictive? Here’s what the review says: “overweight or obese individuals probably do meet the clinical criterion for food addiction, [for example] persistent desire or repeated unsuccessful attempts to quit; important social, occupational, or recreational activities given up or reduced; continued use despite knowledge of adverse consequences.”

If you crave food even past liking it, become desensitized to consumption so that you need more and more to get the same good feeling, and are past a tipping point at which eating has the potential to do real harm, you very well may be addicted to food.

***

Richard Taite is founder and CEO of Cliffside Malibu, offering evidence-based, individualized addiction treatment based on the Stages of Change model. He is also co-author with Constance Scharff of the book Ending Addiction for Good.



People on Autism Spectrum at Increased Risk for Substance Abuse

By Richard Taite

Booze.SplashGenerally, people on the autism spectrum tend to be personally cautious and socially withdrawn. As you would expect, previous research shows that people with autism tend to have low rates of substance abuse – the preference for low risk and avoidance of social situations means less drinking or drug use. But new research from the Washington University School of Medicine found the opposite: in their study of 3,080 Australian twins, people with symptoms of autism were more likely than people without symptoms to abuse alcohol and marijuana. The interesting reason why and perhaps implications for protecting both autistic people and those who happen to be socially withdrawn are inside their fascinating research.

First, people on the autism spectrum are a tricky group to study – because the spectrum includes many people with mild symptoms like those of Asperger’s syndrome, the less extreme side of the spectrum which may go undiagnosed. And so instead of studying people formally diagnosed with autism, in this case the researchers asked people about their symptoms that tend to be related to autism. How would alcohol and marijuana use correlate with symptoms like social-interaction difficulties, communication challenges and a tendency to engage in repetitive behaviors?

Interestingly, what they found is that people with autistic traits were no more likely to drink or use marijuana than people without these traits, but that people with autistic traits who drank or smoked pot were more likely to become addicted to or otherwise abuse these substances

In their study, just under 20 percent of twins without autistic traits met the criteria for alcoholism. But of people with autistic traits, 35 percent were alcohol-dependent. With marijuana, 23 percent of the controls had used marijuana more than 10 times in their lives, compared with 39 percent of people with six or more autistic symptoms.

In a press release accompanying the research, Duneesha De Alwis, PhD, a postdoctoral fellow in the Department of Psychiatry, wrote, “People with autistic traits can be socially withdrawn, so drinking with peers is less likely. But if they do start drinking, even alone, they tend to repeat that behavior, which puts them at increased risk for alcohol dependence.”

But what about previous findings that people with autism are protected from substance abuse? The answer, according to the researchers, is the difference between symptoms and diagnosis. Think about it: a diagnosis is likely to accompany a more extreme form of the disorder. And it seems from this research as if a more extreme form of the disorder may keep autistic people from even experimenting with substances.

But then at the level of individual symptoms or even clusters of symptoms, “It could be that some traits related to autism are protective, while others elevate the risk for alcohol and substance-abuse problems,” says Arpana Agrawal, PhD, associate professor of psychiatry at the university.

If autism itself is protective, autistic tendencies may be a risk factor for substance abuse. Which autistic symptoms increase the risk? Are people with only one or two autistic tendencies at higher risk or are there tipping points on the spectrum that increase and then decrease risk? Agarwal, De Alwis and colleagues are asking these questions in further research. For the time being, I would love to hear your experience with autism, symptoms that could be considered autistic, and substance abuse. What’s your take on the intersection of these challenges?

***

Richard Taite is founder and CEO of Cliffside Malibu, offering evidence-based, individualized addiction treatment based on the Stages of Change model. He is also co-author with Constance Scharff of the book Ending Addiction for Good.



5 Reasons Substance Abuse is Even More Dangerous for Young People

By Richard Taite

We all have secrets.
When you are young, you shape your possibilities. Research in psychology and neuroscience shows us that your personality and your intelligence develop during childhood and teenage years until becoming fully developed by age 25. Likewise, during your younger years, you write the story you tell about yourself – who are you, how do you understand your worth and your potential? Then you live this story through your adult life. In other words, the person you shape while growing up can be the person you’re stuck with. So allowing drugs or alcohol to influence this young person can affect not just who you are today, but who you can be and will become. Here are five reasons why substance abuse is especially dangerous for young people.

1. Damage to the Developing Brain

The brain you are born with is not necessarily the same brain you bring into adulthood. Between these two events – birth and about age 25 – your brain is developing to meet the needs of your environment. How you are parented, intellectual challenges, your nutrition and many more things influence how parts of your brain develop during this time. Substances of abuse can change or stop this development.

A review in the journal Alcoholism: Clinical & Experimental Research collects what we know about how, exactly, alcohol influences the developing brain. The review writes that brain areas “actively developing during adolescence include the prefrontal cortex, limbic system areas, and white matter myelin. These areas serving cognitive, behavioral, and emotional regulation may be particularly vulnerable to adverse alcohol effects.”

Specifically, the prefrontal cortex controls complex decision-making and the “executive function” activities of reasoning, planning and willpower; the limbic system controls emotion, motivation and emotional learning; and white matter myelin is the coating of insulation that allows electrical signals to travel efficiently throughout the brain (and which breaks down in Alzheimer’s disease). Together, impacts on the development of these systems can lead to impulsivity, sensation-seeking and slower cognitive function.

2. Risk of Addiction

According to the National Council on Alcoholism and Drug Dependence, people who start drinking before age 15 are five times more likely to develop alcohol abuse and dependence than people who start after age 21. Part of this, again, is due to the structure and function of the adolescent brain. Basically, the teen brain craves new experiences. It is wired to be impulsive. For most people, this is a transitional period – you are impulsive in your youth and then learn moderation as you age. Of course, impulsivity makes teenagers more likely to experiment with substances of abuse. And, unfortunately, as this article in the American Journal of Psychiatry shows, teens who abuse substances can get stuck in this developmental period of impulsivity. When a young person uses drugs or alcohol, it can embalm him or her in a state of readiness for more drugs and alcohol. The younger you start using, the more serious the problem is likely to become (and the more likely the problem will become serious).

3. Long-Term Health Risk

Here’s the obvious part: the longer you subject your body to substances of abuse, the more likely you are to eventually experience health consequences like cardiovascular disease, dementia and even cancer. The earlier you start, the more years you have available for substance abuse, and the more likely these substances are to eventually start “breaking down” the body systems they affect. But in addition to this traditional view of accumulated risk, new evidence shows that substances may be more harmful to young bodies than to developed bodies. Basically, young bodies aren’t ready to handle the challenge of substances. For example, this study shows that younger people who drink heavily are even more likely than older people who drink similar amounts for similar durations to experience cirrhosis of the liver.

4. Behavioral Health Risk

Health risks associated with teen and young-adult substance use aren’t limited to the direct effects of the substances themselves. Risk also comes from the behaviors of young people who use substances. According to the NCADD fact sheet Facts About Underage Drinking (paid download here), “Each year, approximately 5,000 young people under the age of 21 die as a result of underage drinking.  This includes about 1,900 deaths from motor vehicle crashes, 1,600 as a result of homicides, 300 from suicide, and hundreds from other injuries such as falls, burns, and drownings. And, approximately 600,000 college students are unintentionally injured while under the influence of alcohol.  Approximately 700,000 students are assaulted by other students who have been drinking and about 100,000 students are victims of alcohol-related sexual assault or date rape.”

Substances are dangerous. They can also make you dangerous to yourself or to others.

5. Social Development

Just as physical development is in overdrive during teenage and young adult years, social development is in high gear as well. According to the psychologist Erik Erikson, the primary developmental challenge of young adulthood is to resolve the conflict of intimacy versus isolation – can you give away some independence to form a close relationship with a partner? Erikson saw the ability to form these bonds as essential to the path of human development that leads later to productivity in middle age and integrity as an older person. As long as substance abuse blocks the potential for intimacy, a young person will remain stuck in their personal and social development. Similar is true of career; what you do as a young person defines much of your potential later in life.

The foundation for successful relationships and careers is laid during young adulthood. And these two social stepping-stones in turn lay the foundation for wellbeing in later life. If this critical period is instead spent with substances of abuse, young people can miss these important milestones in their social development.

In young adulthood, life paths diverge – some paths point toward wellbeing, intimacy, security and success; others point toward struggle, declining health, and isolation. Substance abuse at any age can be devastating to mind, body and spirit, but especially when young, addiction or dependence can define the direction of your future life path. Which path will you choose? The choices you make when young can help define who you will be for the rest of your life.

***

Richard Taite is founder and CEO of Cliffside Malibu, offering evidence-based, individualized addiction treatment based on the Stages of Change model. He is also coauthor with Dr. Constance Scharff of the book Ending Addiction for Good.

Image: martinak15 via Compfight



5 Important Advances in Addiction Treatment

By Richard Taite

1000 yard stareThe statistics on addiction treatment and recovery are grim. It is estimated that 10% of Americans, more than thirty million people in all, suffer from addiction, but only 13% of those will ever seek treatment. While they have helped millions to get sober, 12-step programs have a success rate estimated at 8-13%, though some suggest far less, in the range of 5%. There has been no rigorous exploration of 12-step programs, but they continue to be the “treatment of choice” despite their poor outcomes. Of those who go to residential treatment programs, one year post-treatment it is estimated that only 13% remain sober. This might be because most treatment programs rely heavily on the 12-step model for their treatment protocols. Treatment centers like mine, Cliffside Malibu, have a 70% recovery rate at one year, but sadly, most treatment centers have not moved on as we have, to use the evidence-based treatment protocols that are proven to work. …and most do not divulge their success rates.

There is a better way. Over the past two decades, evidence-based therapies have developed bringing hope for true recovery to the addiction treatment industry. Evidence-based simply means “scientifically proven.” These various therapies, when used together, create a treatment synergy that allows for real, long-lasting recovery. My full-time Director of Addiction Research, Dr. Constance Scharff, and I wrote a book, Ending Addiction for Good, now in its second edition, detailing this treatment approach in the hope that other treatment facilities would upgrade their treatment protocols to include these proven techniques. Meanwhile, our efforts are also focused on public education, in the hope that the public will demand from treatment providers access to therapies that truly work.

What are the greatest inroads into addiction treatment? No single treatment is the be-all, end-all, but here are a few for your consideration.

1. Evidence-Based Treatment

Evidence-based treatment is based on the latest scientific research. What works in addiction treatment and what does not is studied and published in academic journals. This is an ever-changing set of treatment protocols, changing as new studies are released and new treatment procedures developed. These treatments can come from any number of fields: medicine, psychology, neuroscience, holistic health practices and/or complementary medicine. Experts are in agreement that evidence-based practices are the most effective for long-term recovery.

The finest treatment centers, like Cliffside Malibu, use a variety of scientifically proven methods with their clients. None of these treatments, on their own, will “cure” addiction, but when used together, they create lasting, long-term recovery when clients complete a full-term of treatment, usually three to four months in duration.

The majority of addiction treatment centers have not moved from 12 step model treatment to evidence-based treatment. This is tragic. 12 step programs were never designed to be primary treatment. While useful, they are support groups of individuals without training in helping people overcome the deep wounds that cause addiction. 12 step programs are an important supplement to treatment, but should not be considered treatment when used alone.

2. Individualized Care

Receiving individualized treatment is also critical for long-term addiction recovery to be successful. Many treatment facilities, to manage costs, put all clients through the same treatment protocol. At eight you might have a meditation group, at 8:30 breakfast followed by a 12-step meeting, group process session, art therapy, and lunch. While this may seem like a productive, well-planned day, it is nothing more than a way to fill the hours. To recover from addiction, one must get at the root causes of their addiction problem – which means using a variety of therapies in an individualized process to overcome these old wounds and build a path to recovery. You or your loved one, because of your particular history of trauma, the drugs you’ve been using, the dosage, and the amount of time you’ve been using, will require a personalized treatment plan using a wide-array of treatments, to overcome addiction for good.

3. Intensive One-on-One Psychotherapy

One-on-one psychotherapy, which should take place at least three days a week in residential treatment and is suggested twice a week for the first year of sobriety, is critical to creating lasting addiction recovery. Its goal is to examine and overcome the psychological causes of addiction. Whatever the trigger was that made a person need to use alcohol or drugs in the first place, that needs to be examined. If this is done, recovery is more likely to stick.

Why is psychotherapy so important? It allows an individual first to receive support and care in a safe environment and build a trusting therapeutic relationship with someone with the skill to help process the pain or trauma from the past. Addiction rarely develops without archaic pain. In order to live a new life, the addict must work through those issues and gain skills for dealing with future difficult events. In this way, the addict develops tools for living and having important, appropriate intimate relationships with others.

4. The Stages of Change

Developed by one of the world’s leading psychologists, Dr. James Prochaska, and his colleagues from the University of Maryland, the Stages of Change model teaches us that change happens in a predictable manner. Because we know how change occurs, we can also anticipate the likely obstacles to change. In other words, if we know where a person is in the change process, we can help them avoid the common issues that cause relapse. At Cliffside Malibu, we walk with a person through the stages of change, helping them navigate the change process safely and effectively. Through an aftercare plan and ongoing support, we’re able to help an individual move through the stages until they are in the “maintenance” stage and effectively able to manage their recovery on their own.

5. Neuroscience

The latest discoveries in neuroscience are teaching us that the real change of addiction recovery is happening in the brain. The brain is much more dynamic and malleable than we ever imagined. The latest research indicates that while the brain is changed by addiction, rewired so to speak, it is also changed, also rewired, by recovery. Our Director of Addiction Research is working with international leaders in neuroscience to show how the brain can be renewed, in a sense, by addiction treatment and recovery.

These are but a few of the many advances being made in addiction treatment. The bottom line: be careful where you send your loved one for treatment. Ask about evidence-based treatment and find out what, if any, of the latest scientifically proven methods of addiction treatment the treatment center you’ve chosen is using. Your loved one deserves the best. There is real hope now in the field of addiction treatment, real recovery. Demand that your loved one receive treatment that is scientifically proven to be effective. They deserve it.

***

Richard Taite is founder and CEO of Cliffside Malibu, offering evidence-based, individualized addiction treatment based on the Stages of Change model. He is also co-author with Constance Scharff of the book Ending Addiction for Good.

Image: Neil Moralee via Compfight

 



This Summer, We Owe Our Veterans an Honest Look at PTSD, Addiction & Suicide

By Richard Taite

Tomb of the Unknowns ("Unknown Soldier") - U.S.Summer is the season we honor our veterans. There’s Memorial Day and the 4th of July, but even beyond these holidays, a summer filled with barbecues and Slip n’ Slides is a time to appreciate the life our country offers and remember the veterans who make it possible. This summer as we are remembering our veterans’ contributions, we are forced to confront our own failures. See, there’s an implicit deal we make as a society with these people who fight for our freedom – you risk your lives so that we don’t have to, and in return we as a society will take care of you. With scandals at V.A. hospitals, we’ve reneged on our end of the deal.

It’s time to recommit to the health of our veterans who willingly sacrifice so much. Part of this commitment must be on the part of health systems to work toward making our veterans whole in body and in mind. But another part must come from you and from me and from everyone who makes a community of support for returning veterans. It is our responsibility to work toward understanding the difficult experiences that dot our veterans’ paths to recovery.

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This Father’s Day, For the First Time, I Am Terrified

By Richard Taite

father and son [1]This Father’s Day, for the first time in my life, I find myself nearly struck dumb with fear. I am the proud father of a one-year-old boy and a four-year-old girl whom I love more than the sun and the moon – more than I love my own being. I am also the founder and CEO of an addiction treatment center, where I see the horrors of what can happen to human beings through their own bad choices and being taken advantage of by others. Until this year my kids seemed so little, so young. They were at home; I could protect them. This year, I am looking at kindergartens for my eldest and I can’t help but see the world through the lens of my profession. What I see is terrifying. I can’t protect them, not all the time. In this world of temptation and sometimes danger, the best I can hope is that my children will learn to become responsible for themselves.

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Synthetic Drug Use Skyrocketing, Targeting Young Users

By Richard Taite
Chemistry.2

Chemistry.2Quick: in 15 seconds, name as many drugs as you can. What did you come up with? Does the list include heroin, marijuana, and meth? Maybe you also thought of cocaine, ecstasy, LSD, alcohol, or the wide variety of prescription drugs. But what about Spice, Molly, Bath Salts, Krokodil, and K2? A recent report by the United Nations Office on Drugs and Crime (UNODC) shows that the manufacture and use of synthetic drugs is skyrocketing – in 2008, about 80 synthetic psychoactive substances had been reported; by 2013 that number had grown to 348. And it’s kids who are widely using these drugs. For example, the National Institute on Drug Abuse reports that in 2012, 11.3 percent of high school seniors reported using synthetic marijuana (mostly Spice) within the past year.

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For Addiction Treatment, Not All Mindfulness Strategies are Created Equal

By Richard Taite

Thailand Sunset  [ShotHotspot.com]When included in addiction treatment and relapse prevention programs, mindfulness and meditation strategies have been shown to reduce anxiety and help to prevent relapse. But mindfulness and meditation are separate practices and even within meditation, not all styles produce the same results. Which is best?

“Anxiety is universal to the human condition, but addicts experience it to an extreme because they have real problems. Meditation and mindfulness practices can help an addict stop worrying about the past, stop fussing about the future, and can help keep an addict from being caught up in racing thoughts about things they can’t control,” says Constance Scharff, PhD, Director of Addiction Research at Cliffside Malibu Treatment Center.

The more stress and anxiety your brain experiences, the more prone you are to addiction. The same is true of trauma – people who have experienced traumatic events are more likely to abuse substances than people without trauma histories. It’s these two challenges – stress and the influence of traumatic memories – that meditation or mindfulness training are thought to heal in people undergoing addiction treatment.

Scharff describes mindfulness as awareness of the present moment. Within meditation practices, there are two major schools – concentrative meditation in which a person focuses on a thought, a sound or on breathing, and nondirective meditation in which a person gently unfocuses his or her mind and lets thoughts wander.

“What we’re learning is that these practices physically change the way the brain works,” Scharff says.

For example, a new study published in the journal Frontiers in Human Neuroscience used fMRI imaging to look inside the brains of 14 experienced meditators. First, the researchers had people chant a sound while focusing their minds on the meditation syllables. Then researchers had people meditate again, but this time letting their minds wander. They also compared both meditation strategies to rest.

The group from the Norwegian University of Science and Technology found that unfocused meditation led to the most activation of brain areas that deal with the processing of memories and emotions. In fact, unfocused mediation far outperformed both focused meditation and rest in its activation of these areas essential for stress reduction and the successful processing of traumatic experiences.

The authors write that, “These techniques are thought to facilitate mental processing of emotional experiences, thereby contributing to wellness and stress management.”

Likewise, a host of studies show long-term changes in brain structures due to mindfulness and meditation practices, including increased gray matter density, increased neuroplasticity (the brain’s ability to create new synapses), increased activation in brain areas that control attention, and even temperature changes in the brain. New research at the UCLA Mindful Awareness Research Center and elsewhere shows these visible, physical changes are sculpted by the practice of meditation – the more you meditate, the more your brain is changed.

“In addition to long-term changes in the mechanics of the brain, at Cliffside we see another, more short-term benefit – we see addicts making an effort to focus on the things that are happening right now and there’s a calm from making that effort,” Scharff says.

Even outside the ways in which meditation changes the brain, and outside the effects of mindfulness practice on focusing attention on the present, the process of learning to the skill itself may provide a valuable forum in which to practice self change.

“For me, the important part is learning to be non-judgmental,” Scharff says. “A person may only go three seconds before a thought intrudes, and that’s OK. It’s the process of accepting current limitations and learning to fail safely without self-judgment that is beneficial.”

Richard Taite is founder and CEO of Cliffside Malibu, offering evidence-based, individualized addiction treatment based on the Stages of Change model. He is also co-author with Constance Scharff of the book Ending Addiction for Good.

Image: Darren Johnson via Compfight

 



 
 

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