Meditation in a lived faith context as a therapeutic intervention

for substance abuse, dependance and addiction: an empirical study

Dr Nikhil Patel, M.D.Psych.

Department of Neuropsychiatry & Deaddiction

Global Hospital & Research Centre, Mt.Abu, Rajasthan, India

ghrc@vsnl.com

Barbara Giorgio,

Australian Catholic University

North Sydney, Australia

b.giorgio@mackillop.acu.edu.au

Abstract The UN WHO labelled addiction as “the crisis of our time”. It is time now to look for low cost, self-administered, drug and side-effect free remedies for this age-old problem considered a “spiritual sickness”. A retrospective study by the Neuropsychiatry Department of Brahma Kumaris’ Global Hospital and Research Centre, Mount Abu, Rajasthan, India found that meditators from abroad who had a history of addiction used the self-help measure of RajaYoga meditation as taught by the Brahma Kumaris. According to their subjective reports, it proved to be the single most effective treatment for their substance abuse and dependence. Abstinence occurred within a very short time of beginning meditation practice and craving entirely ceased after one year. A close to total remission of addiction through meditation within a lived faith context demonstrates the importance of spirituality in meeting the need for fulfilment and satisfaction in life. Introduction The integration of behavioural health and medicine already has an established literature as “complementary medicine” (Helene & Ford, 2000; Andresen, 2000). It is often believed that science and spirituality are counterposed but in fact, the role of the scientific researcher in articulating the overlap, is to reveal an inherent structuring logic that already exists as received wisdom and a study becomes a way of simply formalizing and commenting on this wisdom. There is increasing professional attention to and scientific scrutiny of how spirituality moderates physical and mental health problems in the West, although it has a long tradition in the East. Recognizing the existence of a larger context for meaning seems to have a beneficial impact on personal health and well-being. Piedmont (2004) showed that spirituality represents a sixth dimension of personality and as such, brings to psychology the possibility of a deeper understanding of how we construct meaning and create a sense of unity among the many competing and conflicting forces that affect our lives. For recovering addicts, this broader meaning may provide ways of coping with stressful events (Corrington, 1989) or creating buffers against negative feelings (Warfield & Goldstein, 1996) as well as a higher level of personal maturity (Khantzian & Mack, 1989). “Mindfulness training” derived from Buddhism, is now being used as a psychotherapeutic intervention but its mode of use, like meditation, is without the proper context of lived faith and hence, may not be statistically significant enough as the case has been with previous studies on meditation (Varma, 2003). The present study comes under the heading of what the Neuropsychiatry unit at Global Hospital terms “holistic health” which refers to the interplay of physical, mental, social and spiritual health. The hospital staff embody in their lifestyle, shared religious observances and daily work, a spiritual approach to life not uncommon in the Indian healing tradition (Kakar, 2003). According to the model adopted in the unit, mental health is intimately related to spiritual health although both are distinct from each other. Conventional psychiatric practices are often based on symptom suppression with drugs that

cause serious side-effects and so people are increasingly turning to alternative and holistic practices. This is what took the author to Global Hospital in Rajasthan, India where holistic and conventional therapies overlap. In the psychiatric unit which specializes in the treatment of addictions, Neuropsychiatry unit employs an integrative approach in using drugs, conventional psychotherapeutic interventions and the learning of RajYoga meditation. He found that this kind of meditation can work alone as a powerful therapeutic tool and undertook the present study to confirm his observation. The critical factor in eliminating unwanted behaviours is an understanding of how the mind produces suffering and spiritual discipline is the method for eliminating disturbing thoughts which lead to emotional distress and addictions. Rationale Pardini et al., (2000) pointed out the paucity of empirical studies examining how spirituality assists in substance abuse treatment. Methodological problems and weak associations between variables have plagued previous studies on spirituality and meditation. These indeterminate results have been attributed to a studying meditation independent of its spiritual meaning, resulting in a weakening of its effect. Its benefits in stress reduction and hence health promotion, is arguably greatest when placed within a spiritual context and lived on a daily basis (Varma, 2003). Shapiro (1994), however, pointed out that removing the religious and philosophical context of meditation was necessary to establish its credibility. The authors of this paper do not accept that this is helpful to individuals hoping for long-term benefits. This study was carried out to address both the lack of research on RajYoga meditation specifically and research on meditation in a context of lived faith in the treatment of substance abuse. Addictions are thought to be particularly responsive to meditation hence the choice of this problem for the purpose of the study (Canter, 2003). Current theory on the causation of substance abuse is consistent with the psychological role of transcendence and its incorporation into future interventions. Literature Review Addiction According to the WHO, addiction is “a pathological relationship to any mood or mind-altering substance, person, place, event, experience or thing which has life-damaging consequences” (cited in Pemell, 2003, p.93). The use of drugs in generating a sense of wellbeing, and in instigating searches for the meaning in life, has a well-established literature. For instance, LSD (Leary, in Riedlinger, 1993), ecstasy (Saunders, 1996) and marijuana (Weil, 1998) have all been proved to produce ‘altered states of consciousness’ leading to a state of transcendence (Bowden, 1999). Weil (1998) attributes the use of such substances to an inherently positive drive to realize a ‘spiritual state of being’. The implication is that people seek some form of fulfilment through drug use, which they cannot, or choose not to achieve by other means. There is a need for some greater dimension to their lives, a sense of meaning, life satisfaction, wellbeing and self-actualization (Miller & Plant, 1996). McNamara (2000) however, argues that psychoactive substances can lead to dependence and finally addiction, often not from a desire for spiritual advancement but from a need to escape cumulative stress compounded by poor coping skills and an absence of social support. Denial and rationalisation keeps the addict in bondage to the object of addiction. According to Vipassana (Fleischmann, 1986), drug addiction is addiction to bodily sensations. Someone starts taking drugs for any number of reasons but eventually it is the sensations and their accompanying thoughts that drive a true addict to continue abusing drugs. The addict becomes caught in the web of craving and aversion. RajYoga teaches that deeply ingrained schemas (sanskaras) within the personality are responsible for addictions. Mind, intellect and sanskaras occur in a cyclic pattern which determines how we behave, think and feel. For example, when someone is first offered a cigarette, many thoughts occur out of which the intellect chooses the one that decides to smoke. Repetition deepens the developing habit until the intellect ceases to be able to choose.

Relapse occurs when people do not make a commitment to self-change (Pemell, 2003). RajYoga psychotherapist, Pemell (2003, p.99), uses a model of the self to describe how addictions are created. Compulsions to use and then abuse result from habituation through repeated action. In normal functioning, thoughts from the mind go to the intellect, then the conscience, before acting on the will. However, the mind of an addict drives the will, bypassing the checks of intellect and conscience. Insight is deadened and decision-making severely impaired. Until people reach “rock bottom”, only spiritual healing can save the person. Spirituality RajYoga meditation as an aspect of the ‘spiritual dimension’ to living endorses a whole range of positive valuations. According to personal construct psychology, spirituality is about people’s attempts to make meaning out of circumstances and situations, not simply through an appreciation of the immediate conditions, observable attitudes or palpable experiences, but through reflective, sensitive, ethereal and transcendent means (Mallick & Watts, 2001). It is a willingness to look continuously for meaning and purpose in life. Spiritual wellbeing is vital to overall healthy functioning. It is defined as the appreciation for the depth and richness of life, the vastness of the universe, and wonder at natural processes all of which operate within a personal belief system (Chandler, Holden, & Kolander, 1992). Spirituality, then, can be understood as an idiographic aspect of the person in contrast to religion which is a social phenomenon, an organized structure with many purposes beyond the individual. Spirituality lies, for most people, in the realm of super-ordinate constructs, and is arguably the most abstract of the over-arching constructs which relate to personal meanings of life. Meditation Meditation comes from the Latin “to heal”, to make whole. Addictions are manifestations of not only the fragmentation within the personality but also within society. Addiction is thought to be a spiritual sickness which meditation within a faith context heals. Research on meditation suggestive of its benefits has been compiled by Alexander, Robinson, Orme-Johnson, et al., (1994). They conducted a meta-analysis comparing relaxation and meditation techniques and found TM to be significantly more effective than relaxation practices or meditation for relaxation. It had the effect of reducing psychophysiological arousal, decreasing anxiety, increasing positive mental health measures of self-actualisation and reducing nicotine, alcohol and illicit drug use. Other research focuses on the overarching concept of spirituality within which meditation is an aspect of lived faith practice. Prezioso (1987) claims that the importance of spirituality is most clearly evidenced in the lives of substance abusers. The literature reports that positive spirituality helps alcoholics shift to an acknowledgment of the larger dimensions of their lives and while the specific elements of this transition are not well understood, spirituality clearly plays a part in successful outcomes (Pardini, et al., 2000; Booth & Martin, 1998). Relapse prevention (RP) programmes, based on the principles of social learning theory by Bandura, combines behavioural skills-training procedures, cognitive therapy and lifestyle rebalancing. Within lifestyle rebalancing, meditation and physical exercise are used to enhance the maintenance of behaviour change in the direction of better personal habits to prevent relapse (Marlatt & George, 1998). The meditation referred to in this study is taught in the context of the lived faith of Brahma Kumaris’ RajYoga study and lifestyle. This is in keeping with the hypothesis that meditation is most efficacious when practiced in its spiritual context. A more widely studied meditation technique known to be effective in drug addiction is Buddhist Vipassana (Fleischmann, 1986). Vipassana claims to be unique by working on the subconscious mind by emptying the conscious mind (Goenka, 2002). It is more technique-focussed than RajYoga but the effect is similar in that it fosters self-dependence and inner strength. Like RajYoga, it is experiential rather than intellectual.

One of the key variables that arises in RajYoga practitioners is that they experience peace of mind (BKRY, 1988; O’Donnell, 2000). They did not get this from just a meditation technique but from the experience of peace in meditation being applied to everyday life and its stressful situations. RajYoga is very much about retraining the mind in the direction of greater positivity and peace, to counter negative tendencies based on negative habits of thought and personality traits which make up the “addictive personality”. Awareness is a key factor in this process of recovery. The mind is trained to think before acting and to use the intellect to sift through thought and allow only what is positive and conducive to peace. Hypotheses The first hypothesis was that participants would report BrahmaKumaris RajYoga (BKRY) meditation’s effectiveness in the remission of substance abuse. The second hypothesis was that meditation would be seen as more effective than other psychiatric interventions in coping with withdrawal or craving. Methodology Setting The study was conducted at J.Watumull Global Hospital in Mount Abu, Rajasthan, India. The hospital is a unique establishment practicing both allopathic and alternative medicine and is attached to the headquarters of the Brahma Kumaris (BK) Spiritual University. Thousands of non-Indian meditators come here annually from many parts of the world. Participants Over a period of one year, 3,800 foreign meditators attended retreats at the BK meditation complex known as “Pandav Bhawan”. Instrument and Procedure Retreat participants with a past or present substance abuse history and who had been meditating for more than one year, were asked to complete a questionnaire while attending an interview at the hospital. 10% of all participants filled in the questionnaire at random. A total of 380 participants were divided into groups according to continent of origin. It was anticipated that there would be variation in type of drug used, quantity and frequency of use and degree of addiction. The group who volunteered to be surveyed were required to be “abusers or dependents”. Experimental and recreational users were not included in the study given that the objective was to find a relationship between meditation and cessation of addiction. Results Of the 380 participants, 65% reported “abuse/dependence” of nicotine, 91% of alcohol, 46% of cannabis, 19% of cocaine, 9% of opioids, 20% of other drugs such as amphetamines, prescription drugs etc. 46% reported heavy consumption of nicotine, 29% of alcohol, 33% of cocaine, 11% of opioids and 15% of other drugs. 71% overall, reported dependence on one or more of these substances.

Table 1 Substanc

e

Substance

Label

Psychiatric

Intervention RajaYoga

Nicotine 1 2 36

Alcohol 2 2 42

Cannabis 3 7 18

Cocaine 4 0 9

Opioids 5 2 4

Others 6 0 11

Graph 1

0

5

10

15

20

25

30

35

40

45

0 1 2 3 4 5 6 7

NUMBER OF PEOPLE

SUBSTANCE

Required Help for Persistent Withdrawal

Psychiatric

RajYoga

Table 2

Continent

Number Addicted

by Continent

Number for >75% Effectiveness

RY Meditation

Europe 216 202

Australia 50 45

America 46 44

Africa 13 12

Asia 55 48

Graph 2

Effectiveness of Raj Yoga Meditation in Substance Abuse

0

50

100

150

200

250

Europe Australia America Africa Asia

CONTINENT

NU

MB

ER

AD

DIC

TE

D

Addicted

RY meditation

From a glance at the two graphs it can be seen that both hypotheses were confirmed. The effectiveness of BKRY meditation in substance abuse was confirmed by 95% of participants. The help required for persistent craving graph shows that meditation was chosen in 90% of cases over other psychiatric intervention after one month of abstinence. However, looking at the relative sizes of samples, 2 out of

the 4 users of opioids requested psychiatric help. Dividing meditators by continent showed no favouring of one continent over another in the positive effect of BKRY. The data from the questionnaire also revealed a very rapid effect of meditation on cessation of substance use. 82% of participants reported abstinence within 1 month of beginning BKRY. Only 7% sought other help in addition to the meditation. Discussion 10% of all meditators were formerly suffering from substance addictions. This is not surprising according to the literature. The majority of participants as Westerners, would have been part of a youth culture that endorsed the recreational use of drugs which commonly led to misuse and addiction (Mallicki & Watts, 2001). To interpret the strong findings in this study, the literature suggests that spirituality replaces addiction because both are driven by the same need. The near total remission of addiction through meditation within a lived faith context in this study is therefore substantiated. Meditation when offered in the context of a lived faith or a spiritual way of life is qualitatively very different from meditation practices taught in isolation as relaxation exercises or the use of visualizations and affirmations. Different processes are at work. In a study by Piedmont (2004), spiritual transcendence, especially the facets of universality and connectedness, appear to play a significant role in substance abuse recovery (Piedmont, 2004). In general, the most effective techniques do not stop at relaxation of the body but aim to free the mind of negativity which then allows the development of positive qualities such as love, respect, co-operation, compassion and equanimity. The end result of a stress-free mind is mental health and happiness. Unlike Vipassana and other forms of meditation, RajaYoga follows the natural flow of the mind which is to be constantly engaged in thought. It teaches that the inner change has to occur at the level of mind to eliminate unwanted behaviours and to achieve a state of peace of mind. Concentration is not on the object or mantra but on the positive qualities of the inner self or soul – that part of mind that includes realization, feeling, will, thought, consciousness, intellect and judgment (BK Jayanthi, 2000). Meditation empowers the soul to begin healing from the “spiritual bankruptcy” of addiction. Elevated anxiety levels which precede the activity of addiction, a major factors in relapse, are reduced through daily meditation practice (Pemell, 2003). An added benefit is the natural feeling of ecstasy or bliss resulting from meditation experiences. Conclusion Meditation is not a cure-all for addiction but it assists the healing process and facilitates complete recovery. The results of this study show very strongly on simple descriptive statistics, that the BKRY form of meditation is most effective as a treatment for substance abuse and dependence and for the prevention of relapse. Beyond the particular “brand” of spirituality discussed in this paper, studies of other people in lived faith contexts might show similar results. Ultimately the people under the tyranny of substance abuse may find release from the prison of their emotional pain, low self-esteem and relationship failure in any spirituality whose therapeutic effect is to stress the inherent value of each person and their life in the overall scheme of the world. In transcendence, we experience a higher level of existence through which all of life is interconnected. The benefits do not belong to any one faith. It is the received wisdom. Implications of the Study Over 30 years ago, Robinson (1975) argued that in general, education on drug addiction failed because it did not reflect on the context in which drug use occurs and the existential concerns of users. He advocated understanding peoples’ values, needs and desires, particularly their spiritual needs for fulfilment, satisfaction and self-acceptance. To discover and handle the power for self-transformation required in removing addictions, is the “spiritual” therapy of RajaYoga. The practice of meditation in a shared faith setting complements the role of the psychologist to stimulate this power in clients so that

they become self-empowered. For people not open to a religious context, group therapy can be most beneficial. Piedmont’s (2004) study showed that the community appears to be very relevant in the successful treatment of substance abusers. This ties in with the element of transcendence whose elements of universality and connectedness counteract the narcissism that is so often characteristic of the substance abuser and provides a guideline for how to live an emotionally fulfilling life. Through listening to others, they can empathise and through compassion, free themselves from the bondage of their addictions. The contraindications are that it is not helpful to people in states of extreme agitation or or psychosis. In such cases, it is wise to medicate initially. The guidance of an experienced meditator is advised. A parasympathetic rebound effect is known to occur in people with certain medical conditions (Lazarus & Mayne, 1990). This must be taken into consideration in an initial assessment carried out by the meditation teacher. The implications for future research are that the interventions be developed which specifically access the spiritual qualities of an individual. Intervention strategies used now focus on interpersonal skills, personal organization, empathy, and emotional dysphoria, among others. The challenge is to find a way to develop a client's spiritual resources. Spirituality ought not be seen by health professionals as merely a cultural variable to be acknowledged in therapy but to view it as a method of transformation. BKRY meditation is one approach that could be given serious consideration as a sole or adjuvant therapy in drug addiction. It is free of side effects and imposes no financial burden. This particular style of mediation has the added advantage of being taught in a spiritual context of teachings and lifestyle observances. It is particularly useful for people who have a spiritual inclination. BKRY meditation is taught free of charge at many centres around the world and in Australia. The Adelaide centre is located on Portrush Rd, Linden Park, opposite Burnside Village. People can attend residential retreats on a donation basis facilitated by professional people at beautiful centres in Victoria and New South Wales. Limitations of the Study The findings reported here are exciting and suggest clinical interpretations that are supportive of current theory. However, conclusions are post hoc and need to be explicitly tested using more sophisticated methodologies and analytical techniques. Other limitations in a study of this nature are methodological. Exploratory studies of this nature are fraught with methodological difficulties involving sampling and data collection. It needs to be determined whether these findings would generalize to other groups. The treatment program itself was not controlled. It is possible that meditation would be a good predictor in a more secular program that has less intensive input. However, the findings from this study can serve as a set of hypotheses to be tested in future studies. In the future, independent judges should be used in making the final evaluations of psychosocial outcome. We are taking the word of the participants in a limited context and are unable to ascertain if substance abuse has converted to some other form of addiction.The reporting was subjective as no standardized measure was employed to gain information from the participants. The study did not account for intervening variables such as personality type, IQ, motivation, and others. As it was retrospective, there may be errors in memory if the addiction occurred many years ago and possible biases in what was remembered if subjects had been meditating for a very long time. In addition is the problem of confounding variables. Piedmont’s (2004) study showed that people who score higher on transcendence prior to treatment have better outcomes than those who scored lower. This indicates the possibility that people who come into RajYoga and persist with daily practices and lifestyle observances are already “spiritual”. This limits the applicability of spiritual intervention for substance abuse to a certain type of individual and may exclude many others who exhibit little or no trait of this nature.

A more in-depth analysis of the issues would have to include a consideration of the biological pathways involved in how meditation affects bodily states. For example, in this study, we would need to account for how severe somatic withdrawal symptoms which occur after cessation of use are moderated by meditation, in particular anxiety, depression and obsessive-compulsive behaviors. This subject will hopefully be taken up by the Australian researcher as a PhD topic. Recommendations In spite of its limitations, this study adds to the literature on the efficacy of meditation in the treatment of addiction. More specifically, it has added to the under-researched area of the use of meditation as a treatment within the context of a lived faith complete with daily teachings, practices and lifestyle observances. However, studies with validated scales and questionnaires, and employing statistical design and analysis need to be used for rigor, reliability and validity. More studies need to be carried out to address other aspects of lived faith in health care settings, particularly those that help us better understanding what mediates the effectiveness of meditation as practiced within a lived faith context, for both physical and mental health. Further Research This study initiates a series of on-going empirical studies on spirituality and health to be undertaken by a team of Indian BK medical practitioner-researchers at Global Hospital and the Australian author of this paper. The studies already under way by the same authors of this paper include: 1.“An empirical study on the effectiveness of BKRY meditation as an adjuvant intervention in treating and managing anxiety/depression states in a sample of patients attending the Neuropsychiatry department of Global hospital”. 2.A further study underway involving the BK team and the Australian author is: “An interview-based study on the quality of medical care delivery influencing health outcomes in patients as a function of the carers being part of one lived faith community at Global Hospital”. 3. An offshoot of the second study is: “Advancing psychosomatic medicine in the East for the West: Towards a holistic model of health and disease based on a theory of mind influencing body.” 4. This study is being undertaken by the Australian author. It is an exploratory study based on a guided questionnaire given to overseas meditators visiting Pandavbhawan,Mt. Abu over a period of 1 month in 2005. “An exploration of the factors which contribute to adherence to the BKRY lifestyle and meditation practices among a sample of Western practitioners and the effect of those factors on their self-rated health status.”

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