Over the past fifty years, treatment for alcohol and substance addiction – now called alcohol use disorder (AUD) or substance use disorder (SUD) – has evolved in several significant ways.

The first and most important shift in addiction treatment involved a paradigm shift. Most members of the medical profession and general public now have a new view of the disordered use of substances. The dominant concept of addiction – before the change – was that people who developed addiction had a character flaw, poor willpower, questionable morals, or simply made poor decisions.

That idea is now almost a thing of the past. But many people, both medical professionals and laypeople alike, still harbor those ideas about addiction. Many don’t realize it, but that’s why the stigma around addiction and treatment persists today. In professional circles, however, the moral failing/personal weakness model of addiction has been largely replaced by what’s known as the disease model of addiction.

What is the Disease Model?

Here’s how the American Society of Addiction Medicine defines the disease model:

“Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry…Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability of premature death.”

The takeaway from this definition is that addiction has nothing to do with character or morals. Instead, it has everything to do with changes in the brain caused by repeated exposure to substances of misuse. That change was important – but it was only the first step.

The second way addiction treatment changed is that medical professionals began to understand that treatment for addiction works. More than that, the type of treatment that works is similar to treatment for other chronic, relapsing diseases . Effective treatment for AUD/SUD is integrated, addresses the whole person, and includes behavioral modification, lifestyle changes, community support, and in some cases, medication – just like treatment for conditions such as diabetes, hypertension, or cancer.

The third way addiction treatment has changed involves the role of complementary therapeutic support. That change is directly related to the integrated model of treatment. The complementary supports in integrated treatment help people with AUD/SUD make many of the lifestyle changes necessary for successful, lifelong recovery.

We’ll now offer a complete definition of complementary medicine, then discuss its role in contemporary approaches to addiction treatment.

What is Complementary Medicine?

The National Center for Complementary an Integrative Health (NCCIH), a division of the National Institutes of Health (NIH), defines complementary medicine as any approach to treatment that’s outside the mainstream but used in combination with traditional medicine. Most people place complementary medicine in the same category as alternative or integrative medicine, but that’s not entirely accurate.

Here’s a helpful way to think about the three terms:

• Complementary medicine means approaches to treatment used in addition to traditional, mainstream approaches to treatment
• Alternative medicine means approaches to treatment used instead of traditional, mainstream approaches for treatment
• Integrative medicine means an approach to treatment that coordinates the use of complementary and traditional treatment in a patient-focused, holistic manner that treats the entire person – mind, body, and spirit – rather than focusing on one group of symptoms or addressing problems with one physiological system.

Best practices for substance use disorder treatment are integrative – as described above – and use complementary treatment modalities only in addition to traditional, evidence-based practices, and never instead of. While the evidence base for the effectiveness of complementary modalities is expanding rapidly, the general idea is that they do not replace traditional treatment. Rather, they act as healthy lifestyle supports that improve overall recovery outcomes.

According to the NCCIH, complementary modalities include, but are not limited to, the following:

• Yoga
• Meditation
• Chiropractic Care
• Mindfulness

One reason these modalities are now part of substance use disorder treatment is their increasing acceptance and use by the general population. Most people know yoga, meditation, and mindfulness are more popular now than ever. They know these techniques can help improve quality of life on a variety of levels. These approaches don’t just seem more popular than they were 20, 10, or even five years ago.

Data shows that they actually are more popular.

The Latest Statistics on Complementary Medicine

Every five years, the National Center for Health Statistics (NCHS) collaborates with the National Institutes of Health (NIH) to conduct a comprehensive survey of the U.S. population, called the National Health Interview Survey (NHIS). The 2017 NHIS showed a significant increase in the use of complementary health approaches between 2012 and 2017.

Here are the highlights of the NCHS Data Brief on the 2017 NHIS.

Complementary Approaches: What People are Trying

• Yoga is the most common complementary modality in the U.S.
  • 9.5% of respondents in 2012 indicated they practiced yoga
  • 14.3% of respondents in 2017 indicated they practiced yoga
    • 19.8% of women
    • 8.6% men
  • Use of yoga was highest among adults 18-44
• Meditation is the second most common complementary modality in the U.S. Use of meditation tripled between 2012 and 2017.
  • 4.9% of respondents in 2012 indicated they meditated
  • 14.2% of respondents in 2012 indicated they meditated
    • 16.3% of women
    • 11.8% men
• In 2012, chiropractic care was used just as much as yoga, but in 2017, it was displaced by yoga and meditation. Chiropractic care now the third most common complementary modality in the U.S.
  • • 9.11% of respondents in 2012 indicated they used chiropractic care
    • 10.3% of respondents in 2017 indicated they used chiropractic care
      • 11.1% of women
      • 9.4% of men
    • Use of chiropractic care was the highest among adults age 45-64

We’re going to focus our attention on mindfulness, because that’s the complementary modality that’s most common in addiction treatment and has the broadest evidence base supporting its effectiveness in AUD/SUD treatment. Although you don’t see the term in the statistics above, it’s there: mindfulness is a generic term which includes yoga and meditation. Therefore, when we say mindfulness, what we mean is a group of techniques derived from practices like yoga, meditation, and tai chi/chi kung.

Mindfulness in Addiction Treatment

Mindfulness practices include a wide variety of activities. One central principle unites them all, which is described here by the most well-known mindfulness figure in the world, a Vietnamese Buddhist monk named Thich Nhat Hahn:

“Mindfulness is our ability to be aware of what’s going on both inside us and around us. It is the continuous awareness of our bodies, emotions, and thoughts.”

Mindfulness teaches people in recovery how to slow down and pay close attention to their mind, body, and spirit. It teaches them to see thoughts, experience physical sensations, and perceive spiritual notions without judgement or commentary. It encourages people to resist attaching positive or negative qualities to their thoughts, emotions, and sensations out of habit. Instead, it encourages them to recognize their agency with regards to their internal life. Rather than allowing conditioned reactions to be the only possible responses available to them, mindfulness teaches people they can experience and act on their thoughts and feelings in the way they choose.

In this way, mindfulness empowers people in recovery by giving them tools to manage patterns of thought that lead to alcohol or drug use, cravings that can lead to relapse, and life-interrupting emotional states – shame, fear, and self-doubt, for instance – commonly associated with addiction. They learn they’re not at the mercy of these patterns or states, and that it’s possible to observe them, let them pass without allowing them to take control, and replace them with thought patterns and emotional states that are productive, improve their subjective experience, and increase their likelihood of sustained, lifelong recovery.

That’s a big deal. The fact that complementary medicine and mindfulness are now common elements of the most highly regarded treatment programs means a positive step forward for everyone involved. That includes treatment providers, family, friends, loved ones, and of course, those who need it most: people who seek help for their alcohol or substance use disorder.