Do You Understand Your Addiction Rituals?

Here’s how the story goes: when Danny* gets home from work and his wife Lynn* isn’t there, he heads straight to the kitchen cabinet where he keeps his bag of accessories: rolling papers, a joint rolling machine, a magazine to collect stray bits of marijuana, tobacco and a lighter.

He sits on the couch—the same spot every time. He begins what his wife calls his weed projects: pours himself a glass of wine, rolls a tight joint along with some tobacco and a cardboard filter, smokes it on his back porch, plays a video game, watches a movie and gets in bed by 10 p.m. Danny—a smoker for 15 years—is loyal to this routine, staying true to these exact steps four days per week.

The act of rolling a joint is important to Danny’s marijuana usage, and the ritual itself fulfills a sort of creative urge for him. “Joints are more fun to smoke than a bowl,” he said. “It’s creating something with my hands; it’s a small challenge to make a great joint.”

Using substances is often closely associated with deeply ingrained rituals. Time of day, location and tools are often almost as important as the drug use itself, carrying significant symbolism and meaning. Some ritualized behavior is emotional; a drug or alcohol abuser may purposefully work him or her self into a state of anger or anxiety so that there is a reason to use.

In most cases, ritualized behaviors are unconscious—that is, a substance abuser may have no idea why they do things a certain way, or that these patterns even exist. Mindfulness—a technique that is increasingly being used in addiction treatment—works to bring these unconscious behaviors to light.

“We ask [the drug user] to be more mindful about what is going on in two ways,” said Don Sheeley, a facilitator with SMART Recovery—an addiction recovery support group. “One, to bring the behavior out of the automatic subconscious to the awareness: I am choosing to turn the car right to drive into the parting lot of the liquor store. Second, to be more aware of the emotion that’s driving it. Underneath it, you frequently have stress, tension, anxiety or fear.”

Dr. Sheeley describes a sense awareness exercise he uses in his groups to build consciousness called Dropping Anchor. Participants are instructed to pay attention to their feet on the floor, the position of their arms and the feeling of their hands on the table in front of them. Then they notice their surroundings (his groups are held in a bagel shop): the lighting in the restaurant, the noises of people talking around them and the smell of bagels baking. This and other awareness exercises work by building consciousness of a here and now concreteness, rather than getting trapped in thoughts or feelings.

Mindfulness also works to disrupt rituals by slowing down the time between feeling or thought and action. Tools like Dr. Sheely’s Dropping Anchor exercise help individuals create more time for awareness before acting. During that time, it is perhaps more likely that the person will make a more calculated, careful decision rather than following the urges to use.

According to a May 2014 study in JAMA Psychiatry, drug and alcohol abusers who utilized a mindfulness-based intervention significantly reduced their risk of relapse when compared to 12-step program participants. However, the two models are not necessarily at odds with each other: 12-step programs arguably include a mindfulness component in step 11, prayer and meditation. Since mindfulness techniques are easy to learn and readily accessible, they can be incorporated into any addiction treatment model to enhance its effectiveness.

Fundamental to mindfulness is the principle of nonjudgement. Therefore, in looking at rituals, the substance abuser would never label them as “bad” or “wrong.” Mindfulness would instead ask for complete awareness of behaviors, thoughts and feelings as they occur, and a sense of curiosity as if the individual has never done this before.

One of the most basic tools in mindfulness is the breath. Try this breath awareness exercise:

• Take a moment to become aware of your posture. If you are sitting, feel yourself being supported by your chair or the floor.
• If you are standing, feel the floor beneath you.
• Start to notice your breath. Is it shallow or full? Slow or fast? Are you breathing through your nose or through your mouth?
• Notice the temperature of the air as it moves in and out, and how the air becomes warmer as it leaves your body.
• Pay attention to where you feel your breath the most. You might notice it in your throat, your chest, your belly or elsewhere.
• Become aware of your lungs and rib cage as you inhale and exhale. If you are sitting in a chair or against a wall, you might feel your back ribs pressing into whatever is supporting you. Feel the movement from side to side and back to front.
• Imagine your diaphragm (the dome-shaped muscle that sits at the bottom of your rib cage) pressing down as you inhale and doming up when you exhale.
• In between your inhalation and exhalation, take a brief pause. Notice what happens in your soft palate and jaw.

Does mindfulness help you better understand your substance use rituals?

*Names changed to protect anonymity
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