Earlier this year I sat in on a MBRP addictions treatment group led by Chris Finucane, a LCSW with Kaiser Permanente, where I was an intern for a year (in the Mental and Behavioral Health department), and Suzanne Cooper, a Nurse Practitioner in the Addiction Medicine department at Kaiser. Suzanne is one of the kindest people anyone could meet. She’s a devotee of Thích Nhất Hạnh, the Vietnamese monk who is widely considered one of the greatest living Zen masters, and has practiced with him in Vietnam, France, and the United States. I asked her how she arrived at incorporating her personal mindfulness background into her clinical practice with addictions, ways in which she felt that mindfulness could address shortcomings in traditional addiction treatment, and of course, what Thầy is like!
I’m a student of Thích Nhất Hạnh, and I’ve found it very helpful in my personal life. I went to a conference two years ago—the ASAM conference in Seattle. Alan [Marlatt] was there, and he got up and started talking about walking meditation with Thích Nhất Hạnh and had talked to someone who went to Plum Village and took the Five Mindfulness Trainings. He was talking about his Mindfulness-Based Relapse Prevention [protocol] and kept bringing in Thích Nhất Hạnh. That was like….wow! It was a medical conference. It was about drugs for craving, Suboxone [a drug that treats opiate dependence], the effects of cocaine on the brain and amphetamines and PET scans and Nora Volkow (the head of NIDA) was there. It was very medically research-oriented. I was blown away. He talked about his grant and research, and just that it was being used. It just completely floored me.
A sidenote: a few days before I interviewed Suzanne, I had the privilege of sitting down with Alan Marlatt who mentioned this same scene to me. He stated that many in attendance were very taken aback by his discussion of mindfulness at such a traditional, medical-model conference, and that there had been more than a few suggestions that he was misguided in talking and writing about mindfulness. Of course, he ignored these orders and went ahead with his research and exploration into mindfulness-based addictions intervention. Now he’s the leading researcher in the field–a good lesson in following your passion. Back to Suzanne…
I asked if we could look at [the Mindfulness-Based Relapse Prevention group treatment manual], and he said yes. They sent us their big manual. I tried to start working with it, absorbing it and understanding it. I was having some problems with it because all I had was the paper–I didn’t know how they were actually using it. He was talking at [Richard Field’s] FACES conference, and Marsha Linehan was there and Jack Kornfield and so forth. It was a good conference, in San Diego. We went and heard Alan and Lisa Dale Miller. She did a really good talk on the physiology of meditation, how it physically changes the brain, and it was fascinating to me! At that conference, Alan talked about their first teaching retreat where they were going to present the how-tos of MBRP, and we signed up for it right away. That was in September. That really helped. The questions I had about some of the practices were answered, like the urge surfing, and the “walking down the street” exercise which could be really triggering. The way they did them at that conference was really mild, so I could see that it would be okay and wouldn’t trigger people terribly. They encourage flexibility with it and adaptation, so we’ve been doing that. It’s just wonderful to get the chance to do it. It’s interesting to see who responds and who doesn’t! You’ll have somebody that got a DUI and they’re just still deer-in-the-headlights–they don’t know what the heck this is. ‘How long does this last?’ They’re mandated for treatment, they have to go four nights per week and we’re one of the nights. They don’t see the connection at all! But other people are like, wow. This is the best.
I asked Suzanne my favorite question–what are the implications of a bunch of primarily White people (as such is the demographic of both the American Buddhist community as well as the clinical counseling community) delivering a treatment protocol to diverse populations? This should be an obvious consideration in the addictions field, given that according to a SAMHSA report on the topic, the two racial demographics containing the highest percentage of drug and alcohol dependency in the past year are Native American/American Indian and those of “two or more races” (the third-highest was White and the fourth-highest was Black or African American). Meanwhile, SAMHSA reports that addictions clinicians are predominantly White in almost all settings (the exceptions being Methadone and Short-Term Residential, in which Black clinicians were the predominant racial group). As for the underrepresentation of non-white practitioners in American Buddhism, this topic is well covered and nearly impossible to get statistics on.
Well, I work for Kaiser, and in some ways that determines my [treatment] population. I see primarily White patients; that’s our demographic. I have a friend that went to the Mindfulness retreat with Alan who works on a reservation with Native Americans, and she’s starting MBRP–she’s saying that it’s actually going over very well in the tribe that she’s working with and they seem very comfortable with their bodies and less alienated in that respect than Caucasians. DBT is really what’s going in a lot of addiction treatment. They use it at Pathways at St. Helens which sees a lot of people in the criminal justice system [in which minority ethnic populations are overrepresented]. I’ve heard they’re using it at [the Native American Rehabilitation Association].
Like Alan Marlatt did in our interview, Suzanne stressed that Mindfulness-Based Relapse Prevention is a complement to traditional addictions programs–an alternative, not a replacement.
I don’t think it’s for everybody. I had a patient who’s 50 who’s been using methamphetamines for 20 years. He’s a very nice, friendly guy, and he had a hard time connecting with the mindful movements or the guided practice. He’s somebody who would probably do better with the warmth of a recovery group–a 12-step meeting or something like that. Like Alan said, it won’t benefit everybody. But I think people are very hungry for it. Kaiser offered an 8-week course in Mindfulness-Based Stress Reduction, based on Kabat-Zinn. So many people wanted to take it that they shrank it to a 4-week course. I took it because I wanted to see how it was offered, and the course was packed! There were at least 25 people. Everybody came–everybody was stressed out–and they were looking for help. I think people are aware that they are stressed and they’re looking for relief from stress.
What shortcomings in traditional treatment does mindfulness address?
It addresses the ‘how-to’ differently, perhaps better, than traditional addiction treatment. For example, 12 -step groups talk about forgiveness, courage, and having heart. They don’t say how to access those things or be in touch with it. I don’t think it teaches you how to be with the void that occurs when you give up your substance or your behaviors, and mindfulness does. It’s more nuts-and-bolts. But that’s not to put-down traditional treatment at all. They work together.
I asked Suzanne what big questions faced the mindfulness and addictions field as it moves forward, particularly barriers to it being more widely adopted.
The big issue, I think, is taking refuge. Which may be considered ‘grounding.’ I’m not a therapist, I’m a nurse, so there’s holes in what I know–but my concern is that when things come up for people, difficult emotions, perceptions, and feelings, that they don’t know how to take refuge; how to ground themselves and continue to be stable. And we have run into that a little bit with patients who have a high degree of anxiety and a body scan triggers them. So probably in those cases you need movement: yoga, tai chi, not silent meditation or even guided meditation. In that way you can gradually approach things. I’m not sure how to approach that. I told Alan that, what about that part? And maybe they think through the loving kindness, through various visualizations, that that’s taking refuge or grounding….depending on how deeply the patient goes with their practice, just because with my own self I know you can get in those states which are very hard or painful. How do you tolerate it, how do you find space, loving kindness, what do you do? My dharma teacher, Eileen Kiera–that’s her question about it, as well. She’s supportive that we’re doing it, but the big issue is taking it out of the realm of spirituality and moving it out of a clinical setting. Is too much lost? At this point, I don’t think so. People are loving it, and thinking: I want more of this.
Have you been seeing good results? I asked.
Yes, for certain people it’s very helpful, and for other people it’s not what they need at the time. They need something else.
My second soapbox is the predominance of clinicians without personal mindfulness practices teaching mindfulness to their clients and patients. I asked Suzanne about her thoughts on this.
I think that the basic premise that we’re following is that if you’re going to teach it, you need to have a mindfulness practice. Whether you start that practice when you start teaching or you had it before, regardless you need to establish it. If you’re teaching it and you’re new to mindfulness, then it’s good to let people know that you’re new. I don’t have a problem with it other than that, but I don’t think you can teach it without practicing it. Just like you can’t teach yoga without practicing it.
One final question–What is Thích Nhất Hạnh like?
Unbelievable. He’s unbelievable. He’s just–total reconciliation. It’s just the best.