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Insomnia Linked to Substance Abuse in Adolescents

A study in the Oct. 1 issue of the journal Sleep shows that adolescent insomnia symptoms are associated with depression, suicide ideation and attempts, and the use of alcohol, cannabis and other drugs such as cocaine.

Findings suggest that the presence of insomnia in adolescents increases the risk of developing mental health problems and also may increase the severity of these problems. Results indicate that adolescents who had symptoms of insomnia were 2.3 times more likely to develop depression in early adulthood than adolescents without symptoms of insomnia. Specifically, at baseline, the insomnia group was more likely to use alcohol, cannabis, and non-cannabis drugs, and was more likely to suffer from depression, suicide thoughts, and suicide attempts. The insomnia group also had a greater risk of developing new incidences of depression and suicide attempts after excluding participants who suffered from these specific psychopathologies at baseline.

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CALMING THE ADDICT WITHIN

Columns - Alternative Therapies

Thursday, 31 March 2005

Meditation, used alone, or in connection with other more traditional therapeutic modalities, can be a valuable tool for the addict in all of us. By encouraging the addict to quiet his/her mind and to sit with feelings, meditation can lead to an understanding of those feelings — even those at the root of addiction. As an alternative to running away and self-medicating, meditation practice encourages us to stop, turn toward, and sit with our feelings — and to do so with compassion. Meditation urges us to inquire into the nature of our feelings rather than medicating them.

Learning to quiet the mind can be a significant tool in and of itself — for example as a relaxation technique. But a more significant benefit is that through meditation we are able to see, first hand, that we do not have to be run by our thoughts. We can learn to let go of mental chatter and change our habitual ways of thinking. Insight into the nature of our thoughts allows us to become more familiar with the ways “our best thinking has gotten us to where we are” and, in conjunction with meditative and psychotherapeutic inquiry, helps us to change the way we view our challenges and choices.

Addictions can be seen as habitual methods of finding our way out of painful situations. Our best, albeit misguided, attempts to ease our (emotional) suffering actually increases our (ultimate) suffering in the form of addiction. The very thing that was originally meant to ease our pain moves us farther and farther away from a clear and adaptive solution.

Vipassana mediation (also known as Mindfulness or Insight meditation) techniques encourage us to calm the mind so that we can see our perception of challenging situations and their resolutions in new ways. The ultimate goal of Vipassana meditation practice can be stated as “learning to see ourselves and the world around us clearly (reality as it truly is) with as few distortions as possible.” Of course this is an oversimplification of Buddhist teachings, but will suffice for this article.

A Vipassana meditation sitting (session) can last anywhere from 30 minutes, to several hours, to several days. The meditator sits in a chair with both legs on the floor, or on a cushion on the floor cross-legged, with spine erect, eyes closed and hands resting gently on the thighs or folded in the lap. Movement or shifting is strongly discouraged for the duration of the sitting. Eyes are gently closed as the meditator brings his/her complete attention to the in-breath and the out-breath.

Vipassana meditation has two phases: stilling the mind (also known as Awareness) and inquiring into the nature of our thoughts and the way we see the world (also known as Insight). Stilling the mind (which, by the way can take years of practice to master) is achieved by focusing on our in-breath and our out-breath, labeling our thoughts as they arise as merely ‘thinking’, and returning complete focus again and again to our breath.
The act of meditation is not just those seconds between thoughts but the very activity of noticing that our mind has wandered and gently bringing ourselves back to our breath. This can occur hundreds of times during a single sitting. That is why it is called meditation “practice” — it really takes diligent practice to master.

Through stilling the mind we learn that, at least for the duration of the sitting, we can let go of thoughts big and small and keep returning to our intention of focusing on our breath. In this phase of the practice we realize that our thoughts are just thoughts and that we can, if only briefly, let them go and settle into the peace of mind that comes with simply focusing on something as neutral and simple as the breath.

Mindfulness of the breath also teaches us first-hand about the impermanence of all things — that the breath, like everything else, comes and goes. Things are always changing. The challenge is to not try to hold on so tightly to the pleasant things and experiences we want or to push away the painful ones — the art of being with what is. This ever-increasing awareness can help us to become more comfortable with the impermanence and forthcoming uncertainties we face in life.

The more comfortable we can become with uncertainty (and sitting with the edgy feelings that initially arise, without acting-out or repressing) the less we will tend to hold onto or push away the vicissitudes of life. We learn to accept and surrender to things as they are and only then decide on a course of action.

The Serenity Prayer, frequently read in A.A. meetings seems to encourage this same kind of insight we strive for in meditation — “to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.” If the addict can see his/her addictive behavior as a way of coping with the discomfort of uncertainty and the fear that accompanies it and if he/she can realize the impermanence of this fear and uncertainty, he/she can also see the impermanence of the satisfaction that the object of his/her desire promises.

In our meditation practice, as we learn to still our mind, we begin to acquire the kind of “distance” from our thoughts that can allow us to begin to examine our thoughts, as they arise — without judgment. With increasing objectivity and compassion we begin to look at the content and nature of our thoughts.

We may notice that many of our intrusive thoughts are of worry or anger. We may notice patterns to our thoughts. We may realize that our incessant replaying of certain thoughts is an unconscious attempt to control the outcome of a situation over which we have little control.
And we may realize that thoughts and patterns of thoughts may be an addiction in and of themselves.

Through the kind of awareness and insight we gain through meditation practice — even the rudimentary awareness of the impermanence of each breath — we learn about not holding onto to pleasurable experiences and not pushing away unpleasant ones.

We learn to stay much more in touch with ourselves. When we practice in this way we find out where we are stuck ... the mind keeps moving — around and around, again and again, to the same thoughts and themes. Through insight, carried into our everyday lives, we learn to unhook ourselves from repetitive, destructive and addictive patterns.

The moment in time between the arising of a thought, desire, or feeling and the giving into the craving is the moment to change — i.e., interrupt the addictive pattern and take another course of action. In meditation we learn to focus on the breath and, when a thought arises, good, bad, or indifferent, we learn to neutrally label it as “thinking” and return full awareness back to the breath.

When we learn to not let our thoughts (and the stories they create) carry us away, then we are ready to begin to explore these thoughts — without judgment. If we find ourselves getting lost in a story, it means we are losing ourselves in the thinking rather than exploring the nature of the thought and we should once again return our awareness to the breath.

This moment-to-moment awareness teaches us that we do not have to act impulsively on our thoughts and desires — we can return to the breath. Once we are able to sit with and compassionately inquire into our thoughts and desires we can begin to understand more clearly what the underlying needs and feelings are that drive us.

The strong desire characteristic of addiction narrows our awareness until all we see is what we crave. Meditative awareness and insight helps us to recognize this and invites us to see other possibilities. Through meditation practice we learn that we can sit with all sorts of uncomfortable feelings and difficult emotions without acting on them or pushing them away and thereby have the means by which to understand, with compassion, the real needs beneath the addictions and to choose another way to address these various needs.

Meditation gives us an immediate and direct experience of being with our thoughts and feelings in a different non-reactive way. By sitting with feelings we can learn to identify and understand what is happening inside of us before we take an action as opposed to spontaneously reacting to and acting on feelings from what may be a loaded and, no doubt, historical place within us.

Rather than trying to escape from difficult feelings, meditation practice allows us to learn to compassionately face and explore the myriad of thoughts, feelings, and experiences that repeatedly arise in a single sitting. We practice this in meditation and can then bring this awareness into the moment-to-moment experience of our lives. Through meditation practice, we can learn to compassionately welcome, sit with, and explore what is happening in our minds, our bodies, our thoughts, and our feelings without judgment and without addictions. Combining meditative practice as well as psychotherapy provides an arena in which people can explore ways to recreate their lives, leaving historical patterns in the past and finding new ways of being in their lives today.

Diane L. Nadler, LCSW-R, BCD is a psychotherapist in private practice in New York City. A longtime meditation practitioner, she integrates mindfulness principles into her Psychotherapy, EMDR, Hypnotherapy and Rubenfeld Synergy practice. She can be reached at (212) 253-1573.

This article is published in Counselor,The Magazine for Addiction Professionals, April 2005, v.6, n.2, pp.33-35