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Middle Path Program Replaces Addiction with Spiritual Pursuits

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Duke Health News 919-660-1306

DURHAM, N.C. - Frank Midland used to slug back a pitcher of
martinis to relax. Now he contorts his body into odd positions
and meditates.

"Two hours of yoga is like having a couple of martinis,"
says the 48-year-old recovering alcoholic, who requested an
alias for this story. "I thought it would be really boring, but
it's very relaxing and enjoyable."

Both booze and yoga are forms of escaping stress and
inducing pleasure, he says. But alcohol brings a temporary high
in which too much can rob the drinker of mental, spiritual and
physical well being, Midland says, whereas yoga brings a
lasting pleasure that nourishes the soul and helps the
practitioner fill an internal void that liquor could never
quench.

"Yoga makes you focus inwardly on yourself and it helps
fulfill your spiritual needs, whereas alcohol makes you ignore
them even more," he says.

Midland is well aware that his words have a decidedly
new-age ring, and that skeptics might dismiss his talk as the
euphoria of a new convert into the world of abstinence.

But Midland insists that this new approach has achieved
success where more traditional treatment programs have failed.
As a recent graduate of a newly established addictions program
at Duke called The Middle Path, Midland says he is armed with a
cadre of skills that he hopes will prevent a relapse into his
old habits.

Yoga is simply his favorite among the wide range of
techniques designed to teach patients the art of mindfulness, a
mind-body approach that helps a person live in the moment
instead of the future. "Mindfulness is about living your life
as it comes rather than living it like a dress rehearsal," says
Dr. Marty Sullivan, a Duke cardiologist who recommends the
technique to patients interested in mind-body approaches to
healing.

Why mindfulness works for addicts is no mystery, says Bohdan
Hrynewych, the Duke addictions counselor who created The Middle
Path to complement traditional addiction programs at Duke. The
program's name embodies its philosophy of avoiding extremes in
behavior or action, a trait that is common among
pleasure-seeking addicts of all kinds.

"Our culture and society are very materialistic, and they
encourage people to achieve satisfaction through external
recognition, acquiring goods and material pursuits - all of
which bring temporary pleasure but fail to fill an inner void,"
Hrynewych says. "Addicted people in particular are apt to get
fixated on external sources of comfort, excitement and
satisfaction."

Replacing those external sources with an internal source of
pleasure - one that addicts can learn to conjure up on their
own - can be a more intensive strategy for beating addiction
than traditional means of just talking about the problem or
replacing it with another external pursuit, like shopping,
gambling or sex, he says.

Already, there is evidence to suggest that a spiritual
approach to treating addiction makes scientific sense, says
Duke psychiatrist Dr. Roy Mathew. In a series of brain imaging
studies at Duke, Mathew has shown that drugs like marijuana
stimulate the very same pleasure centers in the brain that are
stimulated by spiritual experiences, such as beautiful music or
cuddling your baby.

Mathew surmises this is why mindfulness works, because it
teaches people to replace a destructive form of pleasure for
another, more constructive one. Specifically, mindfulness
teaches people to pay attention to what is happening in the
moment instead of looking ahead to the future.

"Focus on the thought going through your mind at the moment,
feel the sensation of the wind on your face at the beach,
detach yourself from the pressure and content of your mind for
a minute or two and you become freer from committing
compulsive, automatic actions," says Mathew, director of the
Duke Addictions Program, from which The Middle Path grew.

It's a Buddhist concept that is hard to grasp for people
accustomed to living in the frenzied pace of modern society,
where external pressures rule their lives, he says. But that's
precisely the point of mindfulness - to escape the external
pressures by turning your attention inward and developing
detachment from situations where you feel you have no choice.
Then, you can discover your essential freedom and power.

Hrynewych says such an approach is unique among the many
addiction treatment programs at Duke and nationwide, most of
which are based on the 12-step program of recovery first
adopted by Alcoholics Anonymous.

The 12-step programs invite participants to recognize that
they cannot control their addiction, to call on a higher power
to help them abstain, to make amends to loved ones they have
hurt, and to agree to help other addicts in their quest to
recover. The Middle Path combines AA's traditional approach to
abstinence and reform -- replacing the emphasis on God with a
focus on spirituality -- together with a wide range of
spiritually based techniques.

"We're not discarding the 12-step program; we recognize its
value," he says. "The Middle Path is really 12-steps plus."

Participants in The Middle Path go through intensive group
and individual therapy, family therapy, body-centered therapies
like yoga that focus on the physical and spiritual discomfort
of withdrawal, visual and creative therapies like drawing and
sculpting with clay and acupuncture -- a technique that
research suggests may be useful in alleviating cravings and
helping maintain long-term abstinence. In the future, the
program may include other techniques like biofeedback and
massage.

"During one session, we made clay images of how we viewed
our families - where we put our wife, kids, pets - to help us
come to terms with the way we viewed essential relationships,"
Midland says. "It may sound nuts, but it was a lot more real
and practical than hearing about the chemical makeup of
alcohol."

The spiritual nature of The Middle Path is what drew Midland
to the Duke program after traditional groups like AA - which he
still attends weekly - were unable to meet all of his
needs.

"At AA meetings, it's very externally focused. You tell your
story and someone tells his, but there's generally no feedback.
The Middle Path program is much more internally based while,
paradoxically, emphasizing interpersonal relationships. You
talk about what Tom or Mary said and you deal with it in a very
direct, focused way. Then you actually get to practice new ways
of behaving with others in the group."

Four months have passed since Midland completed the
eight-week program, and the road has been bumpy at times. A
couple of months out of the program, Midland says he "fell off
the wagon" and then realized he had to search deeper in his
repertoire of skills to bolster his resolve to abstain. That's
when he added a four-mile bike ride and swimming to his
routine, both of which he does while meditating.

"It's been a breath of fresh air for me," Midland says, two
months after stepping up his personal regimen of meditation and
exercise. "The program may not be for everybody, but it was
great for me."

In particular, says Hrynewych, The Middle Path program may
be well suited for people with a "dual diagnosis" - those with
an addiction and an underlying psychiatric disorder - because
it focuses on all aspects of a person's life and because
participants can receive psychiatric consultation at Duke in
conjunction with their addictions treatment.

The Duke Addictions Program also offers treatment programs
specifically geared toward women, HIV-positive addicts,
adolescents, addicted mothers and adults who grew up in
addicted families.

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