Cultiver la pleine conscience consiste à porter intentionnellement son attention à l’expérience présente des phénomènes externes (stimuli interoceptifs et sensoriels) et internes (cognitions et émotions) avec une attitude d’acceptation. Plusieurs programmes thérapeutiques fondés sur la pleine conscience ont été utilisés dans les troubles addictifs. La revue de la littérature nous a permis de trouver six articles originaux portant sur des essais cliniques qui étudient les effets de quatre programmes thérapeutiques différents. Cinq essais sur six étaient contrôlés et quatre randomisés. Le pourcentage de perdus de vue en cours d’étude était assez élevé (entre 28 et 55 %). Cinq interventions sur six se sont révélées significativement efficaces dans la réduction des consommations de produits. Parmi les cinq essais contrôlés, quatre ont montré que le programme évalué était plus efficace que le traitement de référence. Dans les études où le suivi des patients était suffisamment prolongé, l’efficacité des thérapies utilisant la pleine conscience et la supériorité de celle-ci sur les traitements témoins devenaient plus nettes et se maintenaient au fil du temps. Les interventions étudiées ont également permis de réduire la symptomatologie psychiatrique et le sentiment de stress perçu. Nous discutons des bénéfices potentiels de la pleine conscience pour les patients souffrant de troubles addictifs, ainsi que des indications, modalités et limites de son utilisation pratique.

In substance use disorders, the lack of empirically supported treatments and the minimal utilization of available programs indicate that innovative approaches are needed. Mindfulness based therapies have been used in addictive disorders for the last 10years. Mindfulness can be defined as the ability to focus open, non-judgmental attention to the full experience of internal and external phenomena, moment by moment. Several therapies based on mindfulness have been developed. The aim of this study is to review the existing data on the use of these programs in addictive disorders.

We have reviewed the literature published from January 1980 to January 2009, using the following keywords: mindfulness, mindfulness based stress reduction program, dialectical behavior therapy, acceptance and commitment therapy, mindfulness based cognitive therapy, addiction, substance use, alcohol and smoking.

Results of six clinical trials evaluating four different programs were found. Five studies were controlled and four were randomized. Drop-out rates were relatively high (from 28 to 55%). In five cases out of six, the program significantly reduced substance use. In four comparative trials out of five, interventions based on mindfulness proved more effective than control conditions. The effectiveness of interventions based on mindfulness and the differential improvement across conditions became greater and was maintained during follow-up when it was long enough. Participants in mindfulness programs were less likely to endorse the importance of reducing emotions associated with smoking and reported significant decreases in avoidance of thoughts which partially mediated alcohol use reduction. Psychiatric symptoms and the level of perceived stress were also significantly reduced.

Mindfulness may help substance abusers to accept unusual physical sensations that might be confused with withdrawal symptoms, decentre from a strong urge and not act impulsively. It may reduce an individual’s susceptibility to act in response to a drug cue. Practice of mindfulness may develop the ability to maintain perspective in response to strong emotional states and mood fluctuations and increase the saliency of natural reinforcers. Mindfulness based programs require an intensive participation, and should therefore be proposed to highly motivated patients. In smoking cessation, they should be used in patients who were unable to quit with less intensive interventions. Some programs are specifically designed for patients with co-occurring psychiatric disorders.

The first clinical studies testing mindfulness based interventions in substance use disorders have shown promising results. They must be confirmed by larger controlled randomized clinical trials. By developing a better acceptance of unusual physical sensations, thoughts about drugs and distressing emotions, mindfulness may help in reducing the risk of relapse.