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WHOLE HEALTH: CHANGE THE CONVERSATION
Advancing Skills in the Delivery of
Personalized, Proactive, Patient-Driven Care
This document has been written for clinicians. The content was developed by the Integrative Medicine
Program, Department of Family Medicine, University of Wisconsin-Madison School of Medicine and Public
Health in cooperation with Pacific Institute for Research and Evaluation, under contract to the Office of
Patient Centered Care and Cultural Transformation, Veterans Health Administration.
Information is organized according to the diagram above, the Components of Proactive Health and Well-Being.
While conventional treatments may be covered to some degree, the focus is on other areas of Whole Health
that are less likely to be covered elsewhere and may be less familiar to most readers. There is no intention to
dismiss what conventional care has to offer. Rather, you are encouraged to learn more about other
approaches and how they may be used to complement conventional care. The ultimate decision to use a
given approach should be based on many factors, including patient preferences, clinician comfort level,
efficacy data, safety, and accessibility. No one approach is right for everyone; personalizing care is of
fundamental importance.
Substance Use Disorder Treatment: Complementary Approaches
Clinical Tool
WHOLE HEALTH: CHANGE THE CONVERSATION
Substance Use Disorder Treatment: Complementary Approaches
Clinical Tool
Introduction
Complementary and alternative medicine (CAM) practices can improve chances of recovery
from substance use disorders (SUDs), especially when used in addition to traditional SUD
treatments and mutual self-help groups. They are not meant to replace traditional
(conventional) treatments, however. Traditional treatments are important for the
development and maintenance of solid recovery, which often includes treating co-
occurring physical or mental health conditions, improving relapse prevention, improving
inter- and intra-personal interaction skills, and rebuilding the areas of one’s life that have
been affected by substance use. Complementary practices provide additional tools that can
enhance various aspects of the patient’s recovery; many patients find CAM practices a
helpful and enjoyable part of their recovery.
CAM practices include a variety of practices or techniques administered or taught by a
trained instructor.1 Specific practices include acupuncture, massage therapy, deep
breathing, meditation (mindfulness or transcendental), guided imagery, movement
therapies (e.g., Feldenkrais method, Alexander technique, Pilates, Rolfing Structural
Integration, Trager psychophysical integration), relaxation techniques, spinal
manipulation, tai chi, qi gong, yoga, and hypnotherapy to name a few.1 For more
information, see the Introduction to Complementary Approaches module.
The complementary approaches listed below are sometimes classed as mind-body
practices, but they may also be classed in other ways (e.g., yoga is sometimes classed as a
movement-based therapy, and energy medicine approaches are sometimes placed in a
category of their own. Be that as it may, many of these practices have been linked to
improvements in general physical and mental health and well-being, the ability to better
cope with daily challenges and stressors, and the enhancement of the healing process in
SUDs. They can be effective methods for improving self-care, which is vital to SUD recovery.
Research on Complementary Approaches for SUDs
Overall, evidence on the efficacy of CAM mind-body practices as adjunct therapies for SUDs
is promising but limited, calling for further research in this area. CAM practices are
generally considered safe if practiced appropriately and administered by trained providers
or instructors adhering to the proper safety practices. Although conclusive evidence for a
given CAM practice may not exist, if the patient is interested and motivated to pursue it,
and the therapy appears safe, it may be beneficial to encourage such efforts, because some
individuals may find these practices extremely helpful for their recovery. One can use the
ECHO (Efficacy, Cost, Harm, and Opinions) tool as a guide to choosing therapies. See the
Deciding if an Approach Is Worth Using: The E.C.H.O. Mnemonic clinical tool for more
information.
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WHOLE HEALTH: CHANGE THE CONVERSATION
Clinical Tool: Substance Use Disorder Treatment—Mind-Body Practices
and Other Complementary Approaches
Mindfulness meditation
Mindfulness meditation is a popular mind-body practice that helps train the mind in
nonjudgmental attention to present moment experiences (“mindful awareness”). This
involves bringing nonjudgmental attention to one’s thoughts, emotions, and sensations
occurring in the present moment, and letting them be as they are, by simply observing as
they come and go, with acceptance. In recent years, mindfulness-based interventions have
become the most commonly evaluated and applied meditation interventions in clinical and
non-clinical settings, with research evidence supporting their efficacy for many mental
health and physical conditions.2 Mindfulness meditation is one mind-body practice that is
of particular relevance to SUD recovery, as it has shown benefits for depression, anxiety,
pain, and stress coping, and possible benefits for PTSD,3,4 all common problems among
Veterans and documented relapse risk factors in SUDs. Mindfulness meditation practice
can benefit the “whole person,” and shows some promise for SUDs,3,5,6 including smoking
cessation.7
There is growing research evidence supporting the use of mindfulness-based approaches
as an adjunct therapy for SUDs; however, conclusive data are still lacking.3,5,6 While some
studies suggested reduced substance use (variety of drugs, alcohol, nicotine) and craving
after mindfulness training, others did not appreciate benefits or showed inconsistent
results, especially when compared to a control condition.2,3,5,6 It is unclear, though, which
persons with SUDs might benefit most from mindfulness training.
Mindfulness-based relapse prevention (MBRP) is an intervention developed specifically for
patients with SUDs.8 This program integrates mindfulness meditation with cognitive
therapy relapse prevention skills, and is intended for and best suits patients who have
completed initial treatment for SUDs (inpatient or outpatient), are motivated to maintain
recovery goals, and are open to making lifestyle changes to support their recovery.8 The
MBRP course typically consists of 8 weekly sessions, delivered in a group format by trained
meditation instructors, with each session including practice, discussion, topic-specific
exercises, and home practice. Clinicians interested in facilitating an MBRP should receive
MBRP facilitator training; it should be emphasized that facilitators’ personal meditation
practice is the foundation for teaching patients meditation-based practices.8 Cultivating
skills in mindful, nonreactive awareness of relapse triggers (thoughts, feelings, sensations,
environmental factors) and other experiences as they are occurring is a key part of self-
management in recovery. Mindfulness meditation can additionally support healing of body
and mind, and the pursuit of personal growth goals, and it can exert positive effects on
quality of life and general health.
For more information, see the Mindful Awareness module.
Transcendental meditation
Transcendental meditation (TM) refers to a mantra form of meditation. It involves
repeating in one’s mind a short phrase (“mantra”) for a given length of time. A mantra is
typically assigned to a practitioner by the certified TM teacher. Evidence on the efficacy of
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WHOLE HEALTH: CHANGE THE CONVERSATION
Clinical Tool: Substance Use Disorder Treatment—Mind-Body Practices
and Other Complementary Approaches
TM in SUDs is less extensive and more inconsistent than for mindfulness meditation.9
Potential benefits of TM may include decreased drug, alcohol, and tobacco use.10
In general, caution should be taken with any type of meditation practice (e.g., mindfulness
meditation, transcendental meditation) in patients with underlying substantial mental
health issues; these patients are recommended to consult with their mental health provider
before beginning a meditation program.11
Yoga
There are many different styles of yoga (e.g., Hatha, Vinyasa, Ashtanga); some are gentler,
such as Hatha yoga, and some are more physically challenging, such as Ashtanga yoga. Yoga
involves engaging in various movements, stretches, and postures, typically to the rhythm of
the breath. It is important for the clinician to discuss the risks and benefits of yoga with
patients, as some poses may need to be avoided in patients with certain health conditions.11
Yoga can be helpful for relieving inner and outer tension and increasing a sense of well-
being and connection with oneself. Therefore, through reducing stress and tension, known
relapse risk factors, yoga can enhance recovery. Preliminary research suggests that yoga
may be a beneficial adjunctive treatment for SUDs,12 including smoking cessation;7
however, more research is needed.11 See clinical tool, Yoga: Looking Beyond “The Mat,” for
additional information.
Acupuncture
Acupuncture is a procedure involving stimulation of targeted points on the body using thin,
solid, metal needles that are manipulated by hand or using electrical
stimulation.13Acupuncture should be performed by an experienced practitioner using
sterile needles.13 Some patients enjoy using acupuncture as a self-care practice. It is
important to discuss the potential risks of acupuncture with patients with certain medical
conditions or who use medications that increase the risk of bleeding.11,13 Limited research
on acupuncture has produced mixed results, providing only minimal evidence for potential
benefits as an adjunctive treatment for SUDs.14-17 See the Acupuncture and Traditional
Chinese Medicine clinical tool for more information.
Massage
Massage can be helpful for relaxation, rejuvenation, and alleviation of muscle tension and
many people enjoy massage as a part of self-care. Preliminary evidence has shown its
potential benefit for alleviating symptoms of alcohol withdrawal18 and reducing anxiety in
alcohol, cocaine, and opiate withdrawal.19 See the clinical tool, Massage Therapy.
Energy therapies
Energy therapies use energy fields including the unconventional use of electromagnetic
fields (e.g., transcranial magnetic stimulation, TMS) or biofield manipulations (e.g., qi gong,
Reiki, therapeutic touch). Very limited support exists for these practices as therapies for
SUDs. TMS is a noninvasive intervention where a clinician stimulates certain parts of a
patient’s brain using a machine emitting electromagnetic field. One preliminary study
showed the potential of TMS for reducing alcohol craving in alcohol-dependent adults.20
See the Energy Medicine clinical tool for general information on these approaches.
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WHOLE HEALTH: CHANGE THE CONVERSATION
Clinical Tool: Substance Use Disorder Treatment—Mind-Body Practices
and Other Complementary Approaches
Qi gong
Qi gong is a technique that combines mental focus, deep breathing, and gentle physical
movements;21 preliminary evidence shows potential benefits of qi gong in reducing
withdrawal symptoms, craving, and anxiety in SUDs,22 but more research is needed.
Biofeedback
Biofeedback therapy is a process that involves training patients to regulate bodily functions
consciously (e.g., breathing, heart rate, blood pressure) to improve overall
health.23Biofeedback is used for reducing stress, headaches, and pain and for
reconditioning injured muscles and controlling asthma attacks.23 There is very little
research of the effects of biofeedback in SUDs. Preliminary evidence has suggested possible
benefits of electroencephalogram (EEG) biofeedback for reducing craving, depression, and
anxiety symptoms in inpatients with polysubstance abuse.24
Hypnotherapy
Hypnotherapy is a possible tool that may help manage one’s internal landscape and
response to triggers. Clinical hypnosis is guided by a licensed, trained clinician and is used
for treating a psychological or physical problem. The patient is guided into an altered state
of awareness, perception, or consciousness where suggestions are then made by the
clinician, or communication is had between patient and clinician, to help guide the patient
toward the problem they are trying to resolve.25 One preliminary study of Veterans with
drug and alcohol use disorders and co-occurring mental health disorders suggested
positive effects of hypnosis on abstinence, self-esteem, anger, and impulsivity.26 However,
evidence is inconclusive for the use of hypnotherapy in SUDs.11 It is recommended to use
hypnotherapy cautiously in patients with psychosis/schizophrenia, bipolar disorder,
multiple personality disorder, dissociative disorders, and seizure disorders.11
Guided imagery/visualization
Guided imagery or visualization is the practice of using one’s imagination to facilitate a
relaxed state. Many individuals find this practice enjoyable. Research is scant on guided
imagery as an adjunctive therapy for SUDs. However, preliminary evidence indicates it may
be helpful as an adjunct treatment for long-term smoking cessation.11
Music therapy
Music therapy is provided by a properly credentialed professional and involves the use of
music-based interventions (e.g., creating, singing, moving to, and/or listening to music) to
help accomplish individual goals that are tailored to the patient’s individual needs and
preferences.27 Many people find music therapy relaxing and enjoyable; however, due to
limited research evidence, there is no consensus regarding the efficacy of music therapy as
an adjunctive treatment for SUDs.28
For more information on mind-body therapies, such as hypnotherapy, biofeedback, and
guided imagery, see the Power of the Mind module. Resource Boxes 1-4 below feature
additional information on various complementary/mind-body approaches for substance
use disorders.
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WHOLE HEALTH: CHANGE THE CONVERSATION
Clinical Tool: Substance Use Disorder Treatment—Mind-Body Practices
and Other Complementary Approaches
Resource Box 1. Complementary Approaches for Substance Use Disorders:
Descriptions, Session Formats, and Links
Mind-Body Tool
Description
Typical Format
Links
Acupuncture
Stimulation of targeted points on
the body using thin, solid metal
needles that are manipulated by
hand or using electrical
stimulation13
Individual
National Center for Complementary and Alternative
Medicine—Acupuncture:
http://nccam.nih.gov/health/acupuncture
Biofeedback
Teaches conscious regulation of
bodily functions (e.g., breathing,
heart rate, blood pressure) to
improve overall health23
Individual
National Center for Complementary and Alternative
Medicine—Biofeedback Information (general information):
http://nccam.nih.gov/taxonomy/term/416
Hypnotherapy
Hypnosis under the care of a
trained clinician, used to help
guide the mind in a way to
facilitate changes that brings one
toward their desired goals
Individual
American Society of Clinical Hypnosis: http://www.asch.net/
Massage
Manipulation of muscle and tissue
to enhance function of those areas
and promote relaxation and well-
being23
Individual
National Center for Complementary and Alternative
Medicine—Massage Therapy for Health Purposes—What You
Need to Know:
http://nccam.nih.gov/health/massage/massageintroduction.
htm
Mindfulness-based
cognitive therapy
(MBCT)
Teaches mindfulness-based skills
to assist with depression, anxiety,
and other mental health
disorders/conditions
Group + Individual;
Group or Individual
once completed course
National Center for Complementary and Alternative
Medicine—Meditation, An Introduction:
http://nccam.nih.gov/health/meditation/overview.htm
University of Washington—Mindfulness-Based Relapse
Prevention (MBRP):
http://www.mindfulrp.com/default.html
University of Massachusetts Medical School, Stress Reduction
(MBSR) Program:
https://www.umassmed.edu/content.aspx?id=41254
Your Guide to Mindfulness-Based Cognitive Therapy (MBCT):
http://mbct.com/
Mindfulness-based
relapse prevention
(MBRP)
Teaches mindfulness-based
relapse prevention skills for SUDs
Group + Individual;
Group or Individual
once completed course
Mindfulness-based
stress reduction
(MBSR)
Teaches mindfulness-based skills
for general health and well-being
Group + Individual;
Group or Individual
once completed course
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WHOLE HEALTH: CHANGE THE CONVERSATION
Clinical Tool: Substance Use Disorder Treatment—Mind-Body Practices
and Other Complementary Approaches
Resource Box 1. Complementary Approaches for Substance Use Disorders:
Descriptions, Session Formats, and Links
Mind-Body Tool
Description
Typical Format
Links
Music therapy
Uses music-based interventions to
help accomplish individual goals
(e.g., creating, singing, moving to,
and/or listening to music), and are
tailored to the patient’s individual
needs and preferences
Individual
American Music Therapy
Association: http://www.musictherapy.org/
Qi gong
Combines specific movements or
postures, coordinated breathing,
and mental focus
Group or Individual
National Center for Complementary and Alternative
Medicine—Tai Chi and Qi Gong for Health and Well-Being,
video: http://nccam.nih.gov/video/taichidvd-full
Relaxation technique:
Deep breathing
Breathing in and out slowly and
deeply through the nose, usually to
a count of 10 for each in-breath
and out-breath23
Group or Individual
National Center for Complementary and Alternative
Medicine—Relaxation Techniques for Health—An
Introduction: http://nccam.nih.gov/health/stress/relaxation.
htm
Department of Veterans Affairs—Visualization/Guided
Imagery:
http://www.mentalhealth.va.gov/coe/cih-
visn2/Documents/Patient_Education_Handouts/Visualizatio
n_Guided_Imagery_2013.pdf
Relaxation technique:
Guided imagery
Using the imagination to facilitate a
relaxed state
Group or Individual
Relaxation technique:
Progressive muscle
relaxation (PMR)
Involves the tensing and releasing
of the various muscle groups, in a
sequence to promote relaxation
Group or Individual
Transcendental
meditation
Recitation of a mantra that is
assigned by a certified TM teacher
Group + Individual;
Group or Individual
once completed course
Maharishi Institute—Why TM?
http://maharishiinstitute.org/consciousness/why-tm/
Transcranial magnetic
stimulation (TMS)
A noninvasive intervention where
a clinician stimulates certain parts
of the brain using a machine
emitting electromagnetic fields
Individual
Inquire about local resources
Yoga (e.g., Hatha,
Vinyasa, Ashtanga)
Engaging in various movements
and postures to the rhythm of the
breath—Hatha yoga is the most
gentle
Group or Individual
National Center for Complementary and Alternative
Medicine—Yoga for Health:
http://nccam.nih.gov/health/yoga/introduction.htm
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WHOLE HEALTH: CHANGE THE CONVERSATION
Clinical Tool: Substance Use Disorder Treatment—Mind-Body Practices
and Other Complementary Approaches
Resource Box 2. Mindfulness-Based Relapse Prevention:
SOBER Brief Meditation
SOBER
Brief Meditation
adapted from Mindfulness-Based Relapse Prevention6
This meditation is especially helpful when having thoughts or urges to use a substance, or when
feeling a need to automatically react to a particular situation. This meditation helps to create a
pause in your experience to allow you to reground and make a choice about how to respond,
instead of automatically reacting to an internal experience or external situation.
Stop: right here and right now; this pause can allow you to step out of autopilot (instead of
automatically reacting to an urge, or distressing situation)
Observe: what is happening right now, in this moment—what’s going on in your mind and
body; bring gentle awareness to your thoughts, sensations, and emotions
Breathe: bring your attention to the sensations of each breath
Expand: expand your awareness to include a sense of the body and mind as a whole
R
espond: now, try to make a mindful choice what to do next (if anything)
VHA Office of Patient Centered Care and Cultural Transformation
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WHOLE HEALTH: CHANGE THE CONVERSATION
Clinical Tool: Substance Use Disorder Treatment—Mind-Body Practices
and Other Complementary Approaches
Resource Box 3. Mind-Body Tools: Introductory Basic Mindfulness
Meditation Practice for Relapse Prevention
Basic Mindfulness Meditation
adapted from Mindfulness-Based Relapse Prevention for the Treatment of Alcohol Dependence:
Eight-Week Course Research Manual29
Find a chair and settle into a comfortable sitting position…. Allow your eyes to close (or keep them
gently open with your gaze tilted slightly toward the floor). Allow yourself to have a relaxed
posture, with your back straight, your head resting gently on top, and with the bottoms of both feet
planted on the floor…. Your posture should be relaxed and dignified, not stiff…. Sitting this way
helps the breath flow easily.
Now, bring your awareness to any sensations of touch or pressure in the body, where it makes
contact with the floor or chair…. Notice the sensations of the bottoms of the feet making contact
with the floor…. Bring awareness to the point of contact between your legs and the chair…. Take a
moment to notice the sensation of touch or pressure in various parts of the body….
Now bring your awareness to the breath as it moves in…and out of your body…. It may be helpful to
place your hand on your lower belly and become aware of the sensations of the breath there…. Just
noticing each…in-breath…and…out-breath….
Notice the sensations of the abdominal wall as it rises with each in-breath, and gently falls with
each out-breath…. There is no need to control your breathing in any way—simply let the breath
breathe itself….
When you notice that your mind has wandered away from the focus on the breath to thoughts,
planning, daydreams, drifting along, this is perfectly OK—it’s simply what minds do. It is not a
mistake. Simply let go of these thoughts and gently congratulate yourself—you have become aware
of your experience again—now bring your awareness back to the breath….
Each time you notice that your mind has wandered, gently bring your awareness back to the breath,
using your breath as an anchor to connect with the present moment, the here and now….
And now, take a few more seconds, noticing each in-breath and out-breath… and when you are
ready, open your eyes.
VHA Office of Patient Centered Care and Cultural Transformation
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WHOLE HEALTH: CHANGE THE CONVERSATION
Clinical Tool: Substance Use Disorder Treatment—Mind-Body Practices
and Other Complementary Approaches
Resource Box 4. Mind-Body Tools for Substance Use Disorders:
Visualization/Guided Imagery Example
Visualization/Guided Imagery Example
Adapted from “The Private Garden” from the Department of Veterans Affairs30
For the original full version, please see:
http://www.mentalhealth.va.gov/coe/cih-
visn2/Documents/Patient_Education_Handouts/Visualization_Guided_Imagery_2013.pdf
Visualization or guided imagery involves using your imagination to facilitate a relaxed state.
Start by closing your eyes. Allow yourself to get into a comfortable position…Begin with a few slow
deep breaths, letting your body relax. Let the chair fully support your body as you continue to
breathe and relax…. Imagine yourself slowly walking down a path—it can be any path you wish. It’s
a beautiful day, and you feel relaxed and happy…. You can feel the warmth and energy of the sun on
your skin…. Soon you come to a gate. You know this gate leads to a special place where you feel
welcome, safe, and comfortable. Push the gate open and allow yourself to enter the garden. Your
garden is filled with your favorite things. Notice the details of your surroundings in your garden—
the sights, the sounds, the smells. Notice the variety of things in your garden…. Everything
peacefully co-exists here…. Begin to explore this place with your sense of touch. Perhaps some
things are soft and warm and others smooth and cool…. Notice what the air feels like…. Now
become aware of the sounds that exist in your garden…. Perhaps your garden is quiet…perhaps
there are a variety of sounds. Some of the sounds may be soft; others louder…. Become aware of the
different smells in your garden…. Perhaps noticing different fragrances that are soothing…. Take
your time in your garden, using it in whatever way you wish…. Spend the time that is necessary for
you to rejuvenate and to care for yourself….
When you are ready to leave, slowly walk back toward the garden gate…. You have enjoyed your
visit and feel relaxed and content…. This good feeling will remain with you throughout the day….
Push the gate open and return to the path that led you to the garden, remembering that you can use
your imagination to return to your garden at any time you wish…. When you are ready, stretch
gently and open your eyes.
Whole Health: Change the Conversation Website
Interested in learning more about Whole Health?
Browse our website for information on personal and professional care.
http://projects.hsl.wisc.edu/SERVICE/index.php
VHA Office of Patient Centered Care and Cultural Transformation
Page 9 of 11
WHOLE HEALTH: CHANGE THE CONVERSATION
Clinical Tool: Substance Use Disorder Treatment—Mind-Body Practices
and Other Complementary Approaches
This clinical tool was written by Aleksandra Zgierska, MD, PhD, Assistant Professor and
integrative medicine family physician and Cindy A. Burzinski, MS, LPCT, SACIT, Assistant
Researcher, in the Department of Family Medicine, University of Wisconsin-Madison School of
Medicine and Public Health.
References
1. National Center for Complementary and Alternative Medicine (NCCAM). Complementary,
Alternative, or Integrated Health: What's In a Name?
2013; http://nccam.nih.gov/health/whatiscam. Accessed May 27, 2014.
2. Chiesa A, Serretti A. A systematic review of neurobiological and clinical features of
mindfulness meditations. Psychol Med. 2010;40(8):1239-1252.
3. Goyal M, Singh S, Sibinga EMS, et al. Meditation Programs for Psychological Stress and Well-
Being. Rockville (MD)2014.
4. King AP, Erickson TM, Giardino ND, et al. A pilot study of group mindfulness-based cognitive
therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depress
Anxiety. 2013;30(7):638-645.
5. Zgierska A, Rabago D, Chawla N, Kushner K, Koehler R, Marlatt A. Mindfulness meditation
for substance use disorders: a systematic review. Subst Abus. 2009;30(4):266-294.
6. Chiesa A, Serretti A. Are Mindfulness-Based Interventions Effective for Substance Use
Disorders? A Systematic Review of the Evidence. Subst Use Misuse. 2013.
7. Carim-Todd L, Mitchell SH, Oken BS. Mind-body practices: an alternative, drug-free
treatment for smoking cessation? A systematic review of the literature. Drug Alcohol
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8. Bowen S, Chawla N, Marlatt GA. Mindfulness-based relapse prevention for addictive behaviors:
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11. Natural Standard Bottom Line Monograph:
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Clinical Tool: Substance Use Disorder Treatment—Mind-Body Practices
and Other Complementary Approaches
17. Kim YH, Schiff E, Waalen J, Hovell M. Efficacy of acupuncture for treating cocaine addiction:
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27. American Music Therapy Association (AMTA). What Is Music Therapy?
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28. Mays KL, Clark DL, Gordon AJ. Treating addiction with tunes: a systematic review of music
therapy for the treatment of patients with addictions. Subst Abus. 2008;29(4):51-59.
29. Zgierska A, Lerner F, Goodman V. Mindfulness Based Relapse Prevention for the Treatment
of Alcohol Dependence (MBRP-Alcohol): eight week course research manual (Unpublished,
Draft, Version 3). Department of Family Medicine, University of Wisconsin, School of
Medicine and Public Health, Madison, Wisconsin, 2010; supported by NIAAA grant # K23
AA017508. Adapted, with permission, from: Mindfulness-Based Relapse Prevention
Treatment Guide (Unpublished), by Bowen S, Chawla N, Marlatt GA, Univeristy of
Washington, Seattle, 2009.
30. U.S. Department of Veterans Affairs. Visualization/Guided Imagery.
2013. http://www.mentalhealth.va.gov/coe/cih-
visn2/Documents/Patient_Education_Handouts/Visualization_Guided_Imagery_2013.pdf.
Accessed June 12, 2014.
VHA Office of Patient Centered Care and Cultural Transformation
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