Mindfulness is receiving increased attention in the scientific community, and has been

described as an awareness of moment by moment experience arising from purposeful

Addictive Behaviors 30 (2005) 13351341T Corresponding author. Present address: Department of Psychiatry and Behavioral Sciences, 1959 NE PacificSpirituality, mindfulness and substance abuse

Janis LeighT, Sarah Bowen, G. Alan MarlattDepartment of Psychology, University of Washington, Box 351525, Seattle WA 98195-1525, United States

Abstract

A growing body of research suggests that mindfulness-based therapies may be effective in treating a

variety of disorders including stress, chronic pain, depression and anxiety. However, there are few

valid and reliable measures of mindfulness. Furthermore, mindfulness is often thought to be related to

spirituality, given its roots in Buddhist tradition, but empirical studies on this relationship are difficult

to find. The present study: (1) tested the reliability and validity of a new mindfulness measure, the

Freiburg Mindfulness Inventory (FMI), (2) explored the relationship between mindfulness and

spirituality, and (3) investigated the relationship between mindfulness and/or spirituality and alcohol

and tobacco use in an undergraduate college population (N=196). Results support the reliability of the

FMI and suggest that spirituality and mindfulness may be separate constructs. In addition, smoking

and frequent binge-drinking were negatively correlated with spirituality scores; as spirituality scores

increased the use of alcohol and tobacco decreased. Thus, spirituality may be related to decreased

substance use. In contrast, a positive relationship between mindfulness and smoking/frequent binge-

drinking behavior was uncovered, and warrants further investigation.

D 2005 Elsevier Ltd. All rights reserved.

Keywords: Spirituality; Mindfulness; Substance abuse; Smoking; Binge-drinking; Freiburg Mindfulness Inventory

1. Introduction0306-4603/$ -

doi:10.1016/j.a

Street, Box 35

E-mail add6560, Seattle WA 98195-6560, United States.see front matter D 2005 Elsevier Ltd. All rights reserved.

ddbeh.2005.01.010

ress: janis2@u.washington.edu (J. Leigh).

attention (i.e., meditation), along with a non-judgmental acceptance of these present-moment

experiences (Kabat-Zinn, 2003). A growing body of research suggests that mindfulness-based

therapies may be effective in the reduction of chronic pain (Kabat-Zinn, 1990), anxiety

(Kabat-Zinn et al., 1992), and in the prevention of depressive relapse (Segal, Williams, &

Teasdale, 2002; Teasdale et al., 2000). Mindfulness-based interventions are now being

considered for the treatment of substance abuse disorders (Marlatt et al., 2004), and

Generalized Anxiety Disorder (Roemer & Orsillo, 2002, 2003).

Although mindfulness meditation is associated with positive outcomes, there are few valid

and reliable methods for assessing the construct of mindfulness. Therefore, the first aim of

this study was to test the reliability and validity of a new mindfulness measure, the Frieburg

Mindfulness Inventory (FMI) (Buchheld, Grossman, & Walach, 2002).

As mindfulness is rooted in Buddhist philosophy, it is often thought to be related to

spirituality; however, to our knowledge this relationship has not been studied empirically.

Spirituality is a fairly new construct in empirical science, when viewed as separate from

religiousness or religiosity. While religiosity may include spirituality within a framework of

specific beliefs, customs, and practices, spirituality is a much more individualized approach to

a practice of worship. A spiritual practitioner may not adhere to a formal religious practice or

associate with an established religion (Longo & Peterson, 2002).

In a recent study of spirituality and substance use in college students, subjects were asked

how important their spiritual or religious beliefs were in their decision to use drugs and/or

alcohol, and in other life decisions (Stewart, 2001). Those students who rated spiritual beliefs

important drank less than those who did not, but this buffering effect diminished as the

students got older. Differences in use between high and low spirituality students did not

diminish over time when examining marijuana use; 41% of students who reported low

importance of spirituality used marijuana, as compared to approximately 15% of students

who reported high importance of spiritual beliefs, across all age groups in the study.

Researchers have also examined the relationship between spirituality (as measured by the

Spiritual Transcendence Index [STI]) (Seidlitz et al., 2002) and the effect of stress on both

emotional and physical adjustment in college students. Findings suggest that spirituality

buffered the adverse effects of stress on negative affect and physical adjustment/symptoms,

but had no significant effect on positive affect (Kim & Seidlitz, 2002). In order to clarify the

relationship between mindfulness and spirituality, the current study included the STI for

comparison with the FMI. In addition, the authors chose to investigate the relationship

between mindfulness and/or spirituality and substance abuse, specifically alcohol and tobacco

use, in a college population.

It has been widely reported that alcohol consumption is a problem on college campuses

throughout America, and the resulting negative consequences are experienced by the drinker

and the non-drinker alike. It is estimated that annually approximately 1400 college students

(between the ages of 18 and 24) die from alcohol-related injuries, 500,000 students are

unintentionally injured while under the influence of alcohol, 600,000 students are assaulted

J. Leigh et al. / Addictive Behaviors 30 (2005) 133513411336by another student who has been drinking, and over 70,000 students are the victims of

alcohol-related sexual assault or rape (National Institute on Alcohol Abuse and Alcoholism

53.3% of non-college students (US DHHS, 2001).

SAS has been reported to be a reliable and valid measure of spirituality, while having no

significant relationship to ones attendance at weekly religious meetings (Howden, 1992).The 28-item SAS is rated on a 6-point scale ranging from Strongly Disagree to Strongly

Agree (e.g., bMy inner strength is related to a belief in a Higher Power or Supreme Being.Q).The STI has been reported to be a reliable and valid measure assessing a more inclusive

concept of spirituality, as distinct from religiousness or religious affiliation (Seidlitz et al.,

2002). The 8-item STI is rated on a 6-point scale ranging from Strongly Disagree to Strongly

Agree (e.g., bMy spirituality gives me a feeling of fulfillment.Q).Alcohol use was assessed with two measures: the Daily Drinking Inventory (DDQ;

Dimeff, Baer, Kivlahan, & Marlatt, 1999), and the Alcohol Use Disorders Identification

Test (AUDIT; NIAAA, 2000). Subjects also identified themselves as either a smoker or a

non-smoker.

3. ResultsResults of The Harvard University School of Public Health 1999 College Alcohol Study

(as reported by Wechsler, Lee, Kuo, & Lee, 2000) found that the overall rate of bbingeQdrinking (5 drinks in a row for men, or 4 drinks in a row for women) did not change

significantly between 1993 and 1999. However, the number of frequent binge-drinkers (those

engaging in binge-drinking an average of 2 or more times per week) did change significantly,

increasing by 14.5% between 1993 and 1999.

Although the health hazards of smoking have been widely reported, cigarette use is

increasing on campuses nationwide. A recent review of the Harvard School of Public Health

College Alcohol Study (Wechsler, Rigotti, Gledhill-Hoyt, & Lee, 1998), found that the

prevalence of current smoking rose by 27.8% from 1993 to 1997 to 28.5% of college

students.

2. Methods

Undergraduate students (N=196) 18 and older completed questionnaires administered

during mass/pre-testing in their Introductory Psychology class. The sample consisted of 123

females (63%), 70 males (36%), and 3 (1%) unidentified.

Mindfulness was measured using the newly developed FMI. The FMI includes 30 items

(e.g., bI am open to the experience of the present moment.Q) rated on a 4-point scale rangingfrom Rarely to Almost Always. Spirituality was assessed with two measures: the Spirituality

Assessment Scale (SAS) (Howden, 1992), and the Spiritual Transcendence Index (STI). The(NIAAA), 2002). Furthermore, full-time college students are more likely to drink than their

non-fulltime peers. Over 63% of college students reported drinking in 2001, as compared to

J. Leigh et al. / Addictive Behaviors 30 (2005) 13351341 1337A reliability analysis of the FMI scale yielded a reliability coefficient of 0.80. A principal

components factor analysis (with Varimax rotation) extracted three factors: (1) Acceptance

Table 1

Smoking, hazardous drinking, peak weekend drinking, mindfulness and spirituality

Non-smokers (n=146151)

M (S.D.)

Smokers (n=3842)

M (S.D.)

Audita,TTT 3.81 (5.14) 10.42 (5.08)Drinks Pk. WE nightTTT 1.40 (2.50) 6.37 (5.00)FMI score (1 to 4)T 2.66 (.33) 2.79 (.31)STI score (1 to 6)TT 3.84 (1.56) 3.04 (1.41)SAS score(1 to 6) 4.62 (.57) 4.43 (.48)

Smokers had significantly higher AUDIT scores than non-smokers (t(191)=7.38, pb0.001), and dranksignificantly more drinks per night on a peak week-end (t(187)=8.71, pb0.001). The significant positiverelationship between smoking and FMI scores (t(190)=2.20, pb0.05), is contrasted with a significant negative

J. Leigh et al. / Addictive Behaviors 30 (2005) 133513411338and Openness to Self and Experiences (e.g., bI accept myself as I am.Q) alpha=0.76, (2) Mind/Body Awareness (e.g., bI notice how my emotions express themselves through my body.Q)alpha=0.73, and (3) Non-Attachment to Thoughts (e.g., bI watch my thoughts withoutidentifying with themQ) alpha=0.62.

To assess the relationship between the constructs of mindfulness and spirituality, a

correlational analysis was performed on the FMI, SAS, and STI mean scores. SAS scores

were positively correlated with FMI scores (r=0.45, pb0.01), and with STI scores (r=0.52,

relationship between smoking and STI scores t(185)=2.89, pb0.01). The negative relationship between smokingand SAS scores approached significance (t(182)=1.95, p=0.052).

a A score of 8 or higher is considered hazardous drinking.

T Significant at 0.05 value.TT Significant at 0.01 value.TTT Significant at 0.001 value.pb0.01). No significant correlation was found between FMI and STI scores. This mightsuggest that the SAS contains features of both mindfulness and spirituality, while the FMI and

STI may be measuring these constructs separately.

A t-test comparing smokers and non-smokers with FMI, SAS and STI mean scores

revealed that non-smokers scored significantly higher than smokers on the STI, while the

reverse was true on the FMI (Table 1). A t-test of drinking behavior was limited to

Table 2

Drinking, mindfulness and spirituality

Non-drinker (n=7981)

M (S.D.)

Frequent binge (n=3941)

M (S.D.)

FMI score (1 to 4)TT 2.65 (.34) 2.83 (.31)STI score (1 to 6)T 4.06 (1.61) 3.30 (1.32)SAS score (1 to 6) 4.63 (.62) 4.54 (.50)

The significant positive relationship between frequent binge-drinking and FMI scores t(120)=2.78, pb0.01) iscontrasted with a significant negative relationship between frequent binge-drinking and STI scores (t(116)=2.54,

pb0.05). SAS score differences were not significant.T Significant at 0.05 value.TT Significant at 0.01 value.

with alcohol and/or tobacco. From a positive reinforcement perspective, the smoker andfrequent binge-drinker may be more attuned to the bhighQ they feel when using thesesubstances. Thus, they smoke and/or frequent binge-drink in order to achieve and maintain

pleasurable physical and emotional sensations.

A planned future study will examine the sensitivity phenomenon using the Eysenck Short

Questionnaire for Extraversion and Neuroticism (Eysenck & Eysenck, 1964). If smoking and

frequent binge-drinking are related to introversion, we would expect to see a positive

relationship between introversion scores and substance use. We will also include measures offrequent binge-drinkers and non-drinkers only, with non-drinkers scoring significantly

higher than frequent binge-drinkers on the STI, while the reverse was true on FMI scores

(Table 2).

To clarify the relationship between smoking/frequent binge-drinking and mindfulness, a t-

test was performed on subscales of the FMI. Smokers scored significantly higher on the

Mind/Body Awareness Subscale (t(190)=2.03, pb0.05). Similarly, frequent binge-drinkersalso scored significantly higher on this subscale (t(120)=3.06, pb0.01).

4. Discussion

Analysis of the FMI scale provided support for its reliability, and the principle components

analysis supported a three-factor solution, with good reliability ratings for the three subscales

extracted. Although the present study demonstrated reliability of the FMI in a college sample,

continued use of this measure by the scientific community is suggested in order to determine

if it is a valid and reliable measure of mindfulness.

FMI scores were not significantly correlated with STI scores, which raises the question of

the differentiation of the two constructs. From a Buddhist perspective, mindfulness is seen as

a necessary technique in the pursuit of spiritual goals. However, mindfulness may also be

viewed as a way of being present and open to ones life experiences; unrelated to a spiritual

path per se. Spirituality, however, can be conceptualized as an acceptance of specific spiritual

beliefs that do not necessarily include a mindful approach to experience. In this sense,

spirituality can be understood as an adoption of a set of philosophical beliefs, whereas

mindfulness may be a way of approaching experiences. Either perspective could theoretically

include the other, but does not necessarily do so.

The positive relationship between FMI scores and smoking/frequent binge-drinking was

unexpected, and may be the result of increased sensitivity to body sensations in those who

smoke and/or frequent binge-drink. This relationship may be viewed from both a negative

and a positive reinforcement perspective. According to Self-Medication Hypothesis

(Khantzian, 1985), individuals use substances as a negative reinforcer to avoid or alleviate

uncomfortable physical or affective states. As suggested by Marx and Sloan (2003), alcohol

may be used as a tool to reduce psychological distress. Perhaps those in our sample were

attempting to desensitize their heightened physical sensitivity, or avoid negative emotions,

J. Leigh et al. / Addictive Behaviors 30 (2005) 13351341 1339experiential avoidance and thought suppression to explore substance use as an avoidance

behavior.

Howden, J. W. (1992). Development and psychometric characteristics of the spirituality assessment scale

(Doctoral dissertation, Texas Womans University, 1992). Dissertation Abstracts International, 54 (1-B), 166B.(UMI No. 9312917).

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and

illness. New York7 Dell Publishing.Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present and future. Clinical Psychology:

Science and Practice, 10(2), 144156.

Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. G., Fletcher, K. E., Pbert, L., et al. (1992). Effectiveness

of a meditation-based stress reduction program in the treatment of anxiety disorders. The American Journal of

Psychiatry, 149(7), 936943.

Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine

dependence. American Journal of Psychiatry, 142(11), 12591264.

Kim, Y., & Seidlitz, L. (2002). Spirituality moderates the effect of stress on emotional and physical adjustment.

Personality and Individual Differences, 32(8), 13771390.

Longo, D. A., & Peterson, S. M. (2002). The role of spirituality in psychosocial rehabilitation. Psychiatric

Rehabilitation Journal, 25(4), 333340.

Marlatt, G. A., Witkiewitz, K., Dillworth, T. M., Bowen, S. W., Parks, G. A., MacPherson, L. M., et al. (2004).

Vipassana meditation as a treatment for alcohol and drug use disorders. In S. C. Hayes, V. M. Follette, & M. M.

Linehan (Eds.), Mindfulness and Acceptance: Expanding the Cognitivebehavioral Tradition (pp. 267287).

New York7 Guildford Press.In contrast to the positive relationship between mindfulness and substance use, we found a

negative relationship between spirituality and substance use. This finding suggests that those

with high spirituality engage in fewer harmful behaviors and is consistent with the 12-step

philosophy. Perhaps those with high spirituality scores have a higher internal locus of control,

a relationship that will be explored in our follow-up study.

Given the rise in both frequent binge-drinking and smoking on college campuses, there is a

growing need for new interventions. Further research may clarify the role of mindfulness and

spirituality in substance use, and assist in prevention efforts by identifying important

mediators of these addictive, and potentially harmful, behaviors.

To our knowledge this is the first study to test the reliability and validity of the FMI in the

United States. This study may also be the first to examine empirically the relationship

between mindfulness and spirituality. While the results are preliminary, they suggest that

these constructs can be measured reliably through self-report and may assist in identifying an

important relationship between substance use and mindfulness. Can heightened sensitivity be

a risk-factor in the use of substances? Our next study may help to answer that question.

References

Buchheld, N., Grossman, P., & Walach, H. (2002). Measuring Mindfulness in Insight Meditation (Vipassana) and

Meditation-Based Psychotherapy: The Development of the Freiburg Mindfulness Inventory (FMI).

Dimeff, L. A., Baer, J. S., Kivlahan, D. R., & Marlatt, G. A. (1999). Brief alcohol screening and intervention for

college students (BASICS): A harm reduction approach. New York7 The Guilford Press.Eysenck, S. B. G., & Eysenck, H. J. (1964). An improved short questionnaire for the measurement of extraversion

and neuroticism. Life Sciences, 3, 11031109.

J. Leigh et al. / Addictive Behaviors 30 (2005) 133513411340Marx, B. P., & Sloan, D. M. (2003). The effects of trauma history, gender, and race on alcohol use and

posttraumatic stress symptoms in a college student sample. Addictive Behaviors, 28, 16311647.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2000). Publications; Alcohol Use Disorders

Identification Test (AUDIT). Retrieved February 17, 2004, from http://www.niaaa.nih.gov/publications/

audit.htm

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2002). A call to action: Changing the culture of

drinking at U.S. Colleges. Bethesda: The Task Force on College Drinking, National Institute on Alcohol Abuse

and Alcoholism.

Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety

disorder: Integrating mindfulness/acceptance-based approaches with existing cognitivebehavioral models.

Clinical Psychology: Science and Practice, 9(1), 5468.

Roemer, L., & Orsillo, S. M. (2003). Mindfulness: A promising intervention strategy in need of further study.

Clinical Psychology: Science and Practice, 10(2), 172176.

Segal, Z., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A

new approach to preventing relapse. New York7 The Guilford Press.Seidlitz, L., Abernethy, A. D., Duberstein, P. R., Evinger, J. S., Chang, T. H., & Lewis, B. (2002). Development of

the spiritual transcendence index. Journal for the Scientific Study of Religion, 41(3), 439453.

Stewart, C. (2001). The influence of spirituality on substance use of college students. Journal of Drug Education,

31(4), 343351.

Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention

of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and

Clinical Psychology, 68(4), 615623.

J. Leigh et al. / Addictive Behaviors 30 (2005) 13351341 1341U.S. Department of Health and Human Services (US DHHS). (2001). 2001 National Household Survey on

Drug Abuse (NHSDA). Retrieved August 28, 2003, from http://www.samhsa.gov/oas/nhsda/2K1nhsda/vol1/

Chapter 3.htm

Wechsler, H., Lee, J. E., Kuo, M., & Lee, H. (2000). College binge drinking in the 1990s: A continuing problem.

Results of the Harvard School of Public Health 1999 College Alcohol Study. Journal of American College

Health, 48(5), 199210.

Wechsler, H., Rigotti, N. A., Gledhill-Hoyt, J., & Lee, H. (1998). Increased levels of cigarette use among college

students: A cause for national concern. Journal of the American Medical Association, 280(19), 16731678.

Spirituality, mindfulness and substance abuseIntroductionMethodsResultsDiscussionReferences