Evidence & Writing
The research on identity, and where we go further
The Social Identity Model of Recovery (Best, Beckwith, Haslam et al., 2016) established what practitioners had long observed: identity change is not a side-effect of recovery, it is the mechanism. Its account is social — recovery as a transition from networks organised around use to networks organised around recovery, with an addict identity supplanted by a recovery identity. We take that as established, and we ask one question further. A recovery identity is a better face than an addict identity. It is still a face. What we train is the attention that notices there is someone wearing it.
Read the argument, check the trials
Our founding article, What Is the Essence of the Craving Trap?, sets out the case in full: why twenty-five years of refinement have not noticeably moved the relapse ceiling, what the randomized trials show — including the honest limitations of the research — and what changes when recovery stops being a repair project and becomes a recognition.
“No wave reaches it. The door was never locked — the fighting is what held it shut, and the capacity to see that was here all along.”
— What Is the Essence of the Craving Trap?, Paul du Buf, ERA-Institute
Read the article
The layer underneath the protocols
Between 40 and 60 percent of people relapse after addiction treatment — a figure published in JAMA in 2000, and subsequent research continues to report substantial rates of return to use. Twenty-five years of better protocols, better medication and better cognitive-behavioural therapy have improved much, and have not noticeably moved that number.
Here is a capacity few protocols train explicitly or intensively: the moment after a craving arises — when a wave of urgency moves through the body and a person either becomes it, or watches it. Attentional practice builds that capacity — kind attention: meeting a craving as a passing event in the body rather than a command, without judging it, obeying it, or fighting it. One proposed mechanism is decentering — experiencing thoughts, sensations and cravings as events rather than commands. The people we work with describe it more simply. The wave passes. Something watched it pass. That something is who they are — and it was never in danger.
The mask was never a lie. It was a wave you mistook for a face. Attention shows you what has been underneath, watching, the whole time.
6 → 12
months: mindfulness-based relapse prevention matches standard relapse prevention at six months — and pulls ahead at twelve (Bowen et al., JAMA Psychiatry, 2014). Capacities compound; strategies fade.
42%
greater reduction in return to drug use when Mindfulness-Oriented Recovery Enhancement was added to methadone treatment — with 59% less dropout (Cooperman et al., JAMA Psychiatry, 2024)
45% vs 24%
no longer misusing opioids at nine months on Mindfulness-Oriented Recovery Enhancement, versus active group therapy (Garland et al., JAMA Internal Medicine, 2022)
These trials tested MBRP and MORE — established eight-week protocols that train the same capacity ERA trains. They are the evidence for the approach, not for our programme: Still·point and the ERA course have not themselves been evaluated in a randomized trial. ERA measures its own outcomes against your baseline, and is building a pathway to formal evaluation.
The 2024 figures are hazard-ratio reductions (HR 0.58 and 0.41) from a phase-2 trial of 154 participants against usual care; the authors call for phase-3 replication. Absolute differences were smaller.
The evidence is real, and it is mixed
A 2021 Cochrane review of 40 randomized trials found that mindfulness-based interventions may slightly reduce days of substance use, with uncertain effects on abstinence and craving. Reviews consistently show stronger effects on craving than on abstinence, and the heterogeneity tracks the quality of delivery — the strongest trials involve the most skilled delivery. That is why we train fidelity, and why we measure against your own baseline rather than against someone else's trial.
Key sources: Bowen et al., JAMA Psychiatry 2014 · Brewer et al., Drug & Alcohol Dependence 2011 · Garland et al., JAMA Internal Medicine 2022 · Cooperman et al., JAMA Psychiatry 2024 · Garland et al., American Journal of Psychiatry 2024 · McLellan et al., JAMA 2000 · Best, Beckwith, Haslam et al., Addiction Research & Theory 2016 · Goldberg et al., Cochrane Database of Systematic Reviews 2021 · Hsiao et al., Mindfulness 2019. The full evidence dossier is available on request to anyone who wants it. The case for treatment to evolve should be arguable on the evidence.
