Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders

By Sarah Bowen, Katie Witkiewitz, Seema L. Clifasefi, Joel Grow, Neharika Chawla, S. Hsu, Haley A. Carroll, E. Harrop, S. Collins, M. Lustyk and 1 more. JAMA psychiatry, 2014

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IMPORTANCE Relapse is highly prevalent following substance abuse treatments, highlighting the need for improved aftercare interventions. Mindfulness-based relapse prevention (MBRP), a group-based psychosocial aftercare, integrates evidence-based practices from mindfulness-based interventions and cognitive-behavioral relapse prevention (RP) approaches. OBJECTIVE To evaluate the long-term efficacy of MBRP in reducing relapse compared with RP and treatment as usual (TAU [12-step programming and psychoeducation]) during a 12-month follow-up period. DESIGN, SETTING, AND PARTICIPANTS Between October 2009 and July 2012, a total of 286 eligible individuals who successfully completed initial treatment for substance use disorders at a private, nonprofit treatment facility were randomized to MBRP, RP, or TAU aftercare and monitored for 12 months. Participants medically cleared for continuing care were aged 18 to 70 years; 71.5% were male and 42.1% were of ethnic/racial minority. INTERVENTIONS Participants were randomly assigned to 8 weekly group sessions of MBRP, cognitive-behavioral RP, or TAU. MAIN OUTCOMES AND MEASURES Primary outcomes included relapse to drug use and heavy drinking as well as frequency of substance use in the past 90 days. Variables were assessed at baseline and at 3-, 6-, and 12-month follow-up points. Measures used included self-report of relapse and urinalysis drug and alcohol screenings. RESULTS Compared with TAU, participants assigned to MBRP and RP reported significantly lower risk of relapse to substance use and heavy drinking and, among those who used substances, significantly fewer days of substance use and heavy drinking at the 6-month follow-up. Cognitive-behavioral RP showed an advantage over MBRP in time to first drug use. At the 12-month follow-up, MBRP participants reported significantly fewer days of substance use and significantly decreased heavy drinking compared with RP and TAU. CONCLUSIONS AND RELEVANCE For individuals in aftercare following initial treatment for substance use disorders, RP and MBRP, compared with TAU, produced significantly reduced relapse risk to drug use and heavy drinking. Relapse prevention delayed time to first drug use at 6-month follow-up, with MBRP and RP participants who used alcohol also reporting significantly fewer heavy drinking days compared with TAU participants. At 12-month follow-up, MBRP offered added benefit over RP and TAU in reducing drug use and heavy drinking. Targeted mindfulness practices may support long-term outcomes by strengthening the ability to monitor and skillfully cope with discomfort associated with craving or negative affect, thus supporting long-term outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01159535

Subfields: Applied Psychology, Clinical Psychology, Epidemiology

View Paper: https://www.semanticscholar.org/paper/a134b969514eb7e939b7ec9c938788b66d6a5f81

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Citations in the corpus

Mechanisms of Mindfulness Training: Monitor and Acceptance Theory (MAT) (2016, background): “, attention, working memory, emotion regulation; for reviews, see Chiesa, Calati, & Serretti, 2011; Keng, Smoski, & Robins, 2011; Tang, Hölzel, & Posner, 2015), stress reduction (Creswell & Lindsay, 2014), as well as manymental and physical health outcomes (e.g., delaying HIV progression, reducing r”
Mindfulness-Based Interventions for Anxiety and Depression (2017, neutral): “These include mindfulness based cognitive therapy (MBCT) for depression, 15 mindfulness-based relapse prevention (MBRP) for drug addiction, 49 mindfulness-based relationship enhancement (MBRE) to improve relationship functioning, 50 and a mindfulness-based program to foster healthy eating, 51 to…”
Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. (2018, background): “Some studies included multiple control groups (k = 22, e.g., Bowen et al., 2014), comorbid diagnoses (k = 5, e.g., depression and pain; De Jong et al., 2016), or both (k = 1, e.g., Zautra et al., 2008).”