Mindfulness-Based Relapse Prevention for Stimulant Dependent Adults: A Pilot Randomized Clinical Trial
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In light of the known associations between stress, negative affect, and relapse, mindfulness strategies hold promise as a means of reducing relapse susceptibility. In a pilot randomized clinical trial, we evaluated the effects of Mindfulness-Based Relapse Prevention (MBRP), relative to a health education control condition (HE) among stimulant-dependent adults receiving contingency management. All participants received a 12-week contingency management (CM) intervention. Following a 4-week CM-only lead in phase, participants were randomly assigned to concurrently receive MBRP (n = 31) or HE (n = 32). The primary outcomes were stimulant use, measured by urine drug screens weekly during the intervention and at 1 month post-treatment, negative affect, measured by the Beck Depression Inventory and Beck Anxiety Inventory, and psychiatric severity, measured by the Addiction Severity Index. Medium effect sizes favoring MBRP were observed for negative affect and overall psychiatric severity outcomes. Depression severity changed differentially over time as a function of group, with MBRP participants reporting greater reductions through follow-up (p = 0.03; effect size = 0.58). Likewise, the MBRP group evidenced greater declines in psychiatric severity (p = 0.01; effect size = 0.61 at follow-up). Among those with depressive and anxiety disorders, MBRP was associated with lower odds of stimulant use relative to the control condition (odds ratio (OR) = 0.78, p = 0.03 and OR = 0.68, p = 0.04). MBRP effectively reduces negative affect and psychiatric impairment, and is particularly effective in reducing stimulant use among stimulant-dependent adults with mood and anxiety disorders.
KeywordsStimulants Mindfulness Treatment outcome Substance abuse Addiction
The authors would like to thank Anne Bellows Lee, Hailey Winetrobe, Megan Holmes, Mary Olaer, and all of the research staff at the UCLA ISAP Clinical Research Center. The authors also thank Alan Marlatt, Katie Witkiewitz, Neharika Chawla, Sarah Bowen, and Judson Brewer for valuable input during the development and implementation phases of the project. We appreciate Elizabeth Suti’s contribution to the study as the mindfulness interventionist. The research presented in this paper was supported by grants R21 DA029255, K23 DA020085 and T32 DA07272-21 from the National Institute on Drug Abuse.
Conflict of interest
No conflict exists. All authors of this paper declare that they have no conflict of interest.
- Beck, A. T. (1967). Depression: clinical, experimental, and theoretical aspects. New York: Harper and Row.Google Scholar
- Beck, A. T., & Steer, R. A. (1990). Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation.Google Scholar
- Bowen, S., Chawla, N., & Marlatt, G.A. (2011). Mindfulness-based relapse prevention for addictive behaviors: a clinician’s guide. Guilford Press.Google Scholar
- Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., & Hsu, S. H. (2014). Relative Efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA Psychiatry, 71(5), 547–556.CrossRefPubMedPubMedCentralGoogle Scholar
- Breslin, F. C., Zack, M., & McMain, S. (2002). An information-processing analysis of mindfulness: implications for relapse prevention in the treatment of substance abuse. Clinical Psychology: Science and Practice, 9(3), 275–299.Google Scholar
- Chawla, N., Collins, S. E., Bowen, S., Hsu, S., Grow, J., Douglas, S. A., & Marlatt, G. A. (2010). The mindfulness-based relapse prevention adherence and competence scale: development, interrater reliability and validity. Psychotherapy Research, 20(4), 388–397.CrossRefPubMedPubMedCentralGoogle Scholar
- Garland, E. L., Gaylord, S. A., Boettiger, C. A., & Howard, M. O. (2010). Mindfulness training Modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: results of a randomized, controlled pilot trial. Journal of Psychoactive Drugs, 42(2), 177–192.CrossRefPubMedPubMedCentralGoogle Scholar
- Glasner-Edwards, S., Marinelli-Casey, P., Hillhouse, M., Ang, A., Mooney, L.J., Rawson, R., & Methamphetamine Treatment Project Corporate Authors. (2009). Depression among methamphetamine users: association with outcomes from the methamphetamine treatment project at 3-year follow-up. Journal of Nervous and Mental Disease, 197(4), 225–231.CrossRefGoogle Scholar
- Marlatt, G. A., & Marques, J. K. (1977). Meditation, self-control, and alcohol use. In R. B. Stuart (Ed.), Behavioral self-management: strategies, techniques, and outcomes (pp. 117–153). New York: Brunner/Mazel.Google Scholar
- Segal, Z. V., Bieling, P., Young, T., MacQueen, G., & Cooke, R. (2010). Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo for relapse prophylaxis in recurrent depression. Archives of General Psychiatry, 67(12), 1256–1264.CrossRefPubMedPubMedCentralGoogle Scholar
- Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, Suppl 20, 22–33.Google Scholar