Abstract
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.
Similar content being viewed by others
References
Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-report: the Kentucky Inventory of Mindfulness Skills. Assessment, 11(3), 191–206.
Beck, A. T. (1967). Depression: clinical, experimental, and theoretical aspects. New York: Harper and Row.
Beck, A. T., & Steer, R. A. (1990). Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation.
Bowen, S., Chawla, N., Collins, S., Witkiewitz, K., Hsu, S., & Grow, J. (2009). Mindfulness-based relapse prevention for substance use disorders: a pilot efficacy trial. Substance Abuse, 30(4), 205–305.
Bowen, S., Chawla, N., & Marlatt, G.A. (2011). Mindfulness-based relapse prevention for addictive behaviors: a clinician’s guide. Guilford Press.
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.
Bowen, S. K., Witkiewitz, K., Dillworth, T. M., Chawla, N., Simpson, T. L., & Ostafin, B. D. (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of Addictive Behaviors, 20(3), 343–347.
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.
Brewer, J. A., Bowen, S., Smith, J. T., Marlatt, G. A., & Potenza, M. N. (2010). Mindfulness-based treatments for co-occurring depression and substance use disorders: what can we learn from the brain? Addiction, 105(10), 1698–1706.
Brewer, J. A., Sinha, R., Chen, J. A., Michalsen, R. N., Babuscio, T. A., & Nich, C. (2009). Mindfulness training and stress reactivity in substance abuse: results from a randomized, controlled stage I pilot study. Substance Abuse, 30(4), 306–317.
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.
Chiessa, A., & Serretti, A. (2014). Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence. Substance Use and Misuse, 49(5), 492–512.
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.
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.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.
Hoffman, S. G., Sawyer, A. T., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.
Hollon, S. D., & Ponniah, K. (2010). A review of empirically supported psychological therapies for mood disorders in adults. Depression and Anxiety, 27(10), 891–932.
Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. G., Fletcher, K. E., & Pbert, L. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry, 149(7), 936–943.
Kinnunen, T., Leeman, R. F., Korhonen, T., Quiles, Z. N., Terwal, D. M., Garvey, A. J., & Hartley, H. L. (2008). Exercise as an adjunct to nicotine gum in treating tobacco dependence among women. Nicotine Tobacco Research, 10(4), 689–703.
Li, C.-S. R., & Sinha, R. (2008). Inhibitory control and emotional stress regulation: neuroimaging evidence for frontal–limbic dysfunction in psycho-stimulant addiction. Neuroscience and Biobehavioral Reviews, 32(3), 581–597.
Ling, W., Hillhouse, M., Domier, C., Doraimani, G., Hunter, J., Thomas, C., & Bilangi, R. (2009). Buprenorphine tapering schedule and illicit opioid use. Addiction, 104(2), 256–265.
Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72(1), 31–40.
Marchand, W. R. (2012). Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress. Journal of Psychiatric Practice, 18(4), 233–252.
Marcus, M. T., & Zgierska, A. (2009). Mindfulness-based therapies for substance use disorders: part 1. Substance Abuse, 30(4), 263–265.
Marlatt, G. A. (1996). Taxonomy of high-risk situations for alcohol relapse: evolution and development of a cognitive-behavioral model. Journal of Addiction, 91(Suppl), S37–S49.
Marlatt, G. A., & Chawla, N. (2007). Meditation and alcohol use. Southern Medical Journal, 100(4), 451–453.
Marlatt, G. A., & George, W. H. (1984). Relapse prevention: introduction and overview of the model. British Journal of Addiction, 79(3), 261–273.
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.
McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., Pettinati, H., & Argeriou, M. (1992). The fifth edition of the addiction severity index. Journal of Substance Abuse Treatment, 9(3), 199–213.
Murphy, T. J., Pagano, R. R., & Marlatt, G. A. (1986). Lifestyle modification with heavy alcohol drinkers: effects of aerobic exercise and meditation. Addictive Behaviors, 11(2), 175–186.
Petry, N. M. (2006). Contingency management treatments. British Journal of Psychiatry, 189(2), 97–98.
Rawson, R. A., McCann, M. J., Flammino, F., Shoptaw, S., Miotto, K., Reiber, C., & Ling, W. (2006). A comparison of contingency management and cognitive-behavioral approaches for stimulant-dependent individuals. Addiction, 101(2), 267–274.
Reiber, C., Galloway, G., Cohen, J., Hsu, J. C., & Lord, R. H. (2000). A descriptive analysis of participant characteristics and patterns of substance use in the CSAT methamphetamine treatment project: the first six months. Journal of Psychoactive Drugs, 32(2), 183–191.
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.
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.
Wegner, D. M., & Zanakos, S. (1994). Chronic thought suppression. Journal of Personality, 62, 615–640.
Witkiewitz, K., & Black, D. S. (2014). Unresolved issues in the application of mindfulness-based interventions for substance use disorders. Substance Use and Misuse, 49(5), 601–604.
Witkiewitz, K., & Bowen, S. (2010). Depression, craving and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 78(3), 362–374.
Witkiewitz, K., Bowen, S., Harrop, E. N., Douglas, H., Enkema, M., & Sedgwick, C. (2014). Mindfulness-based treatment to prevent addictive behavior relapse: theoretical models and hypothesized mechanisms of change. Subst Use and Misuse, 49(5), 513–524.
Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy, 19(3), 211–228.
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Glasner, S., Mooney, L.J., Ang, A. et al. Mindfulness-Based Relapse Prevention for Stimulant Dependent Adults: A Pilot Randomized Clinical Trial. Mindfulness 8, 126–135 (2017). https://doi.org/10.1007/s12671-016-0586-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12671-016-0586-9