Mindfulness-Based Relapse Prevention for Stimulant Dependent Adults: A Pilot Randomized Clinical Trial

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). Stimulant dependent adults age 18 and over. A university based clinical research center. 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= 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.

Mindfulness-based Relapse Prevention for Substance Use Disorders: A Systematic Review and Meta-analysis

“…Of 50 full texts identified as potentially eligible, we excluded 21, including 2 terminated trials and 9 ongoing trials that would likely meet eligibility criteria for this review once completed (see Online Supplement 3). Overall, we identified nine studies (see Online Supplement 5) meeting inclusion criteria ( Bowen et al, 2009 , 2014b ; Brewer et al, 2009 ; Uhlig, 2009 ; Lee et al, 2011 ; Zgierska, 2014 ; Imani et al, 2015 ; Glasner et al, 2017 ).…”

“…The majority of studies did not restrict participants by primary substance of misuse, with participants reporting use of various substances including alcohol, cocaine, marijuana, methamphetamines, and opioids. One study recruited patients meeting DSM criteria specifically for either alcohol or cocaine ( Brewer et al, 2009 ), whereas 3 other studies only recruited participants dependent on stimulants ( Glasner et al, 2017 ), opioids ( Imani et al, 2015 ), or alcohol ( Zgierska, 2014 ). Many RCTs excluded patients with concurrent psychotic disorder, significant suicide risk, or cognitive impairments, though notably 43% (n = 27) of participants in 1 study had an axis I mood or anxiety disorder ( Glasner et al, 2017 ).…”

“…As such, sessions in these RCTs likely included 20 to 30 minutes of guided meditations, experiential skills-based practices, and discussion of practical applications, with participants also receiving handouts, audio-recorded mindfulness homework exercises, and daily craving and mood tracking sheets, as per the MBRP manual ( Bowen et al, 2011 , 2014a ). One RCT evaluated the manual translated into Farsi ( Imani et al, 2015 ), and the remaining RCTs shortened the MBRP manual to be delivered in 9 to 15 hours of total contact time ( Brewer et al, 2009 ; Uhlig, 2009 ; Lee et al, 2011 ; Glasner et al, 2017 ). MBRP providers ranged from trained graduate-level therapists with experience in CBT and mindfulness meditation, to certified meditation instructors, to “trained instructors.” We confirmed involvement of the MBRP developers on the study team of 5 RCTs ( Bowen et al, 2009 , 2014b ; Lee et al, 2011 ; Zgierska, 2014 ; Imani et al, 2015 ), and consultation with the MBRP developers in the development and implementation phases of another RCT ( Glasner et al, 2017 ).…”

“…Five RCTs reported additional interventions or services received by MBRP participants, including TAU services the participants in the comparator group received ( Uhlig, 2009 ; Zgierska, 2014 ; Imani et al, 2015 ), contingency management (which participants in the health education comparison group also received as a co-intervention) ( Glasner et al, 2017 ), and “multiple other treatment programs” (which participants in the relapse prevention comparison group also received as a co-intervention) ( Bowen et al, 2014b ). Comparator interventions included relapse prevention, health education, cognitive behavioral therapy, and TAU (ie, substance use education, the Matrix Model, a predominantly 12-step process-orientated group, or medical management including pharmacotherapy and weekly individual counseling sessions).…”

An historical review of racial bias in prison-based substance abuse treatment design

“…The result allows for a natural state of restful alertness, where those who practice TM learn to recognize their autonomy and infinite individual power. Mindfulness-based stress reduction (MBSR) programming requires those who practice to focus on their ongoing mental processes and self-management (Glasner et al, 2017;Kabat-Zinn et al, 1992). As MBSR drives students to envision their mind at work and the ways in which they pilot their own experiences and decision-making, this practice has the possibility to improve mood states within incarcerated populations confined to the restrictions of a total institution and may help develop healthier psychological functioning.…”