Mindfulness Approach Reduces SUD Relapse Risk

Caroline Cassels

March 20, 2014

Mindfulness-based aftercare significantly reduces relapse risk in patients with substance use disorders (SUDs) in the long-term compared with 2 other standard treatment approaches, new research shows.

Results from a randomized clinical trial show that after initial treatment for drug and alcohol abuse, patients assigned to receive mindfulness-based relapse prevention (MBRP) were significantly less likely to relapse at 12 months compared with their counterparts who received usual 12-step programming.

"These findings suggest that MBRP may support longer term sustainability of treatment gains for individuals with substance-use disorders," the investigators, led by Sarah Bowen, PhD, Addictive Behaviors Research Center, Seattle, Washington, write.

The study was published online March 19 in JAMA Psychiatry.

Relapse Rate High

Research shows that approximately 10.6% of US individuals with SUDs seek treatment and that 40% to 50% of these patients relapse within 1 year, highlighting the need for more effective relapse prevention (RP) therapies.

According to investigators, traditional RP strategies focus on identifying situations that may precipitate relapse and teach cognitive and behavioral skills to reduce risk.

However, they note that such therapies have several limitations, including the fact that "RP places relatively little emphasis on individual needs, values, and issues that may underlie problematic behavior." They add that traditional RP strategies focus on avoiding affective or cognitive discomfort rather than teaching skills designed to help patients tolerate these states.

In contrast, group-based psychosocial aftercare MBRP integrates principles of mindfulness to help patients attend to experiences moment to moment rather than employing avoidance strategies. The investigators note that mindfulness training has been associated with reduced anxiety, disordered eating, and depression relapse, and they also point out that there is growing evidence to support its efficacy in SUD.

To determine the long-term efficacy of MBRP in reducing relapse, investigators compared MBRP, RP, and 12-step treatment as usual (TAU) in 286 individuals who successfully completed initial treatment for SUD at a private clinic and were randomly assigned to 1 of the 3 study groups for 8 weeks of sessions.

The study's primary outcomes included relapse to drug use and heavy drinking as well as frequency of substance use in the past 90 days. Participants were assessed at baseline and at 3, 6, and 12 months.

Measures included self-report of relapse and urinalysis drug and alcohol screenings.

The investigators found that compared with TAU, patients assigned to MBRP and RP reported a significantly lower risk for 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.

Although results also showed that RP had an advantage over MBRP in time to first drug use, at 12-month follow-up, MBRP participants reported significantly fewer days of substance use and significantly decreased heavy drinking than either with RP and TAU.

These findings suggest that MBRP and RP may be equally effective at 3 months' follow-up compared with TAU and blunt the probability and severity of relapses at the 6-month follow-up, with RP delaying time to first drug use, but that MBRP may have a more enduring effect thereafter.

The researchers speculate that the enduring impact of MBRP may be due to "participants' improved ability to recognize and tolerate discomfort associated with craving or negative effect."

"The present randomized trial offers evidence that RP and MBRP are beneficial aftercare interventions compared with typical 12-step aftercare treatment. In addition, MBRP resulted in significantly less drug use and lower probability of any heavy drinking than RP at 12-month follow-up," the investigators add.

The authors report no relevant financial relationships.

JAMA Psychiatry. Published online March 19, 2014. Abstract


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