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Randomized Controlled Trial
. 2014 May;71(5):547-56.
doi: 10.1001/jamapsychiatry.2013.4546.

Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial

Sarah Bowen, Katie Witkiewitz, Seema L Clifasefi, Joel Grow, Neharika Chawla, Sharon H Hsu, Haley A Carroll, Erin Harrop, Susan E Collins, M Kathleen Lustyk, Mary E Larimer
Randomized Controlled Trial

Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial

Sarah Bowen et al. JAMA Psychiatry. 2014 May.

Abstract

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

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Bowen, Grow, and Chawla conduct MBRP trainings for which they receive monetary incentives, although the findings presented in this article have not yet been presented as part of these trainings. No other disclosures were reported.

Figures

Figure
Figure
Study Flow From Screening to Analysis Reasons for exclusion from analysis across all follow-up assessments for (1) mindfulness-based relapse prevention (MBRP): withdrew from the study, enrolled as inpatient, incarcerated, refused, and unable to contact; (2) standard relapse prevention (RP): withdrew from the study, enrolled as inpatient, incarcerated, refused, unable to contact, and died; and (3) treatment as usual (TAU): withdrew from the study, incarcerated, and unable to contact.
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References

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