Moment-by-Moment in Women's Recovery (MMWR): Mindfulness-based intervention effects on residential substance use disorder treatment retention in a randomized controlled trial

Abstract

In this study we test the efficacy of Moment-by-Moment in Women's Recovery (MMWR), a mindfulness-based intervention adapted to support women with substance use disorder (SUD) while in residential treatment. We use a parallel-group randomized controlled trial with a time-matched psychoeducation control to test MMWR effects on residential treatment retention. We used clinical staff-determined residential site discharge status and discharge date from the SUD treatment site record to determine retention. We tested for study group differences in retention defined as time to treatment non-completion without improvement (i.e., patient left treatment before completion of the treatment plan and made little or no progress toward achieving treatment goals based on clinical team determination), as well as differences in self-report of study intervention mechanisms of action (i.e., mindfulness, perceived stress, distress tolerance, emotion regulation, distress, affect, and drug and alcohol craving). The analytic timeframe for the survival analysis was from study intervention start date to 150 days later. The sample (N = 200) was female, majority amphetamine/methamphetamine users (76%), Hispanic (58%), with a history of incarceration (62%). By the 150-day analytic endpoint, the sample had 74 (37%) treatment Completers, 42 (21%) still In-residence, 26 (13%) Non-completers with satisfactory progress, and 58 (29%) Non-completers without satisfactory progress. Survival analysis of the intent-to-treat sample showed the risk of non-completion without improvement was lower in MMWR as compared to the control group (adjusted hazard ratio = 0.42, 95% CI: 0.16-1.08, p = .07). Both groups improved on select self-reported mechanism measure scores at immediate post-intervention, but only in the MMWR group did class attendance (dosage) have a large-size correlation with improved mindfulness (r = .61, p < .01), distress tolerance (r = 0.55, p < .01) and positive affect (r = 0.52, p < .01) scores. The hazard ratio for retention was of medium-to-large effect size, suggesting the clinical relevance of adding MMWR to an all-women's, ethnoracially diverse, SUD residential treatment center. An extended curriculum may be helpful considering the protective benefits of class attendance on psychological health indicators.

Keywords: Dropout; Mindfulness; Residential; Retention; Substance use disorder; Women.

Figure 1.. Trial CONSORT diagram

Note. NA = Neurobiology of Addiction active control condition; MMWR = Moment by Moment in Women’s Recovery; ITT = intent to treat. By design, women missing the first class introduction session were not enrolled in the study, as they were likely to have already left the treatment facility.

Figure 2.. Residential treatment discharge status by group across 150 day period, N=200

Note. NC=Non-completer with (w) or without (w/o) satisfactory progress. Completer: patient completed the course of SUD residential treatment; In-residence: patient still at the residential treatment site at analytic endpoint (i.e., day 150); NC w/ progress: patient left treatment site before completion of the treatment plan and before achieving all treatment goals but are deemed by the clinical team as having made important progress toward their treatment goals and person demonstrated improved stability but require additional intensive treatment; NC w/o progress: patient did not complete treatment and the clinical team determines that they made little to no progress toward achieving treatment goals.