Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: neurocognitive mechanisms and clinical implications PMC
In a RCT of MBRP among a heterogenous sample of individuals with various substance use disorders, increases in dispositional mindfulness facets like acceptance, awareness, and nonjudgment significantly mediated the effect of MBRP on decreasing craving following treatment [39]. Similarly, in a large cluster RCT of MORE versus CBT or TAU, increases in dispositional mindfulness significantly mediated the effect of MORE on reducing craving following treatment [40]. Finally, MORE significantly increased the mindfulness facet of nonreactivity which, in turn, predicted decreases in prescription opioid misuse [41]. Given that SUDs are chronically-relapsing conditions,50,58 any intervention for substance use should acknowledge the risk of relapse and take steps for prevention. In addition to relapse prevention, individuals with SUDs must also prepare for coping with a relapse. The evidence of mindfulness in the prevention of relapse is limited by high attrition rates in RCTs.
Many of the current MBIs follow the structure of the original MBSR protocol developed by Kabat-Zinn in the early 1980s with little variation. The entire field of mindfulness research would benefit from testing variations from the standard 8-week intervention initially developed to determine the appropriate dose-response of meditation in these clinical populations. We believe that meditation is a dose-dependent intervention, but future addiction meditation research must determine the minimum threshold (i.e. time dedicated to meditation in both formal and informal practice) to see the expected improvements in psychiatric, cognitive, and substance use outcomes. Conducting large RCTs with stringent experimental controls may help provide a clearer picture of the effectiveness of MBIs. MBIs might also reduce addictive behavior by strengthening facets of dispositional/trait mindfulness.
Decreasing stress reactivity
Although the included interventions were based on the MM principles, they were heterogeneous; evaluating them together as one “MM intervention” could have introduced bias. Three studies used manualized ACT,(38,39,54) delivered by a trained therapist in either an individual (54) or both individual and group (38,39) therapy format. The ACT sessions took place weekly, ranging in duration from 1½ (54) to 3½ (39) hours per week, over seven (38) to sixteen (39) weeks.
- This focus on triggers and craving may suggest that MBRP is most beneficial for an individual in the earlier stages of changing their substance use.
- Garland and colleagues also conducted a secondary data analysis to compare the effects of MORE on opioid attentional bias (AB) compared with a SG in 115 individuals who used prescription opioids [47].
- It provides a comprehensive long-term treatment that includes psychotherapy (therapist-led, in group and individual formats), case and medical management.
- To prevent relapse, individuals may be able to use mindfulness to cultivate an awareness of when substance use habits are triggered by substance cues even after an extended period of abstinence.
In pharmacological research, it is imperative to examine dose–response relationships to identify the optimal therapeutic dose. Dose–response curves can help to identify the dose needed to achieve a satisfactory clinical outcome while minimizing the side-effect profile of the drug. Although MBIs delivered in clinical settings appear to have few adverse effects [79], the costs and time required to deliver complex behavioral treatments like MBIs necessitate dose–response considerations to identify the minimal therapeutic dose. Null effects of MBIs observed in Stage II or III clinical trials might very well be qualified by extent of mindfulness practice, and thus mindfulness practice engagement should be tested as a treatment outcome moderator.
Matthew Perry was candid about his addiction. His words are now part of his legacy.
If mind-body medicine can significantly reduce stress, then one must ask if it can also help us prevent addiction by helping our society deal with the chronic, overwhelming stress that it is facing. Addiction is in large part considered to be a “disease of despair.” Important contributors to addiction are untreated anxiety and depression, unresolved childhood trauma, social isolation, and poor distress tolerance. If all of us can learn, or be trained, to be more mindful, grateful, present, and connected, perhaps the need, and eventually the habit, of fulfilling our most basic needs with the false promise of a chemical that merely wears off — and leaves us worse off — will become less of a problem in our society. A secondary data analysis of two separate MBRP RCTs was conducted to examine if the finding of mindfulness mediating the effect of MBRP on craving replicates in a new sample of individuals who completed the same measures [36]. In one sample [55](Study 1), the effect of MBRP on psychological flexibility, craving, and mindfulness was small to medium (Cohen’s d ranged from 0.08 to 0.48) and much smaller in the other sample ([59] Study 2; Cohen’s d ranged from 0.03 to 0.21). In Study 1, participants had higher scores on these mindfulness measures at post-treatment relative to TAU, and the post-treatment latent mindfulness factor significantly mediated the associations between MBRP and craving.
