A mindfulness-based, stress and coping model of craving in methamphetamine users.

Massy Mutumba,Ji-Young Lee,Judith T Moskowitz,Samantha E Dilworth,Adam W Carrico,Torsten B Neilands,Matthew J Gullo

doi:10.1371/journal.pone.0249489

Abstract

There is increasing interest in the role of mindfulness and mindfulness-based interventions to optimize recovery from a substance use disorder (SUD). However, relatively little is known about the theory-based psychological and social pathways whereby mindfulness could have beneficial effects for managing a chronic, relapsing SUD. Informed by Revised Stress and Coping Theory, the present cross-sectional study examined affective, cognitive, and social pathways whereby mindfulness is associated with lower methamphetamine craving. A total of 161 HIV-positive, methamphetamine-using sexual minority men completed a screening visit for a randomized controlled trial. Using a hybrid structural equation model, we examined pathways whereby mindfulness is associated with lower methamphetamine craving. We found that greater mindfulness was directly associated with lower negative affect and higher positive affect as well as indirectly associated with less methamphetamine craving. Interestingly, the indirect association between mindfulness and methamphetamine craving appeared to be uniquely attributable to positive affect. Only positive affect was indirectly associated with lower methamphetamine craving via higher positive re-appraisal coping and greater self-efficacy for managing triggers for methamphetamine use. Methamphetamine craving was supported by moderate associations with greater substance use severity and more frequent methamphetamine use. These findings support the role of mindfulness in cultivating positive affect, which could be crucial to build the capacity of individuals to manage methamphetamine craving as a chronic stressor that threatens recovery from SUD.

Highlights

Substance use disorders (SUD) are one of the most prevalent and costly public health challenges throughout the world
There is increasing interest in mindfulness-based interventions to optimize the recovery of individuals living with SUD, relatively few studies have examined the mechanisms of action linking mindfulness to substance use craving
Greater mindfulness was associated with lower negative affect, there was no evidence that negative affect was directly or indirectly associated with lower methamphetamine craving in the multivariate model

Summary

Introduction

Substance use disorders (SUD) are one of the most prevalent and costly public health challenges throughout the world. Evidence-based treatments such as cognitive-behavioral therapy and motivational interviewing are available for stimulant use disorders [4, 5], less than 15% of people living with a SUD seek formal treatment [3]. We hypothesized that mindfulness facilitates metacognitive awareness of affective (i.e. positive and negative affect), cognitive (i.e. self-efficacy and re-appraisal) and social (i.e., social support for abstinence) responses to achieve greater depth of processing in primary and secondary stress appraisals, which in turn leads to more effective management of methamphetamine craving. Consistent with Revised Stress and Coping Theory, we hypothesized that positive affect would uniquely account for the beneficial association of mindfulness with lower methamphetamine craving because it re-invigorates key cognitive (i.e., positive re-appraisal, selfefficacy for managing methamphetamine triggers) and social (i.e., abstinence-specific social support) processes relevant to recovery from a SUD

Materials and methods

Results

Discussion