Mindfulness-based Relapse Prevention Research Articles

A mindfulness-based intervention for Substance Use Disorder in a Brazilian vulnerable population: a feasibility mixed method study

IntroductionSubstance Use Disorder (SUD) is a chronic condition that impacts various facets of an individual’s life, and society as a whole. The Mindfulness-Based Relapse Prevention (MBRP) protocol is an innovative intervention that can help to prevent relapse, particularly when used as a post-treatment approach. However, although there is significant evidence of its effectiveness in studies from high-income countries (HICs), there is a dearth of studies examining its feasibility and efficacy in low- and middle-income countries (LMICs). Thus, this study investigates the feasibility of MBRP as an adjunct to outpatient treatment for SUD in a socially vulnerable Brazilian population.MethodsThe study employed a mixed-methods design in eight Psychosocial Care Centers for Alcohol and Drugs (CAPS-ad) in the city of São Paulo, and involved 140 participants, 24 healthcare professionals and 7 CAPS-ad managers. In total, 17 MBRP intervention groups were conducted. The study assessed qualitative indicators of acceptability, demand, implementation, adaptation, integration, and limited efficacy testing through group interviews, in-depth interviews and field diary records. It also included limited efficacy testing of the protocol using a quantitative pre-post pilot study to investigate consumption behavior, using the Timeline Followback (TLFB) assessment method; depression, using the Center for Epidemiologic Studies Depression (CES-D) scale; anxiety, using the state trait anxiety index (STAXI-2); craving, using the Penn Alcohol Craving Scale (PACS); readiness to change, using the Readiness-to-Change Ruler (RCR); and severity of dependence, using the Severity of Dependence Scale (SDS). The qualitative data were triangulated with the quantitative data to comprehensively evaluate the feasibility of the intervention.ResultsThe sample comprised socially vulnerable participants with a high dropout rate, primarily due to social factors. Despite facing challenges in respect of regular engagement and initial cultural misperceptions of meditation, the intervention showed positive acceptance and mental health benefits, including impacts on consumption behavior.DiscussionThe study emphasizes the importance of adapting the format of the protocol to better suit vulnerable populations, and to ensure its effective integration into the public healthcare system. Future research should explore protocol modifications, assess its effectiveness in different contexts, and conduct cost-benefit analyses for broader implementation.

Exploring heterogeneity in recovery from substance use disorder following mindfulness-based relapse prevention: A latent profile analysis

IntroductionSubstance use disorder (SUD) recovery is heterogeneous. Yet, over the last 50 years, substance use treatment providers and researchers have often defined success as sustained abstinence from substance use. An often overlooked but equally valid pathway to recovery for persons with SUD is non-abstinent recovery. However, most of the literature on non-abstinent recovery exists for individuals with alcohol use disorder (AUD) with few studies of non-abstinent recovery for other types of SUD. Literature exploring the mechanisms that lead to non-abstinent recovery is also lacking. As such, the current study aimed to examine recovery profiles for individuals (N = 454) recruited in two randomized clinical trials comparing mindfulness-based relapse prevention with cognitive-behavioral relapse prevention and/or treatment as usual. MethodsLatent profile analysis empirically derived profiles of recovery following outpatient aftercare SUD treatment. Multinomial logistic regression examined associations between treatment assignment and recovery profile, including potential psychological mediators (e.g., mindfulness) and contextual moderators (e.g., annual household income). ResultsAnalyses supported four recovery profiles: (1) low-functioning frequent substance use; (2) low-functioning infrequent substance use; (3) high-functioning frequent substance use; (4) high-functioning infrequent substance use. There were no significant interaction effects of race or ethnicity by treatment type, or household income by treatment type, in predicting recovery profiles. Trait mindfulness, craving, and psychological flexibility failed to mediate the association between treatment assignment and recovery profile; however, there were statistically significant differences in trait mindfulness with individuals expected to be classified in the low-functioning infrequent substance use profile showing significantly lower levels of trait mindfulness compared to individuals in the two high-functioning profiles. ConclusionsFindings suggest that recovery from SUD is heterogeneous, and profiles of recovery based on dimensions of substance use and functioning can be identified across a variety of SUD, including among people with co-occurring SUD. Additionally, trait mindfulness appears to be a differentiating factor across recovery profiles. Further research is needed to explore how psychological and social factors may moderate and influence both abstinent and non-abstinent forms of recovery.

Mindfulness-based relapse prevention targeting psychological craving and trait mindfulness in young Chinese women with methamphetamine dependence: a randomized controlled trial.

We recruited 58 MA-dependent young adult females from a compulsory isolation drug rehabilitation center in Sichuan Province and randomly divided them into an MBRP group (n = 29) and a control group (n = 29) according to their degree of psychological craving. The MBRP group received 2 hours of MBRP training twice a week for 4 weeks, alongside routine treatment at the drug rehabilitation center. Meanwhile, the control group solely received routine treatment at the drug rehabilitation center without any additional interventions. The assessment was conducted before and immediately after the intervention, with the Compulsive Drug Use Scale (OCDUS) used to assess craving and the Five-Factor Mindfulness Scale (FFMQ) used to assess trait mindfulness. Also, a "mental feedback monitoring balance" instrument was used to assess concentration and relaxation during some training sessions. This randomized trial was conducted to evaluate the effectiveness of decreasing psychological craving and increasing trait mindfulness. At baseline, there were no significant differences in total or dimension scores for FFMQ or OCDUS between the two groups (all P > 0.05). After the intervention, the repeated measures ANOVA showed a significant time main effect on changes in observing, non-judging, and non-reacting scores (all P < 0.05), and a significant interaction effect between time and group on both FFMQ total score and OCDUS score (P < 0.01 or P < 0.05). Mental feedback monitoring indicated significant improvement in concentration and relaxation after breath meditation exercises (P < 0.05 or P < 0.001). Additionally, the MBRP group showed improved relaxation during the body scan exercise (P < 0.01). MBRP training can improve the trait mindfulness of MA addicts and reduce psychological cravings effectively.

Neuromodulation and mindfulness as therapeutic treatment in detoxified patients with alcohol use disorder

BackgroundAlcohol use disorder (AUD) poses a significant global health challenge. Traditional management strategies often face high relapse rates, leading to a need for innovative approaches. Mindfulness-based relapse prevention (MBRP) has emerged as a promising intervention to enhance cognitive control, reduce cue-related craving and improve interoceptive processing. Neuroimaging studies suggest that mindfulness training can modulate brain networks associated with these factors, potentially improving treatment outcomes for AUD. Neuroimaging studies suggest that mindfulness training can modulate brain networks linked to these brain functions, potentially improving treatment outcomes for AUD. However, it is unclear how MBRP links to neurophysiological measures such as frontal midline theta oscillations (FMΘ) and whether the beneficial effects of MBRP can be increased by enhancing FMΘ. Here, we will use two different forms of neuromodulation to target and enhance these oscillations, and evaluate their impact on the effectiveness of MBRP.MethodsThis study will employ a four-arm randomized controlled trial to evaluate the synergistic effects of MBRP augmented with transcutaneous vagus nerve stimulation (tVNS) or closed-loop amplitude-modulated transcranial alternating current stimulation (CLAM-tACS) on cognitive control, cue reactivity and interoceptive processing in AUD patients. Participants will undergo six weekly group MBRP sessions and daily individual mindfulness practices. Assessments will include an inhibition task, cue-induced craving task, and heartbeat discrimination task, alongside heart rate variability and 32-channel EEG recordings. Participants will be assessed pre and post treatment, with a three-month follow-up to evaluate long-term effects on abstinence and alcohol consumption.DiscussionThis study will not only elucidate the causal link between FMΘ and efficacy of MBRP, but contribute to a better understanding of how combined psychological and neuromodulation interventions can improve treatment outcomes for AUD, potentially leading to more effective therapeutic strategies. This study also seeks to explore individual differences in response to treatment, which could inform future approaches to AUD management.Trial registrationThis study received approval by the Charité—Universitätsmedizin Berlin Institutional Review Board (EA1/030/23, 10.11.2023). It was registered on ClinicalTrials.gov (NCT06308484).

Internalized Shame Among Justice-Involved Women in Substance Use Disorder Treatment: Measurement Invariance and Changes During Treatment.

Shame is one of the leading barriers to successful recovery in substance use treatment settings. This secondary analysis study examined measurement invariance of the Internalized Shame Scale (ISS) and explored changes in shame during treatment. Participants (N=105) in the parent study were recruited from a nonprofit residential treatment center for justice-involved women and were randomized to receive mindfulness-based relapse prevention or relapse prevention treatment. A series of confirmatory factor analyses were used to assess measurement invariance in a one-factor measurement model of the ISS. Latent growth curve modeling was used to examine change in shame over time. Our findings support the assumption of measurement invariance across multiple time points and across treatment conditions, supporting comparisons of stigma scores across groups and over time. Although we observed significant reductions in shame from pre- to post-treatment, there were no differences across treatment conditions. Additional research is needed to determine how distinct treatment components relate to reductions in shame among individuals receiving treatment for a substance use disorder.

Enhancing Emotion Regulation and Overcoming Craving in Alcohol Dependence Syndrome Through Mindfulness-based Relapse Prevention

Background: Alcohol dependence syndrome (ADS) is a significant challenge for psychologists due to relapse and its impacts on well-being. Mindfulness-based relapse prevention (MBRP) has emerged as a potential solution, receiving increasing attention in the field of psychological interventions for ADS. This study aimed to evaluate the impact of MBRP, specifically on emotion regulation and alcohol craving as primary outcomes, alongside the secondary consideration of assessing changes in mindfulness levels. Methods: In this quasi-experimental study utilizing a pre-test/post-test design, 50 patients (aged 18–55) with ADS were enrolled in the intervention group (MBRP + usual care) and the usual care alone (UCA) group. The outcome assessment employed the Difficulties in Emotion Regulation Scale-18 (DERS-18) and Alcohol Craving Questionnaire-Short Form Revised (ACQ-SF-R) at three time points: pre-intervention (T1), mid-intervention (T2, four weeks after MBRP initiation), and post-intervention (T3, MBRP completion). Post-intervention comparisons between the intervention and UCA groups utilized repeated measures ANOVA ( p &lt; .05). Result: In the intervention group, significant within-group improvements were observed in mean scores of emotion regulation and craving at T1 (56.8 ± 7.6 and 41.6 ± 7.3), T2 (61.7 ± 10.5 and 41.5 ± 7.4), and T3 (61.5 ± 10.6 and 35.6 ± 5.4), with p values of .006 and .001, respectively. In comparison, the UCA group showed significant post-intervention differences in emotion regulation (46.9 ± 16.4) and craving (34 ± 11.82) scores, with a p value of .004. The effect sizes for emotion regulation (0.42) and craving (1.43) in the intervention group and for emotion regulation (0.50) and craving (0.47) in the UCA group further demonstrated more favorable outcomes in the intervention group, especially in reducing craving. Conclusion: Our research indicates that intervention and UCA yields moderate enhancements in emotion regulation; however, intervention demonstrates superior efficacy in diminishing craving, which is pivotal for relapse prevention. Incorporating MBRP with bespoke interventions might optimize the long-term treatment of ADS.

Mindfulness mechanisms in alcohol use: Comparing top-down and bottom-up processes.

This study compared two mechanisms by which mindfulness may reduce hazardous drinking: effortful control and craving, "top-down" and "bottom-up" processes, respectively. These relationships were compared in a secondary analysis of a randomized controlled trial of mindfulness-based relapse prevention (MBRP) versus relapse prevention (RP) treatments to explore if they differed based on more explicit versus subtle mindfulness training. A total of 182 individuals (48.4% female; 21-60 years old) who reported drinking > 14/21 drinks/week (for females/males, respectively) in the past 3 months but who wished to quit/reduce their drinking were recruited from Denver and Boulder, CO, United States. Participants were randomly assigned to either 8 weeks of MBRP or RP treatment and completed assessments at baseline, halfway through treatment, and at the end of treatment. The Five-Factor Mindfulness Questionnaire-Short Form, Alcohol Urge Questionnaire, and Effortful Control Scale completed halfway through treatment assessed the predictor, dispositional mindfulness, and mediators, craving and effortful control, respectively. The Alcohol Use Disorder Identification Task was completed after treatment and measured hazardous drinking. Cross-group path analyses were conducted including both mediators/treatments in the same model. Comparing models with and without equality constraints across treatments, no paths significantly differed based on a chi-square test of difference, χ²(5) = 5.11, p = .40, and only the indirect effect of craving was significant (B = -1.01, p = .01). Findings suggest mindfulness may be associated with hazardous drinking reductions through craving but not effortful control and this indirect relationship works similarly across treatments engendering mindfulness explicitly and implicitly. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The methods and baseline characteristics of a multi-site randomized controlled trial evaluating mindfulness-based relapse prevention in conjunction with peer support to improve adherence to medications for opioid use disorders.

Medications for opioid use disorders (MOUD) remain the gold standard for treating OUD, but treatment initiation and adherence remain challenging. Exclusive utilization of pharmacotherapy as a treatment modality for OUD is sub-optimal, and a combination of psychotherapies and pharmacotherapies is recommended. General trends indicate the benefits of peer mentoring and MBRP separately. Therefore, we hypothesize that the combined effect of MBRP and Peer mentoring will produce synergistic improvements in MOUD adherence compared to an enhanced twelve-step facilitation (TSF). This paper describes the methods and baseline characteristics of a multi-site randomized controlled trial evaluating the effectiveness of a combination of MBRP and peer support (MiMP) compared to an enhanced TSF in improving adherence to MOUD. Both MiMP and TSF are 12-week manualized protocols that utilize licensed therapists. The interventions are delivered in weekly group sessions that last about 75-90 minutes per session. The primary outcome is MOUD adherence. Secondary and exploratory outcomes include relapse, cravings, depression, anxiety, stress, quality of life, and pain catastrophizing. The participants' ages ranged from 21 years to 77 years, with a mean age of 44.5 (SD ± 11.5 years). There was an almost equal distribution of gender and place of residence. Overall, 51.9% (n=54) of participants identified as female and 48.1% (n=50) were male. Similarly, 51.9% (n=54) of participants resided in urban areas, while 48.1% (n=50) resided in rural areas. Participants identified as either black or white, with over three-quarters identifying as white (77.9%, n= 81) and 22.1% (n= 23) as black. Most participants randomized to the 12-step facilitation group were white (93.1%). Relationships and employment status were well distributed between categories. Over half of the participants reported some college or higher education. Over 90% of the participants made less than $75,000 per year. Some participants indicated that they had both public and private health insurance. This study is innovative in several ways including combining MBRP and peer support, addressing comorbid mental health issues among individuals with OUD, utilizing manualized protocols, and evaluating of both physiological and self-reported measures in assessing cortisol reactivity as a predictor of relapse and treatment outcomes.

The effect of mindfulness on decision-making, inhibitory control, and impulsivity of substance use disorder in-treatment patients: A randomized clinical trial.

This study aimed to investigate the effects of Mindfulness-Based Relapse Prevention (MBRP) in decision-making, inhibitory control and impulsivity compared to Treatment as Usual (TAU) for individuals with Substance Use Disorders (SUD's) in Brazil. A randomized clinical trial was conducted with participants from a therapeutic community (n = 122). Decision-making (Iowa Gambling Task), impulsivity dimensions (UPPS-P Scale), and inhibitory control (Stroop Color-Word Test) were assessed before and after the MBRP 8-week intervention. GLM Multivariate analysis was used to evaluate the effects of MBRP on different impulsivity measures. The results showed that MBRP+TAU improved the general decision-making score (p = 0,008) compared to TAU. However, no significant effects were found in impulsivity dimensions and inhibitory control in individuals with SUDs in the therapeutic community. This study found improvement in decision-making in the total IGT score; however, no effect for self-reported impulsivity and inhibitory control among middle-aged patients after an 8-weeks intervention of MBRP protocol in an inpatient setting. It adds information to the subject, with implications and possible directions to be followed by the next clinical trials with patients with SUDs in treatment. Trial registration: EnsaiosClinicos.gov.br: RBR-6c9njc.

A randomized controlled trial of mindfulness: effects on university students’ mental health

BackgroundThe development of mental health disorders is common in the university population, and mindfulness-based interventions (MBIs) seem to be effective in addressing them in different contexts. Thus, this study investigated the impact of an 8-week MBI adapted to university students from the Mindfulness-Based Relapse Prevention (MBSR) on different symptoms related to mental health problems, specifically symptoms of anxiety, depression, stress and insomnia.MethodsUniversity students (n = 136) were randomized into MBI group (n = 71) or wait-list group (n = 65). All participants completed self-administered questionnaires before and after the intervention, and the experimental group answered questionnaires weekly during intervention. Generalized mixed models were used to assess the effects of the intervention.ResultsThere were improvements in the symptoms of stress (B = 5.76, p < 0.001), depression (B = 1.55, p < 0.01) and insomnia (B = 1.35, p = 0.020) from the beginning of the intervention to the final assessment when it was compared to the control group. No effect was found in respect of trait anxiety. The MBI was found to be effective in reducing important symptoms related to university students’ mental health, possibly grounding further research on the intervention’s potential of preventing the development of mental disorders.Trial registrationThe research was registered in the Brazilian Registry of Clinical Trials (ReBEC) - number RBR-63qsqx, approved at 09/16/2019.

Association of Loneliness and Mindfulness in Substance Use Treatment Retention.

Elevated mental illness prevalence complicates efforts designed to address the opioid crisis in Appalachia. The recovery community acknowledges that loneliness impacts mood and engagement in care factors; however, the predictive relationship between loneliness and retention in medication-assisted outpatient treatment programs has not been explored. Our objectives were to identify associations between mental health factors and retention in treatment and elucidate treatment retention odds. Data were collected from eighty participants (n = 57 retained, n = 23 not retained) of a mindfulness-based relapse prevention (MBRP) intervention for individuals receiving medication for opioid use disorder (MOUD) in Appalachia. Loneliness, depression, and anxiety did not differ between the retained and not retained, nor did they predict not being retained; however, mindfulness was significantly lower among those not retained in treatment compared to those retained (OR = 0.956, 95% CI (0.912-1.00), and p < 0.05). Preliminary findings provide evidence for mindfulness training integration as part of effective treatment, with aims to further elucidate the effectiveness of mindfulness therapies on symptom reduction in co-occurring mental health disorders, loneliness, and MOUD treatment retention.

Effects of Mindfulness-Based Relapse Prevention Therapy on Drug Craving and Emotion Regulation of Therapeutic Community Centers Clients

Background: Many substance abusers suffer uncontrollable symptoms of extreme stress and cannot regulate their emotions after a traumatic experience. Objectives: This study hence investigated the effects of mindfulness-based relapse prevention (MBRP) therapy on drug craving and emotion regulation of therapeutic community (TC) center clients. Methods: This quasi-experimental research adopted a pretest-posttest control group design. The statistical population included all stimulant-related (methamphetamine) visitors to treatment centers (TCs) of Khuzestan Province (Iran) in 2022. The convenience sampling method was employed to select 40 participants, who were assigned to an experimental group and a control group (20 members per group). The experimental group received MBRP therapy (eight 90-minute sessions), whereas the control group received no interventions and remained on the waiting list. The data were collected by using the Desires for Drug Questionnaire (DDQ) and the Emotion Regulation Questionnaire. The ANCOVA was used for data analysis in SPSS-26. Results: The mean and standard deviation (± SD) of the drug cravings and emotion regulation for the MBRP group in the posttest were 46.85 ± 4.47 and 27.50 ± 2.72, respectively; while in the control group, the means were 69.30 ± 7.25 and 29.60 ± 2.16, respectively. MBRP had a significant effect on drug cravings and emotion regulation in clients of TC centers (P &lt; 0.001). According to the results, MBRP effectively reduced drug cravings and improved the emotion regulation of participants in the experimental group. Conclusions: According to the findings, MBRP improved drug cravings and emotion regulation. Hence, MBRP can be adopted to help mitigate drug cravings and enhance the emotion regulation of patients in rehabilitation.

Efficacy of mindfulness-based relapse prevention in a sample of veterans in a substance use disorder aftercare program: A randomized controlled trial

BackgroundComplementary integrative medicine, such as mindfulness-based interventions, (MBI) have demonstrated efficacy in the treatment of depression, anxiety, substance use disorders (SUDs), and pain. Mindfulness-based relapse prevention (MBRP) is an aftercare intervention targeting SUD relapse that integrates cognitive-behavioral relapse prevention and mindfulness meditation practices, raising awareness of substance use triggers and reactive behavioral patterns. This study evaluated the efficacy of MBRP in reducing relapse in veterans following completion of an SUD treatment program. MethodsThis study was a two-site, randomized controlled trial comparing MBRP to 12-step facilitation (TSF) aftercare in military veterans following completion of intensive treatment for SUDs. The 8 weeks of 90-minute, group-based MBRP or TSF sessions were followed by 3-, 6- and 10-month follow-up periods with assessments of alcohol/substance use and secondary outcomes of depression, anxiety, and mindfulness. ResultsForty-seven percent of veterans attended ≥75 % of sessions. Veterans in both the MBRP and TSF aftercare groups maintained reductions in alcohol and illicit substance use during the aftercare treatment. Nineteen participants (11 %; 19/174) reported returning to alcohol use during the study treatment period and the study found no difference between study groups [MBRP: 9 % vs. TSF 13 %; p = 0.42]. Thirteen participants (7.5 %; 13/174) reported a return to illicit substance use during study treatment [MBRP: 5.4 % vs. TSF 10.3 % p = 0.34]. The number of days of drinking and illicit substance use was not different between groups (alcohol, p = 0.53; illicit substance use, p = 0.28). ConclusionAlthough retention in treatment limits interpretation of the findings, both MBRP and TSF were effective in maintenance of treatment gains following an intensive treatment program for veterans with SUDs. Future studies should focus on strategies to improve treatment participation.

Relative efficacy of mindfulness-based relapse prevention among illicit drug abusers: a randomized clinical trial

Relative efficacy of mindfulness-based relapse prevention among illicit drug abusers: a randomized clinical trial

Culturally adapted motivational interviewing with cognitive behavior therapy and mindfulness-based relapse prevention for substance use disorder in Pakistan (CAMAIB): protocol for a feasibility factorial randomised controlled trial

BackgroundThe use of psychoactive substances significantly impacts the health, social and economic aspects of families, communities and nations. There is a need to develop and test psychological interventions aimed for individuals with substance use disorder (SUD) in lower- and middle-income countries (LMICs), such as in Pakistan. The aim of this exploratory trial is to test the feasibility and acceptability of two culturally adapted psychological interventions in a factorial randomised controlled trial (RCT).MethodsThe proposed project will be conducted in three phases. The first phase of the study will focus on cultural adaptation of the interventions through qualitative interviews with key stakeholders. The second phase will be to refine and produce manually assisted interventions. Third and last stage would be to assess the feasibility of the culturally adapted interventions through a factorial RCT. The study will be carried out in Karachi, Hyderabad, Peshawar, Lahore and Rawalpindi, Pakistan. Recruitment of participants will take place from primary care and volunteer organisations/drug rehabilitation centres. A total of 260 individuals diagnosed with SUD (n = 65) in each of the four arms will be recruited. The intervention will be delivered weekly over a period of 12 weeks in both individual and group settings. Assessments will be carried out at baseline, at 12th week (after completion of intervention) and 24th week post-randomisation. The analysis will determine the feasibility of recruitment, randomisation, retention and intervention delivery. Acceptability of intervention will be determined in terms of adherence to intervention, i.e. the mean number of sessions attended, number of home assignments completed, attrition rates, as well as through process evaluation to understand the implementation process, context, participants’ satisfaction, and impact of the study intervention. The health resource use and impact on the quality of life will be established through health economic data.DiscussionThis study will provide evidence for feasibility and acceptability of culturally adapted manually assisted psychological interventions for individuals with SUD in the context of Pakistan. The study will have clinical implications if intervention is proven feasible and acceptable.Trial registrationName of the registry: ClinicalTrials.gov, Trial registration number: NCT04885569, Date of registration: 25th April 2021.

Neuropsychological Mechanisms and Evidence of Mindfulness-Based Interventions for Addiction

Mindfulness meditation is a contemplative practice that involves focused attention and open monitoring. Due to its effectiveness in emotion regulation and attention regulation, mindfulness-based interventions combine mindfulness and other cognitive and behavioral practices to treat substance abuse and behavioral disorders. This article focuses on the neuropsychological mechanisms and empirical research of mindfulness-oriented recovery enhancement (MORE) and mindfulness-based relapse prevention (MBRP). MORE is a cognitive-behavioral treatment that uses mindfulness to cultivate reappraisal and savoring skills. MBRP is another cognitive-behavioral treatment that incorporates mindfulness meditation and core components of relapse prevention. It analyzes the neural mechanism of addiction, mindfulness, and mindfulness-based interventions. Moreover, it provides empirical research evidence of MORE and MBRP, proving that these two are effective treatments for addiction-related problems, including substance abuse and behavioral disorders.

Rationale and design of a multisite randomized clinical trial examining an integrated behavioral treatment for veterans with co-occurring chronic pain and opioid use disorder: The pain and opioids integrated treatment in veterans (POSITIVE) trial

BackgroundChronic pain and opioid use disorder (OUD) individually represent a risk to health and well-being. Concerningly, there is evidence that they are frequently co-morbid. While few treatments exist that simultaneously target both conditions, preliminary work has supported the feasibility of an integrated behavioral treatment targeting pain interference and opioid misuse. This treatment combined Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Relapse Prevention (ACT+MBRP). This paper describes the protocol for the adequately powered efficacy study of this integrated treatment. MethodsA multisite randomized controlled trial will examine the efficacy of ACT+MBRP in comparison to a parallel education control condition, focusing on opioid safety and pain education. Participants include veterans (n = 160; 21–75 years old) recruited from three Veterans Administration (VA) Healthcare Systems with chronic pain who are on a stable dose of buprenorphine. Both conditions include twelve weekly 90 min group sessions delivered via telehealth. Primary outcomes include pain interference (Patient Reported Outcome Measurement Information System - Pain Interference) and hazardous opioid use (Current Opioid Misuse Measure), which will be examined at the end of the active treatment phase and through 12 months post-intervention. Secondary analyses will evaluate outcomes including pain intensity, depression, pain-related fear, and substance use, as well as treatment mechanisms. ConclusionThis study will determine the efficacy of an integrated behavioral treatment program for pain interference and hazardous opioid use among veterans with chronic pain and OUD who are prescribed buprenorphine, addressing a critical need for more integrated treatments for chronic pain and OUD. Trial registrationClinicalTrials.gov Identifier: NCT04648228

Predictors of Treatment Completion among Women Receiving Integrated Treatment for Comorbid Posttraumatic Stress and Substance Use Disorders

Background: Retention in treatment for individuals with comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is an area of concern in treatment outcome studies. The current study explores key variables related to retention in a group of women with comorbid PTSD and SUD enrolled in community SUD treatment randomized to eight weekly sessions of a trauma adapted mindfulness-based relapse prevention (TA-MBRP) or an integrated coping skills (ICS) group intervention. Methods: Two unadjusted and adjusted logistic discrete failure time (DFT) models were fit to examine associations between participants and the time (in weeks) to treatment completion status. Key covariates of interest, including time-varying PTSD Symptom Scale-Self Report (PSS) total score, time-varying Five Factors Mindfulness Questionnaire (FFMQ) total score, group assignment, baseline endorsements of substance use and demographics such as age, race and employment status were fit into the model. Results: In the adjusted PSS model, increased levels of PTSD symptom severity (PSS) scores at week 5 and 7 (PSS OR: 1:06: OR 1.13, respectively) were associated with higher odds of non-completion. In the FFMQ model, increased levels of FFMQ scores at week 6 (OR: 0:92) were associated with lower odds of non-completion. In both models, assignment to the ICS control group and unemployment were associated with lower odds of completion and baseline use of cocaine and sedatives were associated with higher odds of completion. Conclusion: Monitoring PTSD symptom severity and measures of mindfulness can inform providers on strategies to enhance retention early in treatment for individuals with comorbid PTSD/SUD. ClinicalTrials.gov # NCT02755103

Pilot randomized controlled trial of mindfulness-based relapse prevention vs cognitive behavioral therapy for smoking and alcohol use

BackgroundThe combined use of cigarettes and alcohol is associated with a synergistic increase in the risk of morbidity and mortality. Continued alcohol use during a smoking quit attempt is a considerable risk factor for smoking relapse. As such, there is a need for interventions that address both behaviors concurrently. Mindfulness-based interventions hold much promise for simultaneously addressing tobacco and alcohol use. MethodThis pilot study evaluated the feasibility and acceptability of a mindfulness-based intervention using a two-arm randomized controlled trial of Mindfulness-Based Relapse Prevention for Smoking and Alcohol (MBRP-SA) vs Cognitive Behavioral Therapy (CBT). Interventions were delivered via telehealth in a group setting; all participants received a 6-week supply of the nicotine patch. Participants (N = 69) were adults who smoked cigarettes who reported binge drinking and were motivated to both quit smoking and change their alcohol use. Primary outcomes were feasibility and acceptability of MBRP-SA compared to CBT. Changes in tobacco and alcohol use are also presented. ResultsParticipants in MBRP-SA and CBT indicated that the treatments were highly acceptable, meeting a priori benchmarks. Feasibility was mixed with some outcomes meeting benchmarks (e.g., recruitment) and others falling below (e.g., retention). Participants in both conditions demonstrated significant reductions in tobacco and alcohol use at the end of treatment. ConclusionsIn sum, MBRP-SA had comparable outcomes to CBT on all metrics measured. Future research should evaluate the efficacy of MBRP-SA on smoking abstinence and drinking reductions in a large-scale, fully powered trial. This study was registered on clinicaltrials.gov (NCT03734666).

Clinical Practice Guidelines for the Use of Transcranial Direct Current Stimulation in Psychiatry.

Clinical Practice Guidelines for the Use of Transcranial Direct Current Stimulation in Psychiatry.