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Original Investigation |

Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders:  A Randomized Clinical Trial

Sarah Bowen, PhD1; Katie Witkiewitz, PhD2; Seema L. Clifasefi, PhD1; Joel Grow, PhD1; Neharika Chawla, PhD1; Sharon H. Hsu, MS1; Haley A. Carroll, BS1; Erin Harrop, BS1; Susan E. Collins, PhD3; M. Kathleen Lustyk, PhD4; Mary E. Larimer, PhD5
[+] Author Affiliations
1Psychology Department, Addictive Behaviors Research Center, Seattle, Washington
2Psychology Department, University of New Mexico, Albuquerque
3Department of Psychiatry and Behavioral Sciences, University of Washington–Harborview Medical Center
4Psychology Department, Seattle Pacific University, Seattle, Washington
5Center for the Study of Health and Risk Behaviors, Psychiatry and Behavioral Sciences, University of Washington, Seattle
JAMA Psychiatry. 2014;71(5):547-556. doi:10.1001/jamapsychiatry.2013.4546.
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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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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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