Are Mindfulness-Based Interventions Effective for Substance Use Disorders? A Systematic Review of the Evidence

Mindfulness-based interventions (MBIs) are increasingly suggested as therapeutic approaches for effecting substance use and misuse (SUM). The aim of this article is to review current evidence on the therapeutic efficacy of MBIs for SUM. A literature search was undertaken using four electronic databases and references of retrieved articles. The search included articles written in English published up to December 2011. Quality of included trials was assessed. In total, 24 studies were included, three of which were based on secondary analyses of previously investigated samples. Current evidence suggests that MBIs can reduce the consumption of several substances including alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates to a significantly greater extent than waitlist controls, non-specific educational support groups, and some specific control groups. Some preliminary evidence also suggests that MBIs are associated with a reduction in craving as well as increased mindfulness. The limited generalizability of the reviewed findings is noted (i.e., small sample size, lack of methodological details, and the lack of consistently replicated findings). More rigorous and larger randomized controlled studies are warranted.     

Dispositional Mindfulness and Aggression Among Women in Residential Substance Use Treatment

There is a large literature on substance misuse and interpersonal aggression, including aggression perpetrated by women in treatment for substance misuse. There is also a growing body of literature on mindfulness and substance use, as well as mindfulness and aggression. However, to date, there has been little research on whether dispositional mindfulness is associated with increased aggression among women in treatment for substance misuse. The current study, therefore, examined whether dispositional mindfulness was associated with aggression, above and beyond substance use and demographic characteristics, in women in residential substance misuse treatment (N = 137). Results showed that lower dispositional mindfulness was associated with increased aggression (physical, verbal, and aggressive attitude). Moreover, this relationship between dispositional mindfulness and aggression remained even after controlling for alcohol problems, drug problems, and age, all known predictors of aggression. Our results provide the first empirical evidence that dispositional mindfulness is negatively associated with aggression in women in treatment for substance misuse. Pending replication, this could have important implications for treatment. Specifically, mindfulness-based interventions may prove helpful for the concurrent treatment of substance misuse and aggression.     

Introduction to the Special Issue: Drugs,Wars, Military Personnel,and Veterans

This special issue examines major structural, sociocultural, and behavioral issues surrounding substance use and misuse among US military personnel and veterans who served in recent military conflicts in Iraq and Afghanistan. This introduction provides a brief historical review of the US's experiences of the linkages between war and substance use, misuse, and abuse. It then describes how the various topics covered in this issue span the military-veteran life course and explains the significance of each contribution.     

Substance-Treatment Professionals' Perceived Barriers to Incorporating Mindfulness Into Treatment

Background: Despite scientific favor, psychological interventions supported by research are often underutilized by practitioners due to perceived obstacles in implementation. Increased transparency between researchers and practitioners throughout treatment development and dissemination is therefore necessary. The rising popularity of mindfulness-based approaches in the treatment of substance-use disorders suggests such transparency is necessary in further developing, disseminating, and implementing such approaches within the context of substance treatment. Objectives: The present study aimed to increase transparency by surveying substance-treatment professionals regarding their perceptions of barriers to adopting mindfulness in the treatment of substance use. Methods: Substance-treatment professionals throughout the United States (N = 103) completed an online survey about their perceptions of potential barriers to implementing mindfulness into substance treatment. Results: Overall, professionals were moderately familiar with mindfulness as a treatment for substance use. Approximately one-third reported providing mindfulness in substance treatment; however, only 7% reported providing mindfulness using a research-supported treatment manual. Across professionals of various backgrounds, the need for further training was rated as the greatest barrier to implementation. Conclusions/Importance: Results suggest that practitioners are generally familiar with and willing to implement mindfulness in the treatment of substance use. Future research and implementation efforts should focus on methods of increasing training availability, accessibility, and relevance to address the needs and expectations of substance-treatment professionals.     

A Randomized Controlled Trial of a Mindfulness and Acceptance Group Therapy for Residential Substance Use Patients

Background: Substance use disorders are understood as a chronically relapsing condition that is difficult to treat. However, in recent years there have been promising developments in the treatment of substance use disorders, specifically with interventions based on mindfulness and acceptance and commitment therapy. Little research has examined whether these types of interventions may positively impact residential substance use treatment outcomes. Objectives: Thus, in the current study we developed and examined, in a randomized controlled trial, a 4-week, eight-session, adjunctive mindfulness and acceptance group therapy for patients in residential substance use treatment. Our primary outcomes were substance use cravings, psychological flexibility, and dispositional mindfulness at treatment discharge. Methods: Patients (N = 117) from a private residential substance use facility were randomized to receive the adjunctive mindfulness and acceptance group or treatment-as-usual. Patients were assessed at treatment intake and at discharge from a 28–30-day residential program. Results: Although treatment groups did not statistically differ at discharge on any primary outcome, small effect sizes favored the mindfulness and acceptance group on cravings and psychological flexibility. Conclusions/Importance: Continued research is needed to determine whether the addition of mindfulness and acceptance-based interventions improve outcomes long term following residential substance use treatment.     

Trait mindfulness and early maladaptive schemas in women seeking residential substance use treatment: A preliminary investigation

Mindfulness has received an abundance of research attention in recent years, largely due to mindfulness-based interventions demonstrating positive mental and physical health outcomes. However, less research has examined individual’s trait levels of mindfulness and how it is related to mental health, particularly among individuals seeking substance use treatment. Therefore, in the current study, we examined the relation between trait mindfulness and early maladaptive schemas (EMS), which are dysfunctional cognitive and behavioural patterns that theoretically underlie the development of mental health problems, among women seeking residential substance use treatment. Pre-existing, adult female, patient records from a residential substance abuse treatment facility were reviewed (N?=?67). Results demonstrated that higher trait mindfulness was negatively associated with 12 of the 18 EMS. Moreover, patients who endorsed multiple EMS reported lower trait mindfulness than patients who endorsed zero (or one) EMS. These findings are the first to examine the relation between trait mindfulness and EMS among women seeking substance use treatment. Findings suggest that EMS and trait mindfulness are robustly related and future research should examine whether mindfulness-based interventions reduce EMS.     

The Relation Between Moment-to-Moment Mindful Attention and Anxiety Among Young Adults in Substance Use Treatment

Background: A growing body of research has examined the intersection of mindfulness and substance use, and a large body of research has examined the relation between mindfulness and anxiety. Unfortunately, no research has been conducted on the relation between mindfulness and anxiety symptoms among young adults (i.e., 18–25 years old) in treatment for substance use. The purpose of the current study was to examine the relation between one facet of mindfulness, moment-to-moment attention, and anxiety (panic and generalized anxiety) among young adults in treatment for substance use. Methods: Preexisting patient records from a residential substance use treatment center for young adults were reviewed (N = 148). Patient records were examined from May 2012 to August 2013, which represented all young adult patients admitted to the residential treatment facility during this time. Results: Findings demonstrated that moment-to-moment mindful attention was associated with symptoms of panic disorder and generalized anxiety disorder even after controlling for gender, age, education, alcohol use, drug use, and the shared variance in generalized and panic symptoms. There were no gender differences in moment-to-moment mindful attention. Conclusions: These findings provide preliminary evidence that moment-to-moment mindful attention is associated with panic and generalized anxiety in young adults in substance use treatment. Combined with previous research on mindfulness-based interventions among adults in substance use treatment, research should examine the efficacy of mindfulness-based interventions for young adults in substance use treatment.     

Differences in Trait Mindfulness Across Mental Health Symptoms Among Adults in Substance Use Treatment

Mindfulness is a growing area of investigation among individuals manifesting substance use disorders, as mindfulness meditation may help to prevent relapse to substance use. The current study examined levels of trait mindfulness in substance users seeking treatment from May 2012 to August 2012 in a Tennessee residential center and whether patients with probable (i.e., diagnoses based on a self-report screening instrument) comorbid depression or PTSD reported lower mindfulness than patients without a probable comorbid diagnosis. Data were collected from a convenience sample of archival patient records (N = 125) and four instruments. The majority of patients were male (n = 84) and non-Hispanic Caucasian (92%); the mean age of the sample was 37.36 (SD = 12.47). Results showed that lower trait mindfulness was associated with increased levels of substance use, depression, and PTSD. Patients with a probable depression or PTSD diagnosis reported lower mindfulness than patients without these disorders. Patients with probable comorbid depression and PTSD reported the lowest levels of mindfulness. These findings suggest that altering levels of mindfulness may be important for individuals manifesting dual-diagnoses in substance user treatment. The study's limitations are noted.     

Mindfulness-Based Relapse Prevention in a Jail Drug Treatment Program

Background: More than half of prisoners in the United States are estimated to suffer from a substance use disorder. Mindfulness involves attention to the present moment, and nonjudgmental acceptance of sensations, thoughts, and emotional states. Mindfulness-based relapse prevention (MBRP) following substance use disorder treatment has been shown to reduce substance use. Objective: We sought to adapt and test MBRP for a jail substance use disorder treatment setting. Methods: We enrolled successive cohorts of incarcerated men participating in a drug treatment program in a large urban jail (n?=?189) into six weekly sessions of either MBRP or an comparison communication skills intervention, between 2013 and 2015. MBRP was delivered by a culturally competent African–American trainer. Pre- and post-test measures included mindfulness, anxiety, posttraumatic stress disorder (PTSD), and drug craving. Results: At baseline, measures of mindfulness were significantly inversely correlated with anxiety, PTSD symptoms and drug cravings. Anxiety, PTSD symptoms and cravings declined significantly in both treatment arms, and mindfulness increased. Comparison of the two study arms using maximum likelihood estimation suggested a small but significantly greater increase in mindfulness in the treatment arm. Conclusions/Importance. An attention control trial of a mindfulness intervention, delivered by a culturally competent trainer, is feasible in a jail setting.     

A preliminary investigation of the relationship between dispositional mindfulness and eating disorder symptoms among men in residential substance use treatment

The comorbidity between eating disorders (EDs) and substance use disorders (SUDs) is of particular concern given the high rates of mortality, relapse and poor treatment outcomes associated with both disorders. As a result, there has been a growing impetus within the field to elucidate factors that might influence and aid treatment for this comorbidity. One such factor is dispositional mindfulness, as past literature has demonstrated a significant relationship between mindfulness and both EDs and SUDs. However, we are unaware of any research that has examined the relationship between dispositional mindfulness and ED symptoms in a sample of men in residential treatment for SUDs. Medical records from 152 men were included in the current study. Alcohol and drug use and problems, ED symptoms and dispositional mindfulness were assessed with self-report measures. Hierarchical regression analysis indicated that dispositional mindfulness was inversely related to ED symptoms after controlling for alcohol use, drug use and age. Although results are preliminary and continued research in this area is needed, our findings suggest that there may be potential usefulness in targeting and enhancing mindfulness among patients in residential treatment for SUDs with cooccurring psychiatric symptoms (e.g., EDs).     

When you see it,let it be: Urgency,mindfulness and adolescent substance use

The emotion-based domains of impulsivity, positive and negative urgency, are facets that have garnered attention due to their associations with substance use, and mindfulness based strategies have shown promise in reducing substance use in adults. The aim of the current study was to examine relations among urgency, mindfulness, and substance use in adolescence. Cross-sectional data were collected from students (N = 1,051) at a large, private high school in the Pacific Northwest. Both positive and negative urgency were uniquely associated with greater likelihood of lifetime and current alcohol use; only positive urgency predicted lifetime marijuana use. Mindfulness was associated with a lower likelihood of lifetime alcohol or marijuana use. Interactions between urgency and mindfulness were not supported. Our findings highlight the need to explore relations among baseline mindfulness, skills based mindfulness, and personality in adolescent alcohol and other drug use.     

Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model,manual development,and pilot outcomes

Little is known about the assessment and treatment of self-stigma in substance abusing populations. This article describes the development of an acceptance based treatment (Acceptance and Commitment Therapy–ACT) for self-stigma in individuals in treatment for substance use disorder. We report initial outcomes from a study with 88 participants in a residential treatment program. The treatment involves 6 h of a group workshop focused on mindfulness, acceptance, and values work in relation to self-stigma. Preliminary outcomes showed medium to large effects across a number of variables at post-treatment. Results were as expected with one potential process of change, experiential avoidance, but results with other potential mediators were mixed.     

Spirituality, mindfulness and substance abuse

A growing body of research suggests that mindfulness-based therapies may be effective in treating a variety of disorders including stress, chronic pain, depression and anxiety. However, there are few valid and reliable measures of mindfulness. Furthermore, mindfulness is often thought to be related to spirituality, given its roots in Buddhist tradition, but empirical studies on this relationship are difficult to find. The present study: (1) tested the reliability and validity of a new mindfulness measure, the Freiburg Mindfulness Inventory (FMI), (2) explored the relationship between mindfulness and spirituality, and (3) investigated the relationship between mindfulness and/or spirituality and alcohol and tobacco use in an undergraduate college population (N=196). Results support the reliability of the FMI and suggest that spirituality and mindfulness may be separate constructs. In addition, smoking and frequent binge-drinking were negatively correlated with spirituality scores; as spirituality scores increased the use of alcohol and tobacco decreased. Thus, spirituality may be related to decreased substance use. In contrast, a positive relationship between mindfulness and smoking/frequent binge-drinking behavior was uncovered, and warrants further investigation.     

Risk assessment of mechanism-based inactivation in drug-drug interactions

Drug-drug interactions (DDIs) that occur via mechanism-based inactivation of cytochrome P450 are of serious concern. Although several predictive models have been published, early risk assessment of MBIs is still challenging. For reversible inhibitors, the DDI risk categorization using [I]/K(i) ([I], the inhibitor concentration; K(i), the inhibition constant) is widely used in drug discovery and development. Although a simple and reliable methodology such as [I]/K(i) categorization for reversible inhibitors would be useful for mechanism-based inhibitors (MBIs), comprehensive analysis of an analogous measure reflecting in vitro potency for inactivation has not been reported. The aim of this study was to evaluate whether the term λ/k(deg) (λ, first-order inactivation rate at a given MBI concentration; k(deg), enzyme degradation rate constant) would be useful in the prediction of the in vivo DDI risk of MBIs. Twenty-one MBIs with both in vivo area under the curve (AUC) change of marker substrates and in vitro inactivation parameters were identified in the literature and analyzed. The results of this analysis show that in vivo DDIs with >2-fold change of object drug AUC can be identified with the cutoff value of λ/k(deg) = 1, where unbound steady-state C(max) is used for inhibitor concentration. However, the use of total C(max) led to great overprediction of DDI risk. The risk assessment using λ/k(deg) coupled with unbound C(max) can be useful for the DDI risk evaluation of MBIs in drug discovery and development.     

The relationship between crime and drugs: what we have learned in recent decades

The focus of this article is criminal drug users and their changing behavior. Two important considerations are addressed within this topic. First, an overview of drug use is given, including a brief historical perspective on its treatment as well as its implications on crime. The article also discusses why substance abuse treatment in the criminal population is necessary and on what scale. Specifically, the etiology of the relationship between crime, violence and substance abuse is explored. It then delves into what has worked and what hasn't. Finally, recommendations are made regarding where the research indicates we should go from here.     

HISTORY,CULTURE, AND SUBSTANCE USE IN A RURAL SCOTTISH COMMUNITY

This paper provides a detailed discussion of substance use and misuse in a rural community in the Western Highlands of Scotland, United Kingdom. Attention is focused on the way in which patterns of substance use arise from a complex interplay of historical, cultural, social, and personal events. The discussion illustrates how large changes in patterns of intoxication in rural communities can be rendered intelligible through an understanding of the impact of economic, religious, and social changes. The analysis is based on an historical and ethnographic account, carried out between 1987 and 1990 with adolescents, of patterns of use which range from pagan ceremonies in the 16th century to contemporary “soft drug” use. [Translations are provided in the International Abstracts Section of this issue.]     

Cognitive and Affective Mechanisms Linking Trait Mindfulness to Craving Among Individuals in Addiction Recovery

The present study aimed to identify affective, cognitive, and conative mediators of the relation between trait mindfulness and craving in data culled from an urban sample of 165 persons (in abstinence verified by urinalysis) entering into residential treatment for substance use disorders between 2010 and 2012. Multivariate path analysis adjusting for age, gender, education level, employment status, and substance use frequency indicated that the association between the total trait mindfulness score on the Five Facet Mindfulness Questionnaire and alcohol/drug craving was statistically mediated by negative affect (measured by the PANAS, beta = ?.13) and cognitive reappraisal (measured by the CERQ, beta = ?.08), but not by readiness to change (measured by the URICA, beta = ?.001). Implications for mindfulness-oriented treatment of persons with substance use disorders are discussed. The study's limitations are noted.     

Relationship between dispositional mindfulness and substance use: Findings from a clinical sample

There has been rapidly increasing interest over the past decade in the potential of mindfulness-based approaches to psychological and medical treatment, including a recent growth in the area of substance abuse. Thus, the relationship between trait mindfulness and substance use has been explored in several studies. Results, however, have been mixed. While several studies of college student populations have evinced positive correlations between levels of trait mindfulness and substance use, the opposite seems to be true in clinical samples, with multiple studies showing a negative association. The current study reviews research in both non-treatment seeking college students and in clinical samples, and examines the relationship between trait mindfulness and substance dependence in a clinical sample (N = 281). Further, the study assesses the moderating effect of avoidant coping that might explain the disparate findings in the clinical versus nonclinical samples.     

Mindfulness as a mediator of the association between adverse childhood experiences and alcohol use and consequences

One-third of college students report past-year heavy episodic drinking, making college student alcohol use an important area for continued research. Research has consistently linked early experiences of adversity to problematic substance use in adolescence and adulthood. Given the negative health consequences associated with heavy episodic drinking, it is imperative to identify mechanisms that contribute to this relation. Low levels of mindfulness have been linked to early adversity as well as impulsivity and alcohol use, therefore, the current study aims to examine the mediating role of mindfulness in the relation between early adversity and current alcohol use and consequences. Undergraduate students (N = 385) at a Midwestern university completed an online questionnaire assessing experiences of childhood adversity, trait mindfulness, and current alcohol use and related consequences. Results indicated that increased adverse experiences and lower levels of mindfulness predicted both increased alcohol consumption and consequences (ps < 0.025), with mindfulness mediating the relationships. Mindfulness is a predictor of alcohol outcomes and appears to mediate the relation between early adversity and alcohol use and consequences. Findings suggest that students with a history of adversity are more likely to exhibit lower levels of mindfulness, which may lead to an increase in alcohol consumption and consequences in early adulthood. Targeted alcohol intervention efforts that incorporate mindfulness skills may be particularly beneficial for those who have experienced early adversity.