Monday, March 31, 2014

Mindfulness-Based Relapse Prevention Found Effective for Substance Abuse, Study Finds

Relapse is highly prevalent following substance abuse treatment, indicating that there is an urgent need for effective aftercare interventions. Now a new study has found that cognitive-behavioral relapse prevention (RP) and mindfulness-based relapse prevention (MBRP) are both effective aftercare interventions for substance abuse treatment, but that the latter may have an especially enduring effect as far as reducing drug-use days and heavy drinking are concerned. The study was headed by Sarah Bowen, Ph.D., an assistant professor of psychiatry and behavioral sciences at the University of Washington. The results appear in JAMA Psychiatry.

RP helps patients identify environmental situations that precipitate relapse and teaches them how to avoid such situations or cope with them. MBRP is based on some of the components of RP, such as identifying situations that precipitate relapse. However, it also includes mindfulness training—that is, it teaches patients how to become aware of emotional or physical states that might provoke a relapse, to learn to relate to the discomfort of such states more skillfully, and to identify underlying needs that might be driving a craving, such as a need for relief or comfort.

They study included 286 individuals who had completed treatment for substance use disorders. They were randomized to treatment as usual—that is, 12-step programming and psycho-education—RP, or MBRP. Between-group differences were not found at the three-month follow-up. However, at the six-month follow-up, both RP and MBRP subjects had a significantly reduced risk of relapse to drug use and/or heavy drinking compared with treatment-as-usual subjects. And at the 12-month follow-up, MBRP was found to be even more effective than RP in reducing drug use and heavy drinking.

"This is a very interesting study," John Renner, M.D., associate chief of psychiatry at the VA Boston Healthcare System and an addiction psychiatrist, told Psychiatric News. "It provides a useful comparison of the efficacy of CBT-based RP treatment and MBRP. Previous studies of MB treatments for substance use disorders have been promising, but have provided only two- or four-month follow-up data. The 12-month follow-up data from this study are of particular importance, since longer-term efficacy is a critical issue for any intervention of substance use disorders.... [The 12-month follow-up data] suggest that MBRP may provide better long-term outcomes than RP. Clinicians will be interested to see if this important finding is replicated." Renner is a member of the APA Council on Addiction Psychiatry.

Extensive information about treating substance abuse disorders can be found in the "American Psychiatric Publishing Textbook of Substance Abuse Treatment, Fourth Edition." Also see the Psychiatric Services article, "Substance Abuse Intensive Outpatient Programs: Assessing the Evidence."

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