Mindfulness-Based Relapse Prevention
Substance abuse is a significant public health problem. In the U.S. alone, annual costs of substance abuse exceed half a trillion dollars (ONDCP, 2004). In 2006, more than 23 million Americans received treatment for substance use disorders (SUDs; SAMHSA, 2006). Yet treatment outcome research has indicated that the majority of those who receive treatment will return to substance use (i.e., “relapse”). These statistics testify to the need for improved treatment for SUDs. Mindfulness-Based Relapse Prevention (MBRP) was developed by my colleagues at the University of Washington (Bowen, Chawla, & Marlatt, in press) in response to this need. MBRP integrates coping skills training with the teaching of skillful responses to substance use triggers, increasing tolerance of challenging physical, emotional, and cognitive states, thereby decreasing the need to alleviate discomfort through substance use.
MBRP is a group-based treatment conducted over the course of 8 weeks. Clients typically meditate for 30-45 minutes in session and are assigned approximately 45 minutes of daily meditation, using audio-recorded instructions. The mindfulness practices are intended to increase discriminative awareness and acceptance, with a specific focus on affective and physical discomfort, teaching clients to observe physical, cognitive, emotional, or craving states without “automatically” reacting. Through formal meditation practices, other mindfulness-based exercises, and discussion, clients practice a nonjudgmental approach to negative affective states, learning to “investigate” the emotional, physical and cognitive components of experience, rather than immediately attempting to escape them. It is hypothesized that clients’ mindful recognition of and attention to problematic cognitive and affective states provide a “pause,” interrupting the habitual reaction. Over time, repeated exposure to previously avoided experience (e.g., depressive states), in the absence of habitual responses (e.g., substance use), may weaken the response of craving in the presence of emotional discomfort.
We are currently in the data collection phase for two separate randomized clinical trials evaluating the efficacy of MBRP in comparison to Relapse Prevention (RP). RP is a coping-skills based intervention that does not focus on training in mindfulness. The first study, being conducted by colleagues at the University of Washington, is recruiting individuals from an outpatient community substance abuse treatment center, the Recovery Centers of King County in Seattle, WA. The second study, being conducted at WSU-V, is recruiting participants from the Volunteers of America-Oregon Women’s Residential Center in Portland, OR. For both studies we are interested in evaluating whether MBRP or RP lead to the reduction of post-treatment substance use and whether MBRP or RP are more/less effective for specific individuals.
Grant support for this research:
2010 – 2011 Washington State University-Vancouver, Mini-Grant, Evaluation of Mindfulness-Based Relapse Prevention for Women in Residential Treatment for Substance Use Disorders following a Criminal Offense, $4,592, K. Witkiewitz (PI). Role: Principal Investigator
2009 – 2011 National Institute on Drug Abuse, R01 DA025764-01A1, Mindfulness-Based Relapse Prevention: Efficacy and Mechanisms, $478,165, G. Marlatt (PI). Role: Co-Investigator
Bowen, S. W., Chawla, N., Collins, S. E., Witkiewitz, K., Hsu, S., Grow, J., Clifasefi, S., Garner, M. Douglass, A., Larimer, M., Marlatt, G. A. (2009). Mindfulness-based relapse prevention for substance use disorders: A Pilot Efficacy Trial. Substance Abuse, 30, 295-305.
Bowen, S., Witkiewitz, K., Dillworth, T. M., & Marlatt, G. A. (2007). The role of thought suppression in the relationship between mindfulness meditation and substance use. Addictive Behaviors, 32, 2324-2328.
Bowen, S. W., Witkiewitz, K. A., Dillworth, T., Chawla, N., Simpson, T., Ostafin, B., Larimer, M. E., Blume, A. W., Parks, G.; & Marlatt, G. A. (2006). Mindfulness Meditation and Substance Use in an Incarcerated Population. Psychology of Addictive Behaviors, 20, 343-347.
Ostafin, B. D., Chawla, N., Bowen, S., Dillworth, T. M., Witkiewitz, K., & Marlatt, G. A. (2006). Intensive mindfulness training and the reduction of psychological distress: A preliminary study. Cognitive Behavioral Practice, 13, 191-197.
Witkiewitz, K. & Bowen, S. (2010). Depression, craving and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 78, 362-374.
Witkiewitz, K., Marlatt, G. A., & Walker, D. D. (2005). Mindfulness-Based Relapse Prevention for Alcohol and Substance Use Disorders. Journal of Cognitive Psychotherapy, 19 (3), 211-228.