With relapse common following substance abuse treatment, the authors of a new study state that there is an urgent need for effective aftercare interventions.
They found that cognitive-behavioral relapse prevention (RP) and mindfulness-based relapse prevention (MBRP) are both effective aftercare interventions following substance abuse treatment, but that the latter may have a more enduring effect.
The study was headed by Sarah Bowen, Ph.D., an assistant professor of psychiatry and behavioral sciences at the University of Washington, with findings published online March 19 in JAMA Psychiatry.
RP helps patients identify environmental situations that precipitate relapse and teaches them how to avoid such situations or how to cope with them. It might include, for example, identifying and avoiding high-risk situations and practicing drink- or drug-refusal skills. MBRP also integrates components of RP, such as identifying situations that trigger relapse. However, it also includes mindfulness training, which teaches patients how to become aware of emotional or physical states that might provoke a relapse, learn to relate to the discomfort of such states more skillfully, and identify underlying needs that might be driving a craving, such as a need for relief or comfort.
This study included 286 individuals who had successfully completed initial treatment for substance use disorders at a private, nonprofit treatment facility. They were randomized to treatment as usual (a 12-step program and psychoeducation), RP, or MBRP. The primary outcomes included relapse to drug use or heavy drinking as well as frequency of substance use during the previous 90 days. Variables were evaluated at baseline and at three-month, six-month, and 12-month follow-up points. The measures included both self-report of relapse and urinalysis drug and alcohol screenings.
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 significantly fewer heavy drinking days 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.
The reason that MBRP provided an added edge over the long term, the researchers suggested, may have been because mindfulness practice helped patients “recognize and tolerate discomfort associated with craving or negative affect.”
“This is a very interesting study,” John Renner, M.D., associate chief of psychiatry at the VA Boston Healthcare System and a member of the APA Council on Addiction Psychiatry, told Psychiatric News. “It provides a useful comparison of the efficacy of CBT-based RP treatment and MBRP. Previous studies of [mindfulness] 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 in substance use disorders.”
The 12-month follow-up data, he added, “suggest that MBRP may provide better long-term outcomes than RP. Clinicians will be interested to see if this important finding is replicated.”
“For psychiatrists and other health care professionals, it is important to inform [patients] of treatment options, and when providing clinical care, to be open to alternative models,” Bowen told Psychiatric News. “Mindfulness-based approaches are coming into the health care system and are garnering pretty compelling evidence across many different patient populations.” For example, as Bowen and her colleagues noted in their report, mindfulness training has been associated with reductions in anxiety, depression relapse, and disordered eating.
The study was funded by the National Institutes of Health. ■