Posted 10.19.2017 | by AMRA

Roughly half of all substance use program graduates relapse within six months. This has led researchers to seek better ways of reducing the frequency and severity of relapses after treatment. Mindfulness-Based Relapse Prevention (MBRP) is a program offered after residential or intensive outpatient treatment to prevent relapse.

MBRP teaches mindfulness skills to help substance users cope more effectively with their cravings. Rather than treating cravings as a danger to be avoided, MBRP approaches cravings as transient mental states that can be investigated and tolerated without triggering relapse.

Using data from a previously published MBRP trial, Enkema & Bowen [Drug and Alcohol Dependence] investigated whether MBRP actually weakened the association between craving and substance use. They reasoned that if it did, the link between craving and subsequent use would be weakest for those who practiced mindfulness meditation the most.

The 57 study participants (77% male, 63% Caucasian, average age = 38 years) had been randomly assigned to the MBRP arm of a parent study comparing MBRP to other aftercare programs. The participants had completed either an inpatient or intensive outpatient substance use program before starting MBRP.

In the previously published parent study, MBRP participants showed a 54% reduced risk of drug use and a 59% decreased risk of heavy drinking compared with the participants in comparison treatments.

The present study made use of MBRP participants’ reports of the quantity and frequency of their substance use (if any) during the six-month period following their completion of the program. The participants also indicated the intensity of their cravings and the extent of their formal (e.g. seated meditation) and informal (e.g., using mindfulness to “urge surf” cravings) mindfulness practice within the week of completing the 8-week MBRP program.

The study used the cravings and mindfulness practice data at post-intervention to predict substance use during the six months following MBRP completion.

The intensity of craving at post-intervention was significantly related to the extent of substance use during the six months following program completion. For every single point increase in craving (on a 30-point craving scale), participants used substances an additional 13 days during six-month follow-up.

More frequent and longer periods of formal mindfulness practice significantly weakened the degree of association between cravings and substance use. In other words, for those who practiced more, levels of craving at post-intervention were less predictive of the extent of substance use during follow-up. Informal practice, on the other hand, did nothing to weaken the relationship between cravings and use.

The results are consistent with the theory that mindfulness practice helps substance users maintain their sobriety by weakening the automatic connection between craving and subsequent use. This conclusion is subject to the limitation that the relationship between formal practice and resistance to craving may be due to factors other than mindfulness. For example, participants who are more motivated to practice may also be more motivated to resist relapse.


Enkema, M. C., & Bowen, S. (2017). Mindfulness practice moderates the relationship between craving and substance use in a clinical sample. Drug and Alcohol Dependence.

[Link to abstract]