Posted: 04.07.2014 | by AMRA

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An estimated 40% to 60% of substance abusers relapse following treatment, emphasizing the need for the development of more effective relapse prevention and harm reduction approaches. Bowen et al. [JAMA Psychiatry] evaluated the effectiveness of three substance abuse relapse prevention programs among 286 participants who had just completed either an inpatient or intensive outpatient substance abuse program.

Participants, who were predominantly male (70%) and ethnically diverse (51% non-Hispanic White, 21% non-Hispanic Black, 11% Hispanic, and 13% Mixed /Other), were randomly assigned to either 1) a treatment as usual (TAU) condition based on a 12-Step model, 2) an 8-week cognitive-behavioral relapse prevention program (RP) emphasizing motivation, coping skills, and avoiding triggers for relapse, and 3) an 8-week Mindfulness-Based Relapse Prevention Program (MBRP) emphasizing using mindfulness skills to tolerate negative moods and urges.

Primary outcome measures were the number of days until a first lapse in drug use or heavy drinking (defined as 4 or more drinks for women and 5 or more drinks for men) and the number of days during which drug use or heavy drinking occurred. The outcomes were assessed by self-report, but 70% of the participants were subject to court-mandated drug and alcohol screens which by and large agreed with their self-reports (only 5% of the screens were positive when participants denied substance use).

There were no significant differences in the attrition rates between treatments, and no differences between treatments at 3 month follow-up in terms of either the number of days until first drug or heavy drinking lapse or the number of days of drug use or heavy drinking; all three groups had fairly high abstinence rates.

Over the 12 months they were followed MBRP and RP participants showed a 54% decreased risk of relapse for drug use and a 59% decreased risk for heavy drinking compared with TAU participants. While the MBRP group showed a 21% higher relapse risk for drug use than the RP group, the two did not differ in relapse rates for heavy drinking.

An analysis of the number of days that those who relapsed actually engaged in drug use or heavy drinking showed that at 6 months RP and MBRP relapsers had 31% fewer heavy drinking days than TAU relapsers with no difference between the RP and MBRP groups. At 12 months, however, MBRP relapsers had 31% fewer drug use days and a significantly higher probability of not engaging in heavy drinking compared with RP relapsers.

While both RP and MBRP proved superior to TAU at 6 months with RP having an edge over MBRP in terms of length of time until first lapse, by 12 months MBRP had an edge over RP in reducing the number of days of drug use and heavy drinking after first lapse.

Reference:

Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., . . . Lustyk, M. K. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: A randomized clinical trial. JAMA Psychiatry. [PMID: 24647726]

[Link to abstract]