Posted: 04.25.2014 | by AMRA
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. While mindfulness-based relapse prevention approaches may have considerable theoretical appeal, traditional mindfulness programs may not be completely suitable for underserved populations who have their own unique needs, and may need to be modified accordingly.
Amaro et al. [Subst Use Misuse.] studied the feasibility and benefits of incorporating “Moment-by-Moment in Women’s Recovery: A Mindfulness-Based Approach to Relapse Prevention” (MBRP-W) into existing substance use programs serving a culturally diverse, low-income cohort of women with trauma exposure histories. The 9-week program used a modified MBSR format designed to increase its relevance to women with issues of addiction, relapse, mental illness, low literacy levels, and trauma.
Three hundred and eighteen low-income ethnically-diverse women who were actively attending publicly-funded substance use programs were enrolled additionally in the MBRP-W program. The cohort was 45.3% Hispanic, 34.6% non-Hispanic Black, and 20.1% non-Hispanic White, with 45.6% having been court-mandated to treatment. Based on the difficulties of meeting the logistical demands of residential treatment, 44.3% of the women attended no sessions, 19.8% attended 1-4 sessions, and 35.8% attended 5-9 sessions. Scheduling conflicts with courts, medical providers, child protective services, and dropout from their primary clinic all contributed to attrition and lowered attendance.
Average satisfaction ratings from those who attended the final MBRP-W session were “very good to excellent” on program usefulness, quality, and importance. Participants who attended 5 or more sessions showed significantly greater rates of decline in alcohol addiction over 12 months, and greater declines in drug addiction at 6 and 12 months, than those who never attended. While perceived stress declined for the entire cohort, the rate and extent of decline was steeper for those who attended 5 or more sessions. MBRP-W did not accelerate a decline in trauma symptoms, however, as the entire cohort experienced a similar decline over time.
This preliminary feasibility study lacked a control group, but it is one of the first large-scale studies with this vulnerable population. As such, it points to the potential benefits of employing a mindfulness-based relapse prevention program with underserved women receiving care in publicly-funded substance use facilities, while at the same time underscoring the real-life difficulties that can serve as a barrier to good attendance in such programs.
Amaro, H., Spear, S., Vallejo, Z., Conron, K., & Black, D. S. (2014). Feasibility, acceptability, and preliminary outcomes of a mindfulness-based relapse prevention intervention for culturally-diverse, low-income women in substance use disorder treatment. Substance Use & Misuse, 49(5), 547-559. [PMID: 24611850]