Posted 08.19.2019 | by AMRA
Many women attending residential substance use disorder treatment fail to successfully complete their program. These women often have complex social histories, multiple psychiatric and medical diagnoses, and histories of incarceration. They may also have trouble adjusting to the programs due to conflicts with staff and peers, substance withdrawal and cravings, and difficulty abiding by program rules and structure. Mindfulness may help women negotiate these difficulties by reducing their automatic reactivity to cravings, interpersonal conflicts, and other emotional triggers.
Black et al. [Behaviour Research and Therapy] studied whether a mindfulness-based intervention specifically designed for women in residential substance use disorder treatment settings could reduce the likelihood of prematurely leaving the program in unimproved condition.
The researchers randomly assigned 200 women in residential substance use disorder treatment (average age = 33 years; 58% Hispanic; 62% with incarceration history; 76% with amphetamine/methamphetamine abuse) to either the Moment-by-Moment Women’s Recovery (MMWR) program or a time-matched psycho-educational control.
Both were add-on interventions with participants continuing to receive all of the services ordinarily provided by the residential treatment program. In both of the interventions, the participants met twice weekly for 80-minute group sessions over the course of six weeks.
The MMWR program was based on Mindfulness-Based Stress Reduction, but specifically designed for ethnoracially diverse women in residential substance use treatment. The program addressed the role of mindfulness in dealing with cravings and relapse, trauma, parenting, conflicts with staff and peers, and other issues likely to arise in treatment.
The psycho-educational control consisted of didactic material regarding brain structure, function, and biochemical changes pertaining to substance abuse. Attendance in both groups averaged 9 out of 12 classes, and participants rated both groups highly in terms of satisfaction.
Upon patient discharge, residential program clinical staff rated participants as to whether they were still in residence, had successfully completed the treatment, had dropped out of treatment but were clinically improved, or had dropped out of treatment and were clinically unimproved. The follow period was 150 days after the start of the study intervention. The researchers were interested in whether MMWR could reduce the likelihood of being in the “non-completing and unimproved” category.
They also assessed participants at baseline and post-intervention on measures of mindfulness (using the Five Facet Mindfulness Questionnaire), perceived stress, distress tolerance, emotional regulation, subjective distress, mood, and substance cravings.
The results showed that the risk of non-completion without improvement was lower for the MMWR group than controls (Hazard Ratio=0.46; medium-to-large effect). There were positive trends for both groups to improve on various psychological measures over time, but between-group differences were not significant.
Notably, there were significant correlations between class attendance and various psychological measures for the MMWR group but not the control group. In particular, only the MMWR group had large and significant correlations between days of class attendance and mindfulness (r=.61), distress tolerance (r=.55), and positive mood scores (r=.52).
The study shows that MMWR participants are less likely to leave residential treatment without satisfactory improvement. It supports the utility of adjunctive MMWR for residential drug treatment programs that provide services to ethnoracially diverse women. Improvement on a number of psychological variables was dose dependent on MMWR class attendance, meaning the more classes attended the greater the improvement.
Study shortcomings include the possibility that the six-week MBSR intervention may have been shorter than optimal length, and the outcome judges were not blind to condition.
Black, D. S., & Amaro, H. (2019). Moment-by-Moment in women’s recovery (MMWR): Mindfulness-based intervention effects on residential substance use disorder treatment retention in a randomized controlled trial. Behaviour Research and Therapy.