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MBRP-W for culturally diverse underserved women

Posted: 04.25.2014 | 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. 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 […]

April 25th, 2014|News|

MBRP reduces substance use at 12 months

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 […]

April 7th, 2014|News|

“Urge Surfing” Helps Quitters on First Day of Smoking Abstinence

Posted from archive: 04.23.2013 | by AMRA

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The frequency and intensity of cravings is one of the main predictors of failure in smoking cessation attempts. Nosen & Woody [Drug and Alcohol Dependence] reported on the effects of two brief interventions on nicotine withdrawal cravings during the first day of abstinence from smoking. One group of smokers received a mindfulness intervention that stressed acceptance of cravings, allowing them to come and go without attempts to control. A second group received a standard psychoeducational intervention. Both brief 60 to 90 minute interventions were delivered via computer slide show with voice-overs. A third group served as a no-treatment control.

The day after the intervention, one half of the group of 176 smokers quit smoking, and quitters were paged at various intervals throughout the day to rate their cravings. Participants also completed a questionnaire on their beliefs about cravings (e.g., whether they viewed cravings as signs of personal weakness or thought they needed to be controlled).

Both interventions significantly lowered cravings upon awakening the next morning. Both groups also experienced rising levels of craving throughout the day, so that after 2-3 hours their cravings equaled those of controls. After 10 hours, however, the standard psychoeducational intervention group continued to experience increasing cravings, whereas the mindfulness group experienced a significant drop in craving intensity. The mindfulness group also endorsed significantly fewer dysfunctional beliefs about cravings.

These results suggest that even brief training in “urge surfing” may significantly help quitters during their first day of abstinence.

Reference:

Nosen, E., & Woody, S. R. (2013). Brief psycho-education affects circadian variability in nicotine craving during cessation. Drug and Alcohol Dependence, 132(1-2), 283-89. [PMID: 23478153]

[Link to abstract]

December 31st, 2013|News|

MBIs Show Promise for Reducing Substance Use, Especially Smoking

Posted from archive: 04.05.2013 | by AMRA

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Chiesa & Serretti [Substance Use & Misuse] comprehensively reviewed 24 quantitative, controlled studies of mindfulness-based and associated interventions (MBIs) on different types of substance abuse and misuse. The MBIs studied included MBSR, MBCT, MBRP, DBT and ACT, as well as other modalities. Substance abuse types included alcohol, tobacco, opiates, cannabis, methamphetamines, and mixed substance abuse. Retention rates were generally moderate to high (e.g., 50-90 for alcohol abusers, 63-100 for cigarette smokers, and 57-82 for opiate abusers) and there were no reported adverse effects.

There was some limited evidence that MBIs can reduce substance use over and above wait-list controls, nonspecific educational support groups, and some specific controls, but conclusions were hampered by methodological limitations including small sample size, lack of either randomization, blind assessment, or objective measures of substance use, and insufficient information on treatment adherence and follow-up. Some of the best evidence for efficacy was with the use of MBIs for smoking cessation, where all 4 reviewed studies showed significant benefits over and above controls.

There were also some surprising findings: three studies (one using MBSR, 2 using ACT) failed at significantly reducing stress. Two of the 3 studies using the Five Facet Mindfulness Questionnaire (FFMQ) failed to observe significant differences in mindfulness, while a third observed only transient differences on a single subscale. The authors emphasize the need for future replications with larger sample size and improved methodological rigor before firmer conclusions can be made.

Reference:

Chiesa, A., & Serretti, A. (2013). Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence. Substance Use & Misuse. doi: 10.3109/10826084.2013.770027 [PMID: 23461667]

[Link to abstract]

December 30th, 2013|News|