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Van Doren N, Ng H, Rawat E, McKenna KR, Blonigen DM. Virtual reality mindfulness training for veterans in residential substance use treatment: Pilot study of feasibility and acceptability. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209315. [PMID: 38378078 DOI: 10.1016/j.josat.2024.209315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/12/2024] [Accepted: 02/11/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Mindfulness training is effective in recovery from substance use disorders; however, adoption can be difficult due to environmental and personal distractions. Virtual reality (VR) may help overcome these challenges by providing an immersive environment for practicing mindfulness, but there is currently limited knowledge regarding patient and provider perceptions of VR-based tools. OBJECTIVE The present study investigated the feasibility and acceptability of VR mindfulness training for veterans in residential substance use treatment as well as potential benefits of VR mindfulness interventions in this population. We conducted a pilot feasibility/acceptability study as a first step toward conducting a larger randomized controlled trial (RCT). METHODS The study recruited participants (N = 32) from a 30-day residential substance use program and collected both qualitative and quantitative feedback on the VR mindfulness intervention using a mixed-methods approach. Patients (n = 20) and providers (n = 12) rated the acceptability, usability, and satisfaction of the intervention. Using a within-subjects design, patients provided pre-post emotion ratings and reported on state mindfulness and VR presence after completing a single-session self-guided VR mindfulness intervention. Patients provided qualitative interview data on their overall impressions, while providers gave the same information via survey. RESULTS Both patients and providers reported high satisfaction and confidence in the intervention. Moreover, within subjects t-tests showed that patients experienced significant reductions in negative affect and significant increases in positive affect from pre-post, along with high levels of state mindfulness and presence. Results of thematic analysis revealed that the intervention facilitated focused attention on the present moment, induced a state of calm and relaxation, and reduced negative thoughts and emotions. Participants requested improvements such as better integration of audiovisual elements, a more personalized and longer intervention, and more comfortable fitting headset. Finally, the intervention presented with several advantages compared to other mindfulness experiences including reduced distractions and a sense of safety and privacy. CONCLUSIONS Self-guided VR mindfulness intervention is feasible and acceptable to patients and providers. VR mindfulness training provides an immersive experience that uplifts mood and reduces distractions. VR may provide a scaffolding tool to set the stage for deepening mindfulness skills. Results of the present study could inform further development and tailoring for future interventions.
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Affiliation(s)
- Natalia Van Doren
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States of America.
| | - Helen Ng
- Department of Psychology, University of California, Berkeley, CA, United States of America
| | - Eshaan Rawat
- Department of Engineering, Stanford University, Stanford, CA, United States of America
| | - Kevin R McKenna
- VA Palo Alto Healthcare System, Department of Veterans Affairs, Palo Alto, CA, United States of America
| | - Daniel M Blonigen
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
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Donate APG, de Macedo EC, Bedendo A, Félix Júnior I, Gallo GG, Opaleye ES, Noto AR. The effect of mindfulness on decision-making, inhibitory control, and impulsivity of substance use disorder in-treatment patients: A randomized clinical trial. PLoS One 2023; 18:e0293502. [PMID: 37934743 PMCID: PMC10629638 DOI: 10.1371/journal.pone.0293502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
This study aimed to investigate the effects of Mindfulness-Based Relapse Prevention (MBRP) in decision-making, inhibitory control and impulsivity compared to Treatment as Usual (TAU) for individuals with Substance Use Disorders (SUD's) in Brazil. A randomized clinical trial was conducted with participants from a therapeutic community (n = 122). Decision-making (Iowa Gambling Task), impulsivity dimensions (UPPS-P Scale), and inhibitory control (Stroop Color-Word Test) were assessed before and after the MBRP 8-week intervention. GLM Multivariate analysis was used to evaluate the effects of MBRP on different impulsivity measures. The results showed that MBRP+TAU improved the general decision-making score (p = 0,008) compared to TAU. However, no significant effects were found in impulsivity dimensions and inhibitory control in individuals with SUDs in the therapeutic community. This study found improvement in decision-making in the total IGT score; however, no effect for self-reported impulsivity and inhibitory control among middle-aged patients after an 8-weeks intervention of MBRP protocol in an inpatient setting. It adds information to the subject, with implications and possible directions to be followed by the next clinical trials with patients with SUDs in treatment. Trial registration: EnsaiosClinicos.gov.br: RBR-6c9njc.
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Affiliation(s)
- Ana Paula Gonçalves Donate
- Department of Psychobiology, Núcleo de Pesquisa em Saúde e Uso de Substância, Universidade Federal de São Paulo, SP, São Paulo, Brazil
| | - Elizeu Coutinho de Macedo
- Laboratório de Neurociência Cognitiva e Social, Centro de Ciências Biológicas e da Saúde, Universidade Presbiteriana Mackenzie, SP, São Paulo, Brazil
| | - André Bedendo
- Department of Psychobiology, Núcleo de Pesquisa em Saúde e Uso de Substância, Universidade Federal de São Paulo, SP, São Paulo, Brazil
| | - Itamar Félix Júnior
- Department of Psychobiology, Núcleo de Pesquisa em Saúde e Uso de Substância, Universidade Federal de São Paulo, SP, São Paulo, Brazil
| | - Giovanna Gonçalves Gallo
- Department of Psychobiology, Núcleo de Pesquisa em Saúde e Uso de Substância, Universidade Federal de São Paulo, SP, São Paulo, Brazil
| | - Emérita Sátiro Opaleye
- Department of Psychobiology, Núcleo de Pesquisa em Saúde e Uso de Substância, Universidade Federal de São Paulo, SP, São Paulo, Brazil
| | - Ana Regina Noto
- Department of Psychobiology, Núcleo de Pesquisa em Saúde e Uso de Substância, Universidade Federal de São Paulo, SP, São Paulo, Brazil
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Killeen TK, Baker NL, Davis LL, Bowen S, Brady KT. Efficacy of mindfulness-based relapse prevention in a sample of veterans in a substance use disorder aftercare program: A randomized controlled trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209116. [PMID: 37364669 DOI: 10.1016/j.josat.2023.209116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/13/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Complementary integrative medicine, such as mindfulness-based interventions, (MBI) have demonstrated efficacy in the treatment of depression, anxiety, substance use disorders (SUDs), and pain. Mindfulness-based relapse prevention (MBRP) is an aftercare intervention targeting SUD relapse that integrates cognitive-behavioral relapse prevention and mindfulness meditation practices, raising awareness of substance use triggers and reactive behavioral patterns. This study evaluated the efficacy of MBRP in reducing relapse in veterans following completion of an SUD treatment program. METHODS This study was a two-site, randomized controlled trial comparing MBRP to 12-step facilitation (TSF) aftercare in military veterans following completion of intensive treatment for SUDs. The 8 weeks of 90-minute, group-based MBRP or TSF sessions were followed by 3-, 6- and 10-month follow-up periods with assessments of alcohol/substance use and secondary outcomes of depression, anxiety, and mindfulness. RESULTS Forty-seven percent of veterans attended ≥75 % of sessions. Veterans in both the MBRP and TSF aftercare groups maintained reductions in alcohol and illicit substance use during the aftercare treatment. Nineteen participants (11 %; 19/174) reported returning to alcohol use during the study treatment period and the study found no difference between study groups [MBRP: 9 % vs. TSF 13 %; p = 0.42]. Thirteen participants (7.5 %; 13/174) reported a return to illicit substance use during study treatment [MBRP: 5.4 % vs. TSF 10.3 % p = 0.34]. The number of days of drinking and illicit substance use was not different between groups (alcohol, p = 0.53; illicit substance use, p = 0.28). CONCLUSION Although retention in treatment limits interpretation of the findings, both MBRP and TSF were effective in maintenance of treatment gains following an intensive treatment program for veterans with SUDs. Future studies should focus on strategies to improve treatment participation.
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Affiliation(s)
- Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC, 29425, United States of America.
| | - Nathaniel L Baker
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC, 29425, United States of America.
| | - Lori L Davis
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama Health System, 3701 Loop Rd, Tuscaloosa, AL 35404, United States of America.
| | - Sarah Bowen
- Department of Psychology, Pacific University, Graduate Psychology Health Prof. Building 2 297 (Hillsboro), 503-352-3614, UC Box A191, Portland, OR, United States of America.
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC, 29425, United States of America.
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Braun TD, Green Z, Meshesha LZ, Sillice MA, Read J, Abrantes AM. Self-compassion buffers the internalized alcohol stigma and depression link in women sexual assault survivors who drink to cope. Addict Behav 2023; 138:107562. [PMID: 36463606 PMCID: PMC10184311 DOI: 10.1016/j.addbeh.2022.107562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depression is strongly implicated in drinking to cope and the development of alcohol use disorders (AUD) in women, particularly among women with a history of sexual assault victimization (SAV). Alcohol use in women is heavily stigmatized, and substance use stigma is associated with depression. This study examined the link between internalized alcohol stigma (AS) and depression and tested whether self-compassion buffered (i.e., moderated) this association in a sample of women with a history of SAV and unhealthy drinking to cope. METHOD Women sexual assault survivors (N = 288; 82 % White, 91.2 % Non-Hispanic, 20.2 % sexual minority) reporting unhealthy drinking (Alcohol Use Disorders Inventory Test-C ≥ 4) and drinking to cope (Drinking Coping Motives Questionnaire-Revised ≥ 2) completed online self-report surveys. Hierarchical regression analyses tested associations between internalized-AS and self-compassion with depression after controlling for covariates (age, income, education, AUD symptoms, and posttraumatic stress disorder) and then, whether self-compassion moderated the Internalized-AS and depression link. RESULTS Internalized-AS accounted for 1.4 % of variance in depression (p < .01); self-compassion accounted for added variance when subsequently modeled (8.2 %, p < .001). Moderation analyses revealed self-compassion to buffer the internalized-AS and depression link. Among participants reporting high levels of self-compassion, there was no association between internalized-AS and depression (p = .894). DISCUSSION While findings are modest, they align with the previously observed link between internalized-AS and depression and extend these findings to women with a history of SAV endorsing elevated coping motives and unhealthy drinking. Self-compassion may protect against this link, pending further research sampling greater diversity of participants and longitudinal and controlled designs.
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Affiliation(s)
- Tosca D Braun
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.
| | - Zoë Green
- University of Connecticut Health Center, Farmington, CT, United States
| | - Lidia Z Meshesha
- Department of Psychology, University of Central Florida, Orlando, FL, United States
| | - Marie A Sillice
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Jennifer Read
- Department of Psychology, University at Buffalo, Buffalo, NY, United States
| | - Ana M Abrantes
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States
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Félix-Junior IJ, Donate APG, Noto AR, Galduróz JCF, Simionato NM, Opaleye ES. Mindfulness-based interventions in inpatient treatment for Substance Use Disorders: A systematic review. Addict Behav Rep 2022; 16:100467. [PMID: 36425879 PMCID: PMC9679543 DOI: 10.1016/j.abrep.2022.100467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/21/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022] Open
Abstract
Inpatient treatment for Substance Use Disorder (SUD), such as Therapeutic Communities and Residential Treatment has been used to test the effect of Mindfulness-Based Interventions (MBI) over different outcomes. Although there is evidence of the effectiveness of MBIs, little is known about the particularities that the place may have in the outcomes. The main objective of this Systematic Review was to evaluate the effectiveness of MBIs for SUDs performed in the inpatient context. PubMed, Web of Science and PsycInfo were used for the search. Quantitative and qualitative studies with no control, usual treatment or other active comparator intervention for SUDs inpatient treatment from 1980 to 2020 were included. From 21 selected studies, 18 were quantitative and 3 qualitative; 12 studies were RCT. Most samples were comprised with women. Based on characteristics of outcomes, we were able to divide them into: Substance Use and Associated Outcomes, Stress, Impulsivity e Evaluation of the MBI protocol. Results suggest that stress assessment is a determining factor for treatment success in these settings. Regarding substance use, although several outcomes have been assessed, the most remarkable results were craving reduction and improvement in treatment adherence. There is evidence that MBIs in inpatient settings benefited those who participated in the experimental groups on some outcomes, such as stress and substance use. Little is mentioned about the impact of the environment over the outcomes and short follow-ups were a relevant limitation of most of the studies. Future assessments must increase follow-up time and evaluate the relationship between the context and the MBI.
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Affiliation(s)
- Itamar José Félix-Junior
- Research Center on Health and Substance Use, Psychobiology Department, Universidade Federal de São Paulo, Brazil
| | - Ana Paula G Donate
- Research Center on Health and Substance Use, Psychobiology Department, Universidade Federal de São Paulo, Brazil
| | - Ana Regina Noto
- Research Center on Health and Substance Use, Psychobiology Department, Universidade Federal de São Paulo, Brazil
| | | | | | - Emérita Sátiro Opaleye
- Research Center on Health and Substance Use, Psychobiology Department, Universidade Federal de São Paulo, Brazil
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Maneesang W, Hengpraprom S, Kalayasiri R. Effectiveness of Mindfulness - Based Therapy and Counseling programs (MBTC) on relapses to methamphetamine dependence at a substance dependency treatment center. Psychiatry Res 2022; 317:114886. [PMID: 36252419 DOI: 10.1016/j.psychres.2022.114886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/27/2022] [Accepted: 10/04/2022] [Indexed: 01/05/2023]
Abstract
This non-concurrent controlled intervention study aimed to examine the effectiveness of the Mindfulness - Based Therapy and Counseling programs (MBTC) on the treatment of methamphetamine use disorder among 70 individuals (37 females) receiving methamphetamine dependency treatment. Participants were divided into a control group undergoing the usual program and an experimental group using MBTC plus the usual program at a treatment center in Thailand. The study was conducted using the Methamphetamine Craving Questionnaire, urine Color Immunochromatographic Assay and the Mini-International Neuropsychiatric Interview. Stress, depression, and mindfulness were also assessed. MBTC comprised of practicing mindfulness for 90-120 min weekly for eight weeks. Participants were assessed before and after the treatment(s) and at follow-ups visits at 2, 4, 8, 12, and 24 weeks. Mean age (30.3 ± 5.8 years), age of first methamphetamine use (18.2 ± 4.5 years) and other demographics did not differ between groups. At six-month follow-up, the experimental group had significantly lower craving (-7.89, 95%CI = -15.47, -0.32), stress (-7.44, 95%CI = -12.21, -2.67), and depression (-2.95, 95%CI = -5.31, -0.6) and statistically significant higher mindfulness scores (12.86, 95%CI = 9.37, 16.35) than the control group. In addition, methamphetamine relapse in the MBTC group (5/35, 14.3%) was significantly lower than the control group (16/35, 45.7%).
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Affiliation(s)
- Wanjaree Maneesang
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 254 Phayathai Rd, Wang Mai, Khet Pathum Wan, Bangkok 10330, Thailand
| | - Sarunya Hengpraprom
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 254 Phayathai Rd, Wang Mai, Khet Pathum Wan, Bangkok 10330, Thailand.
| | - Rasmon Kalayasiri
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
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Quinn CA, Walter ZC, de Andrade D, Dingle G, Haslam C, Hides L. Controlled Trial Examining the Strength-Based Grit Wellbeing and Self-Regulation Program for Young People in Residential Settings for Substance Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13835. [PMID: 36360714 PMCID: PMC9657698 DOI: 10.3390/ijerph192113835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
This cohort-controlled trial examined whether the 12-session Grit Wellbeing and Self-regulation Program enhanced the treatment outcomes of young people accessing residential alcohol and other drug (AOD) treatment. Grit focuses on increasing wellbeing and reducing substance use and mental health problems by building self-regulation skills, strengths, social connections, and health behaviours. Participants were 194 (66% male, Mage 27.40) young people (aged 18-35 years) accessing a six-week residential treatment program for substance use. Participants received standard treatment, or standard treatment plus Grit (two sessions/week for six weeks). The primary outcome was substance use, measured as: (i) global substance use and (ii) alcohol, methamphetamine, and cannabis use involvement. Secondary outcomes included wellbeing, depression, anxiety, and vocational engagement. Participants were assessed at baseline, and 6-weeks (secondary outcomes only), 3-months, 6-months, and 12-months post-program enrolment. Results revealed that both groups showed a significant improvement in all outcomes at three months, and improvements were maintained at 6- and 12-month follow-ups. The Grit group had a larger reduction in methamphetamine and cannabis use involvement compared to the control group. This study presents promising evidence that a six-week residential program can achieve improvements in AOD use, depression, anxiety, wellbeing and vocational engagement. Further, targeting self-regulation may enhance such programs.
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Affiliation(s)
- Catherine A. Quinn
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Zoe C. Walter
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Dominique de Andrade
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, Deakin University, Melbourne 3125, Australia
| | - Genevieve Dingle
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Catherine Haslam
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Leanne Hides
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
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Holzman JBW, Hawks JL, Kennedy SM, Anthony BJ, Anthony LG. Parenting in a Pandemic: Preliminary Support for Delivering Brief Behavioral Parent Training Through Telehealth. Behav Modif 2022; 47:128-153. [PMID: 35707864 PMCID: PMC10076234 DOI: 10.1177/01454455221103226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Behavioral problems, such as noncompliance and aggression, are a common referral reason to mental health services for young children. Behavioral parent training (BPT) is the leading intervention for addressing behavioral problems and leads to benefits in a variety of parental factors (e.g., parenting efficacy and parenting stress). While the COVID-19 pandemic dramatically shifted service delivery toward telehealth services, limited work has evaluated the effectiveness of BPT when delivered in a brief, group format through telehealth. The current retrospective chart review study evaluated the engagement to and preliminary effectiveness of a brief version of BPT delivered through telehealth to 64 families of 3- to 7-year-olds referred for behavioral problems. Families attended an average of 4.55 of 6 sessions and most families had two caregivers who engaged in the intervention. Significant reductions in caregivers' report of children's behavioral problems and improvements in parenting self-efficacy resulted. Future research and clinical implications are discussed.
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Affiliation(s)
- Jacob B W Holzman
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, USA.,Pediatric Mental Health Institute at Children's Hospital of Colorado, Aurora, USA
| | - Jessica L Hawks
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, USA.,Pediatric Mental Health Institute at Children's Hospital of Colorado, Aurora, USA
| | - Sarah M Kennedy
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, USA.,Pediatric Mental Health Institute at Children's Hospital of Colorado, Aurora, USA
| | - Bruno J Anthony
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, USA.,Pediatric Mental Health Institute at Children's Hospital of Colorado, Aurora, USA
| | - Laura G Anthony
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, USA.,Pediatric Mental Health Institute at Children's Hospital of Colorado, Aurora, USA
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Somohano VC, Vasquez A, Shank T, Irrgang M, Newman AG, Evans C, Wyse J, Denneson L, O'Neil M, Lovejoy T. Perceptions of Women With Comorbid PTSD and Substance Use Disorder on Mechanisms Underlying Mindfulness-Based Interventions. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Witkiewitz K, Pfund RA, Tucker JA. Mechanisms of Behavior Change in Substance Use Disorder With and Without Formal Treatment. Annu Rev Clin Psychol 2022; 18:497-525. [PMID: 35138868 DOI: 10.1146/annurev-clinpsy-072720-014802] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article provides a narrative review of studies that examined mechanisms of behavior change in substance use disorder. Several mechanisms have some support, including self-efficacy, craving, protective behavioral strategies, and increasing substance-free rewards, whereas others have minimal support (e.g., motivation, identity). The review provides recommendations for expanding the research agenda for studying mechanisms of change, including designs to manipulate putative change mechanisms, measurement approaches that expand the temporal units of analysis during change efforts, more studies of change outside of treatment, and analytic approaches that move beyond mediation tests. The dominant causal inference approach that focuses on treatment and individuals as change agents could be expanded to include a molar behavioral approach that focuses on patterns of behavior in temporally extended environmental contexts. Molar behavioral approaches may advance understanding of how recovery from substance use disorder is influenced by broader contextual features, community-level variables, and social determinants of health. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA; .,Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Rory A Pfund
- Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jalie A Tucker
- Department of Health Education & Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, Florida, USA
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Fatkin T, Moore SK, Okst K, Creedon TB, Samawi F, Fredericksen AK, Roll D, Oxnard A, Lê Cook B, Schuman-Olivier Z. Feasibility and acceptability of mindful recovery opioid use care continuum (M-ROCC): A concurrent mixed methods study. J Subst Abuse Treat 2021; 130:108415. [PMID: 34118705 PMCID: PMC8478704 DOI: 10.1016/j.jsat.2021.108415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022]
Abstract
As opioid overdose deaths increase, buprenorphine/naloxone (B/N) treatment is expanding, yet almost half of patients are not retained in B/N treatment. Mindfulness-based interventions (MBIs) designed to promote non-judgmental awareness of present moment experience may be complementary to B/N treatment and offer the potential to enhance retention by reducing substance use and addressing comorbid symptoms. In this pilot study, we examined the feasibility and acceptability of the Mindful Recovery OUD Care Continuum (M-ROCC), a trauma-informed, motivationally sensitive, 24-week MBI. Participants (N = 18) were adults with Opioid Use Disorder prescribed B/N. The study team conducted assessments of satisfaction, mindfulness levels, and home practice, as well as qualitative interviews at 4 and 24-weeks. M-ROCC was feasible in a sample with high rates of childhood trauma and comorbid psychiatric diagnoses with 89% of participants retained at 4-weeks and 72% at 24-weeks. Positive qualitative interview responses and a high rate of participants willing to refer a friend (100%) demonstrates program acceptability. Participant mindfulness increased from baseline to 24-weeks (β = 0.24, p = 0.001, d = 0.51), and increases were correlated with informal mindfulness practice frequency (r = 0.7, p < 0.01). Although limited by small sample size, this pilot study highlights the feasibility and acceptability of integrating MBIs into standard primary care Office-Based Opioid Treatment (OBOT) among a population with substantial trauma history.
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Affiliation(s)
- Thomas Fatkin
- Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Sarah K Moore
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America.
| | - Kayley Okst
- Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Timothy B Creedon
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Farah Samawi
- Cambridge Health Alliance, Cambridge, MA, United States of America.
| | | | - David Roll
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Alexandra Oxnard
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Benjamin Lê Cook
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America.
| | - Zev Schuman-Olivier
- Harvard Medical School, Boston, MA, United States of America; Cambridge Health Alliance, Cambridge, MA, United States of America; Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America.
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12
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Schuman-Olivier Z, Trombka M, Lovas DA, Brewer JA, Vago DR, Gawande R, Dunne JP, Lazar SW, Loucks EB, Fulwiler C. Mindfulness and Behavior Change. Harv Rev Psychiatry 2021; 28:371-394. [PMID: 33156156 PMCID: PMC7647439 DOI: 10.1097/hrp.0000000000000277] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/22/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.
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Zullig KJ, Lander LR, Tuscano M, Garland M, Hobbs GR, Faulkenberry L. Testing Mindfulness-Based Relapse Prevention with Medications for Opioid Use Disorder Among Adults in Outpatient Therapy: a Quasi-experimental Study. Mindfulness (N Y) 2021; 12:3036-3046. [PMID: 34659584 PMCID: PMC8504564 DOI: 10.1007/s12671-021-01763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to explore the effectiveness of mindfulness-based relapse prevention (MBRP) with individuals receiving medication for opioid use disorder (MOUD) in a naturalistic, open-ended outpatient group treatment setting. METHODS Eighty participants (mean age 36.3) who had at least 90 consecutive days substance free self-selected into treatment (MBRP, n = 35) or comparison groups (treatment as usual, TAU, n = 45). Outcomes tracked included treatment retention and relapse, and self-reported craving, anxiety, depression, and mindfulness at baseline, 12 weeks, 24 weeks, and 36 weeks post-recruitment. MBRP group participants attended biweekly 60-min sessions for 24 weeks. A linear mixed model analysis of variance determined the significance of the MBRP intervention on changes in craving, anxiety, depression, and mindfulness. RESULTS No significant differences in sex, education level, insurance status, relationship status, or employment status were detected at baseline between groups. The 36-week retention (74%, MBRP/MOUD; 71%, TAU/MOUD) and relapse rates (43%, MBRP/MOUD; 47%, TAU/MOUD) were similar for the groups. There were only four relapses on opioids. Significant reductions (p < .05) were observed in the MBRP/MOUD group for craving, anxiety, and depression in addition to significant increases in mindfulness compared to those in TAU/MOUD. CONCLUSIONS Although state and federal resources are available to expand MOUD, no standard of behavioral therapy has been established as most complimentary to MOUD. The current study results suggest MBRP can be implemented as an outpatient therapy for individuals in MOUD.
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Affiliation(s)
- Keith J. Zullig
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, WV USA
| | - Laura R. Lander
- Department of Behavioral Medicine and Psychiatry and Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, USA
| | - Meghan Tuscano
- West Virginia University Research Corporation, Morgantown, USA
| | - Megan Garland
- Department of Occupational and Environmental Health Sciences, West Virginia University School of Public Health, Morgantown, USA
| | - Gerry R. Hobbs
- Department of Statistics, West Virginia University, Morgantown, USA
| | - Laurel Faulkenberry
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, USA
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Stieger M, Allemand M, Roberts BW, Davis JP. Mindful of personality trait change: Are treatment effects on personality trait change ephemeral and attributable to changes in states? J Pers 2021; 90:375-392. [PMID: 34486730 DOI: 10.1111/jopy.12672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Are treatment effects on personality trait change ephemeral and attributable to change in clinical states? Data of an intervention study were used to examine if change in clinical states (e.g., stress or depression) accounts for change in personality traits and to test whether both changes in traits and clinical states were independently associated with substance use. METHOD Seventy-nine substance use patients (Mage = 25.3, SD = 2.7; 35% female) took part at a 4-week intervention and completed a total of 15 bi-monthly assessments across 28 weeks to measure change in traits and states during and after treatment. RESULTS The results suggest that participants showed large trait and state changes over time, which happened rapidly with the majority occurring during the first four weeks. Trait and state changes were highly correlated, but not perfectly redundant. Significant variance in personality trait change remained after controlling for change in clinical states. Moreover, both trait and state change independently predicted substance use. CONCLUSION Personality trait change occurred relatively fast and was maintained until the last follow-up assessment six months after the end of the intervention. Also, the findings point to the notion that the conceptual distinction between traits and states may not be as important as originally thought.
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Affiliation(s)
- Mirjam Stieger
- Department of Psychology, Brandeis University, 415 South Street, Waltham, Massachusetts, 02453, USA
| | - Mathias Allemand
- Department of Psychology and University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Andreasstrasse 50, Zürich, 8050, Switzerland
| | - Brent W Roberts
- Department of Psychology, University of Illinois, Urbana-Champaign, 603 E. Daniel Street M/C 716, Champaign, Illinois, IL 61820, USA.,Hector-Institut für Empirische Bildungsforschung, University of Tübingen, Geschwister-Scholl-Platz, Tübingen, 72074, Germany
| | - Jordan P Davis
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 West 34th St., Los Angeles, California, CA 90089, USA
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Wu TY, Nien JT, Kuan G, Wu CH, Chang YC, Chen HC, Chang YK. The Effects of Mindfulness-Based Intervention on Shooting Performance and Cognitive Functions in Archers. Front Psychol 2021; 12:661961. [PMID: 34248757 PMCID: PMC8268485 DOI: 10.3389/fpsyg.2021.661961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/31/2021] [Indexed: 12/02/2022] Open
Abstract
This study investigated the effects of a mindfulness-based intervention (MBI) called mindfulness-based peak performance (MBPP) on athletic performance and cognitive functions in archers, as well as the role of psychological status and the dose-response relationship of MBPP in archery performance. Twenty-three archers completed a simulated archery competition and the Stroop task prior to and after MBPP training, which consisted of eight sessions over four weeks, while the mindfulness and rumination levels of the archers were assessed at three time points, namely, before, at the mid-point of, and after the MBPP program. The results revealed that the MBPP program significantly improved the shooting performance (p = 0.002, d = 0.27), multiple cognitive functions (ps < 0.001, d = 0.51~0.71), and mindfulness levels of the archers on the post-test, compared to the pre-test (p = 0.032, ηp2 = 0.15 for general; p = 0.004, ηp2 = 0.22 for athletic). Additionally, negative ruminations level was decreased from the pre-test to the middle-test and post-test (ps < 0.001, ηp2 = 0.43). These findings provide preliminary evidence to support the view that MBPP could serve as a promising form of training for fine motor sport performance, cognitive functions, and specific psychological status, such that it warrants further study.
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Affiliation(s)
- Tsung-Yi Wu
- Department of Combat Sport, National Taiwan University of Sport, Taichung, Taiwan
| | - Jui-Ti Nien
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Garry Kuan
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Chih-Han Wu
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Yi-Chieh Chang
- Physical Education Center, Chung Shan Medical University, Taichung, Taiwan
| | - Hsueh-Chih Chen
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei, Taiwan.,Institute for Research Excellence in Learning Science, National Taiwan Normal University, Taipei, Taiwan
| | - Yu-Kai Chang
- Institute for Research Excellence in Learning Science, National Taiwan Normal University, Taipei, Taiwan.,Department of Physical Education, National Taiwan Normal University, Taipei, Taiwan
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Watson-Singleton NN, Pennefather J, Trusty T. Can a culturally-responsive Mobile health (mHealth) application reduce African Americans’ stress?: A pilot feasibility study. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01534-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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17
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Polak K, Meyer BL, Neale ZE, Reisweber J. Program Evaluation of Group Transcending Self Therapy: An Integrative Modular Cognitive-Behavioral Therapy for Substance Use Disorders. Subst Abuse 2020; 14:1178221820947653. [PMID: 32874092 PMCID: PMC7436794 DOI: 10.1177/1178221820947653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/03/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Substance Use Disorders (SUDs) are increasingly prevalent among Veterans. Effective interventions for SUDs that also meet the clinical reality of open treatment groups are needed. Transcending Self Therapy: Group Integrative Cognitive Behavioral Treatment (Group TST-I-CBT) was developed to address this need. Group TST-I-CBT is a four-module, 20-session treatment designed so that a person can enter at any point in the treatment. We conducted a program evaluation of Group TST-I-CBT for veterans with SUDs. METHODS Participants were N = 68 veterans enrolled in the 28-day Substance Abuse Residential Rehabilitation Treatment Program at an urban Veterans Administration Medical Center who received either Group TST-I-CBT (N = 34) or treatment-as-usual (TAU; N = 34). Medical records were reviewed and participant treatment outcome data was retrieved. Group TST-I-CBT clients completed a knowledge and feedback form at treatment completion. RESULTS Compared to TAU participants, Group TST-I-CBT participants were significantly less likely to have a positive urine drug screen (UDS) during treatment (17.6% versus 0%; P = .01) and within one month post-discharge (50% versus 17.6%; P = .04). Among Group TST-I-CBT clients, Quality of Life Inventory scores significantly increased by an average of 14 points from pre- to post-treatment, t(15) = -3.31, P = .005, d = 0.83. Group TST-I-CBT clients displayed cognitive-behavioral therapy knowledge (mean correct answers ranged from 92%-100%) and rated Group TST-I-CBT as helpful, understandable, and useful (mean scores ranged from 9.3-9.6 out of 10). CONCLUSIONS These preliminary data indicate that Group TST-I-CBT may be an effective group therapy as part of SUD treatment. A formal randomized controlled trial of Group TST-I-CBT may be warranted.
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Affiliation(s)
- Kathryn Polak
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Brian L Meyer
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Zoe E Neale
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jarrod Reisweber
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, VA, USA
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McCrady BS, Witkiewitz K, Venner KL, Fokas K. Education and Training in Substance Use Disorders and Addictions: The University of New Mexico Integrated Training Model. TRAINING AND EDUCATION IN PROFESSIONAL PSYCHOLOGY 2020; 14:60-69. [PMID: 33767800 PMCID: PMC7989818 DOI: 10.1037/tep0000287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper describes SUD/addictions training at the University of New Mexico. Coordinated and integrated academic, research, and clinical training resources are described, with an emphasis on the integration of resources across multiple training domains. Academic training resources in the Psychology Department include core clinical courses, basic science courses, and opportunities for students to develop expertise in health or quantitative psychology. Other academic resources come from affiliated departments and colleges such as Sociology, the College of Population Health, the College of Education, and Health Sciences. Research training resources are available within the Psychology Department, affiliated Departments and Colleges, and specialized research centers including the Center on Alcoholism, Substance Abuse, and Addictions, and the Mind Research Network. A network of community partners provides additional research sites. Clinical training resources are provided through a specialized alcohol treatment clinic and a diversity clinic within the Department, opportunities for students to serve as research clinicians, and community practicum sites supervised by on-site doctoral level psychologists or Departmental faculty. The UNM training program provides one model for graduate training in SUD/addictions. Keys to the program are the presence of multiple SUD/addictions clinical faculty member with active research programs, willingness to mentor students in research and clinical work, and basic science faculty whose research is relevant to addictive behaviors. Other critical elements include systematic development of clinical training opportunities, effective collaborations with community agencies for research and clinical training, meaningful research partnerships with other academic departments and specialized research centers, and external funding for training activities.
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Affiliation(s)
- Barbara S McCrady
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico
| | - Kamilla L Venner
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico
| | - Kathryn Fokas
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico
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Brown DR, Jackson TCJ, Claus ED, Votaw VR, Stein ER, Robinson CSH, Wilson AD, Brandt E, Fratzke V, Clark VP, Witkiewitz K. Decreases in the Late Positive Potential to Alcohol Images Among Alcohol Treatment Seekers Following Mindfulness-Based Relapse Prevention. Alcohol Alcohol 2019; 55:78-85. [DOI: 10.1093/alcalc/agz096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/26/2019] [Accepted: 10/24/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract
Aim
Heightened craving among individuals with alcohol use disorder (AUD) has been attributed to a hypersensitivity to alcohol cues in attentional brain networks. Active mindfulness training has been shown to help improve attentional control. Here, we examined alcohol cue-related hypersensitivity among individuals with AUD who received rolling group mindfulness-based relapse prevention (MBRP) in combination with transcranial direct current stimulation (tDCS), over right inferior frontal gyrus.
Methods
Participants (n = 68) viewed a series of emotionally negative, emotionally neutral and alcohol-related images. Following image presentation, participants were asked to rate their level of craving for the alcohol cues, and their level of negative affect evoked by neutral and negative cues. During the task, electroencephalogram (EEG) was recorded to capture an event-related component shown to relate to emotionally salient stimuli: the late positive potential (LPP). Participants who completed a follow-up EEG (n = 37) performed the task a second time after up to eight sessions of MBRP coupled with active or sham tDCS.
Results
We found that both craving ratings and the LPP significantly decreased in response to alcohol cues from pre- to post-treatment, but not for other image cues. The magnitude of alcohol image craving reductions was associated with the number of MBRP group sessions attended. Active tDCS was not associated with craving ratings, but it was associated with greater LPP amplitudes across image types.
Conclusions
Taken together, these results suggest that disruption of alcohol-cue hypersensitivity in people with AUD may be a target mechanism of MBRP.
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Affiliation(s)
- Darin R Brown
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Trevor C J Jackson
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Eric D Claus
- Department of Translational Neuroscience, Mind Research Network of the Lovelace Biomedical Research Institute, 1101 Yale Blvd NE, Albuquerque, NM 87106, USA
| | - Victoria R Votaw
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Elena R Stein
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Charles S H Robinson
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Adam D Wilson
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Emma Brandt
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Violet Fratzke
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Vincent P Clark
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
- Department of Translational Neuroscience, Mind Research Network of the Lovelace Biomedical Research Institute, 1101 Yale Blvd NE, Albuquerque, NM 87106, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
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de Andrade D, Elphinston RA, Quinn C, Allan J, Hides L. The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review. Drug Alcohol Depend 2019; 201:227-235. [PMID: 31254749 DOI: 10.1016/j.drugalcdep.2019.03.031] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/18/2019] [Accepted: 03/27/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Residential treatment is a standard treatment for individuals with severe and complex substance use problems. However, there is limited evidence on best practice approaches to treatment in these settings. This review provides a comprehensive update on the evidence base for residential treatment, and directions for future research and clinical practice. METHOD A systematic review of all studies published between January 2013 and December 2018 was conducted. Public health and psychology databases (Medline, CINAHL, PsycARTICLES and PsycINFO) were systematically searched, and forward and backward snowballing were used to identify additional studies. Studies were included if they were quantitative, assessed the effectiveness of residential substance treatment programs for adults, were published in the English language and in peer-reviewed journals. The Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies was used to assess methodological quality. RESULTS Our search identified 23 studies. Eight were rated as methodologically strong, five as moderate and ten rated as weak. Quality ratings were impacted by attrition at follow-up and research design. Despite limitations, results provide moderate quality evidence for the effectiveness of residential treatment in improving outcomes across a number of substance use and life domains. CONCLUSION With caution, results suggest that best practice rehabilitation treatment integrates mental health treatment and provides continuity of care post-discharge. Future research and practice should focus on better collection of outcome data and conducting data linkage of key health, welfare and justice agency administrative data to enhance understanding of risk and recovery trajectories.
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Affiliation(s)
- Dominique de Andrade
- School of Psychology, Lives Lived Well Research Group, The University of Queensland, St. Lucia Campus, Sir Fred Schonell Drive, St. Lucia, 4067, Queensland, Australia.
| | - Rachel A Elphinston
- School of Psychology, Lives Lived Well Research Group, The University of Queensland, St. Lucia Campus, Sir Fred Schonell Drive, St. Lucia, 4067, Queensland, Australia
| | - Catherine Quinn
- School of Psychology, Lives Lived Well Research Group, The University of Queensland, St. Lucia Campus, Sir Fred Schonell Drive, St. Lucia, 4067, Queensland, Australia
| | - Julaine Allan
- School of Psychology, Lives Lived Well Research Group, The University of Queensland, St. Lucia Campus, Sir Fred Schonell Drive, St. Lucia, 4067, Queensland, Australia; Lives Lived Well, Level 1/55 Little Edward St, Spring Hill, 4000, Queensland, Australia
| | - Leanne Hides
- School of Psychology, Lives Lived Well Research Group, The University of Queensland, St. Lucia Campus, Sir Fred Schonell Drive, St. Lucia, 4067, Queensland, Australia
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McClintock AS, Goldberg SB, Coe CL, Zgierska AE. Mindfulness practice predicts interleukin-6 responses to a mindfulness-based alcohol relapse prevention intervention. J Subst Abuse Treat 2019; 105:57-63. [PMID: 31443893 DOI: 10.1016/j.jsat.2019.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/27/2019] [Accepted: 07/26/2019] [Indexed: 01/23/2023]
Abstract
Chronic alcohol misuse can result in chronically elevated interleukin (IL)-6, a pro-inflammatory cytokine, in the bloodstream. Given that Mindfulness-Based Relapse Prevention (MBRP) has been shown to reduce alcohol misuse, MBRP might also be effective in reducing IL-6 concentrations. Past research has found, however, that IL-6 does not respond consistently to mindfulness-based interventions. Building on prior studies, we examined whether between-person variability in engagement with mindfulness training (i.e., formal mindfulness practice time) is associated with between-person variability in changes in serum IL-6, using data from a randomized controlled trial evaluating MBRP for Alcohol Dependence (MBRP-A). Participants were 72 alcohol dependent adults (mean age = 43.4 years, 63.9% male, 93.1% White) who received a minimum dose (i.e., at least four sessions) of MBRP-A either at the start of the trial (n = 46) or after a 26-week delay (n = 26). IL-6 concentrations did not significantly change from pre- to post-intervention for the full sample. Nevertheless, greater mindfulness practice time was significantly associated with reduced IL-6 levels (r = -0.27). The association between practice time and IL-6 changes remained significant when controlling for intervention timing (i.e., immediate or after the 26-week delay), demographic characteristics, and changes in mindful awareness, obsessive-compulsive drinking, and depressive symptoms. The association between practice time and IL-6 changes was not significant when omitting the minimum treatment dose requirement. Overall, results suggest that the level of engagement in mindfulness training may predict changes in the inflammatory pathophysiology in adults with alcohol dependence.
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Affiliation(s)
- Andrew S McClintock
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, United States of America.
| | - Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, United States of America
| | - Christopher L Coe
- Department of Psychology, University of Wisconsin-Madison, United States of America
| | - Aleksandra E Zgierska
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, United States of America
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Effect of Mindfulness-Based Relapse Prevention on Impulsivity Trajectories Among Young Adults in Residential Substance Use Disorder Treatment. Mindfulness (N Y) 2019; 10:1997-2009. [PMID: 32595783 DOI: 10.1007/s12671-019-01164-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives Impulsivity has been identified as an important construct in predicting the initiation and maintenance of substance use among at-risk populations. Interventions emphasizing mindfulness strategies appear particularly promising in reducing substance use and marking change in various aspects of impulsivity. Methods The current study used a rolling group mindfulness-based relapse prevention (MBRP) intervention for young adults in residential substance use disorder treatment. We examined change in impulsivity facets measured by the S-UPPS for youth randomly assigned to MBRP (n = 45) versus those assigned to treatment as usual plus 12 step/self-help (n = 34). We also examined how change in impulsivity mediated changes in substance use post-treatment. Results In general, results indicated that MBRP is effective at reducing facets of trait impulsivity in treatment-seeking individuals with SUDs. Only positive and negative urgency mediated the relation between treatment assignment and substance use. Conclusions MBRP is a viable and useful intervention for young adults in residential treatment for substance use disorders and can aid in marked change in facets of impulsivity. Both positive and negative urgency were significant mechanisms of change in reducing substance use following treatment. Results are discussed focused on the utility of MRBP as a clinical intervention for at-risk, marginalized, and young adults.
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Mindfulness-based interventions for addictions among diverse and underserved populations. Curr Opin Psychol 2019; 30:11-16. [PMID: 30682663 DOI: 10.1016/j.copsyc.2018.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 01/01/2023]
Abstract
Mindfulness-based interventions (MBIs) show strong promise for treating addictions, but there is much work to be done to ensure that they are culturally appropriate, accessible, and optimally effective for priority populations who could potentially have the most to gain. This article briefly highlights research on MBIs for addictions among diverse and underserved populations and proposes next steps for increasing their potential to target addiction-related health disparities. Future directions include: 1) Prioritize diversity in clinical trials and conduct appropriately powered moderation analyses; 2) Consider treatment adaptations; 3) Examine underlying mechanisms to optimize MBIs for specific populations; 4) Improve implementation in community-based and other appropriate settings; and 5) Consider use of technology to provide just-in-time support and increase scalability for diverse populations.
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