Effect of Mindfulness-Based Relapse Prevention on Impulsivity Trajectories Among Young Adults in Residential Substance Use Disorder Treatment

Substance Use Motives as Mediators of the Associations between Self-Control Constructs and Negative Substance Use Consequences: A Cross-Cultural Examination

The present study sought to examine three distinct research questions: a) are self-control constructs (i.e., negative/positive urgency, self-regulation, and emotion-regulation) indirectly related to negative alcohol/marijuana consequences via substance use motives, b) to what extent are these indirect effects consistent across differing drugs (i.e., alcohol and marijuana), and c) are these models invariant across gender and countries. Participants were 2,230 college students (mean age=20.28, SD=0.40; 71.1% females) across 7 countries (USA, Canada, Spain, England, Argentina, Uruguay, and South Africa) who consumed alcohol and marijuana in the last month. Two (one for alcohol and one for marijuana) fully saturated path models were conducted, such that indirect paths were examined for each self-control construct and substance use motive on negative consequences (e.g., negative urgency → coping motives → negative consequences) within the same model. Within the comprehensive alcohol model, we found that lower self-regulation and higher negative urgency/suppression were related to more alcohol consequences via higher coping and conformity motives. For marijuana, we found that lower self-regulation and higher negative urgency/suppression were related to more marijuana consequences via higher coping motives (not significant for conformity motives). Unique to marijuana, we did find support for higher expansion motives indirectly linking positive urgency to more negative consequences. These results were invariant across gender groups and only minor differences across countries emerged. Prevention and intervention programs of alcohol and marijuana around university campuses may benefit from targeting self-control related skills in addition to motives to drug use to prevent and reduce negative drug-related consequences.

Does Childhood Trauma Predict Impulsive Spending in Later Life? An Analysis of the Mediating Roles of Impulsivity and Emotion Regulation

We sought to investigate whether adverse childhood experiences increase impulsive spending in later life, and whether emotion dysregulation and impulsivity mediate this association. Limited research has examined associations between these factors, and examining the mechanisms involved may inform interventions for impulsive spending. This study used a cross-sectional, correlational design including 189 adult participants who completed an online survey assessing childhood trauma, adverse childhood experiences, impulsive spending, impulsivity, and emotion dysregulation. Greater adverse childhood experiences and childhood trauma were positively correlated with impulsive spending, as well as general impulsivity and emotion dysregulation. Mediation analyses indicated that emotion dysregulation and greater impulsivity accounted for the positive relationship between childhood trauma and impulse spending. Adverse childhood experiences and childhood trauma are associated with increased risk of impulse spending in adulthood via elevated general impulsivity and emotion dysregulation.

Brain changes following mindfulness: Reduced caudate volume is associated with decreased positive urgency

Mindfulness training has been shown to improve psychological health and general well-being. However, it is unclear which brain and personality systems may be affected by this practice for improving adaptive behavior and quality of life. The present study explores the effects of a 5-week mindfulness-based intervention (MBI) at the neuroanatomical level and its relationship with dispositional mindfulness and impulsivity. Sixty-six risky drivers were quasi-randomly assigned to a mindfulness training group (MT) or a control group (N). Participants underwent magnetic resonance imaging and completed the Five Facet Mindfulness Questionnaire (FFMQ) and the UPPS-P impulsivity scale twice, at baseline and after receiving the MBI. We observed that MBI changes dispositional mindfulness in the non-reactivity and observing facets. Further, we observed that the magnitude of change in impulsivity was associated with the change in dispositional mindfulness. Whole-brain voxel-wise analysis revealed that the volume of the right caudate nucleus of the MT group (n = 27) showed a reduction compared to that of the control group (n = 33), which increased in terms of the pre-post measurement (MT=-1.76 mm3; N = 6.31 mm3). We also observed that reduced caudate nucleus volume correlated with decreased positive urgency in the MT group. Taken together, our results show that MBI improves the skills of observing and non-reactivity to inner experience, while producing changes in the structure of the caudate nucleus. These structural changes are associated with a reduction in impulsivity levels, decreasing the tendency to act rashly in situations that generate positive emotions and thus facilitating more adaptive behavior.

Psychosocial Correlates of Motivation for Abstinence Among People Who Used Drugs After Community Rehabilitation Treatment in China: A Structural Equation Modelling

Background

Enhancing abstinence motivation of drugs is an effective strategy for the rehabilitation of people who used drugs and prevention of drug use relapse. However, little is known about its risk and protective factors. This study aimed to examine the potential intrapersonal (ie, impulsivity, depression, anxiety, sleep quality) and interpersonal factors (ie, perceived social support) of abstinence motivation among people who completed the community rehabilitation treatment.

Methods

A total of 222 participants (mean age = 43; male = 89.2%) were recruited from eleven communities located in Wenzhou, China. Data were collected using a self-reported questionnaire in counselling room settings between April and June 2021.

Results

The proportions of participants with depression, anxiety, and poor sleep quality were 38.8%, 19.5%, and 21.2%, respectively. Age and family history of physical disease were significant background factors of abstinence motivation. Impulsivity, depressive symptoms, anxiety symptoms, and poor quality of sleep were negatively associated with abstinence motivation. Perceived social support from family and important others was positively associated with abstinence motivation. Structural equation modeling fitted the data well in which impulsivity and perceived social support were both associated with abstinence motivation indirectly through mental health problems.

Conclusion

The identified psychosocial factors should be addressed in community rehabilitation treatment and follow-up service to enhance abstinence motivation and the long-term effectiveness of the treatment.

The effect of mindfulness on decision-making, inhibitory control, and impulsivity of substance use disorder in-treatment patients: A randomized clinical trial

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.

Mindfulness-based interventions in inpatient treatment for Substance Use Disorders: A systematic review

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.

An examination of the acquired preparedness model among college student marijuana users

ObjectiveTo examine the Acquired Preparedness Model using a behavioral impulsivity facet and positive marijuana expectancies to examine direct and indirect effects on marijuana use and related problems. Participants: 250 college students (61.7% female, 54% white) recruited from a southeastern university. Methods: Participants completed an online survey of delay reward discounting, marijuana expectancies, consideration of future consequences, and marijuana-related outcomes. Results: Delay reward discounting and consideration of future consequences related to marijuana-related problems, but not marijuana use. However, positive marijuana expectancies did not mediate the relation between impulsivity and marijuana outcomes. Conclusions: These results emphasize delay reward discounting and consideration of future consequences as important factors associated with marijuana-related problems. Interventions aimed at decreasing delay reward discounting and augmenting future orientation may be effective in college students who report light to moderate marijuana use. Future studies would benefit from longitudinal study designs using multiple impulsivity measures among light and heavy users.

Trauma-Integrated Mindfulness-Based Relapse Prevention for Women with Comorbid Post-Traumatic Stress Disorder and Substance Use Disorder: A Cluster Randomized Controlled Feasibility and Acceptability Trial

Background: Comorbid post-traumatic stress disorder and substance use disorder (PTSD-SUD) among women receiving substance use treatment are common. Few evidence-based interventions target PTSD-SUD, however, fewer are gender responsive. Mindfulness-based relapse prevention (MBRP) has shown effectiveness for women with SUD, although it does not explicitly target PTSD. Integration of trauma-focused and gender-responsive treatments into MBRP may address the limited availability of PTSD-SUD interventions for women. This study assessed feasibility and acceptability of trauma-integrated MBRP (TI-MBRP). Methods: A single-blind computer-generated cluster-randomized design was employed in which women with PTSD-SUD (N = 83) received either TI-MBRP (k = 5) or MBRP (k = 5). Measures of PTSD symptom severity and craving were administered at pre-, post-, 1-, 3-, 6-, 9-, and 12-month follow-up and assessed at the individual level. Results: TI-MBRP demonstrated acceptability among participants; however, attrition was high (64%) at 12-month follow-up. Reductions in PTSD were greater in the MBRP than in the TI-MBRP group at postcourse and 1-month follow-up, and there were significant reductions in PTSD severity and craving over the 12-month period in both conditions. Conclusions: Integrating trauma- and gender-focused interventions into MBRP was feasible and acceptable. MBRP alone may be effective in reducing both PTSD and SUD symptoms in women with PTSD-SUD; however, confirmatory studies are warranted. Clinical Trial Registration Number: NCT03505749.

Short mindfulness-based intervention for psychological and academic outcomes among university students

This study aimed to evaluate the effectiveness of a short mindfulness intervention on anxiety, stress and depression symptoms, as well as on inhibition of dominant responses and academic performance among university students. Fifty volunteers (M(age) = 23.8; SD = 5.3) with high levels of depression, anxiety or stress were randomly allocated to a mindfulness practice group or an active control group (listening to stories). Students who underwent the mindfulness practice had decreased levels of anxiety, stress and depression compared to the control group. The mindfulness program also had a beneficial impact on the students' academic performance. There was no change in the ability to inhibit dominant responses to neutral stimuli (letters); however, we observed a change in responses to neutral faces. Further research perspectives and the clinical implications of the study are discussed.

Mindfulness-based interventions for substance use disorders

BACKGROUND

Substance use disorders (SUDs) are highly prevalent and associated with a substantial public health burden. Although evidence-based interventions exist for treating SUDs, many individuals remain symptomatic despite treatment, and relapse is common.Mindfulness-based interventions (MBIs) have been examined for the treatment of SUDs, but available evidence is mixed.

OBJECTIVES

To determine the effects of MBIs for SUDs in terms of substance use outcomes, craving and adverse events compared to standard care, further psychotherapeutic, psychosocial or pharmacological interventions, or instructions, waiting list and no treatment.

SEARCH METHODS

We searched the following databases up to April 2021: Cochrane Drugs and Alcohol Specialised Register, CENTRAL, PubMed, Embase, Web of Science, CINAHL and PsycINFO. We searched two trial registries and checked the reference lists of included studies for relevant randomized controlled trials (RCTs).

SELECTION CRITERIA

RCTs testing a MBI versus no treatment or another treatment in individuals with SUDs. SUDs included alcohol and/or drug use disorders but excluded tobacco use disorders. MBIs were defined as interventions including training in mindfulness meditation with repeated meditation practice. Studies in which SUDs were formally diagnosed as well as those merely demonstrating elevated SUD risk were eligible.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

Forty RCTs met our inclusion criteria, with 35 RCTs involving 2825 participants eligible for meta-analysis. All studies were at high risk of performance bias and most were at high risk of detection bias. Mindfulness-based interventions (MBIs) versus no treatment Twenty-four RCTs included a comparison between MBI and no treatment. The evidence was uncertain about the effects of MBIs relative to no treatment on all primary outcomes: continuous abstinence rate (post: risk ratio (RR) = 0.96, 95% CI 0.44 to 2.14, 1 RCT, 112 participants; follow-up: RR = 1.04, 95% CI 0.54 to 2.01, 1 RCT, 112 participants); percentage of days with substance use (post-treatment: standardized mean difference (SMD) = 0.05, 95% CI -0.37 to 0.47, 4 RCTs, 248 participants; follow-up: SMD = 0.21, 95% CI -0.12 to 0.54, 3 RCTs, 167 participants); and consumed amount (post-treatment: SMD = 0.10, 95% CI -0.31 to 0.52, 3 RCTs, 221 participants; follow-up: SMD = 0.33, 95% CI 0.00 to 0.66, 2 RCTs, 142 participants). Evidence was uncertain for craving intensity and serious adverse events. Analysis of treatment acceptability indicated MBIs result in little to no increase in study attrition relative to no treatment (RR = 1.04, 95% CI 0.77 to 1.40, 21 RCTs, 1087 participants). Certainty of evidence for all other outcomes was very low due to imprecision, risk of bias, and/or inconsistency. Data were unavailable to evaluate adverse events. Mindfulness-based interventions (MBIs) versus other treatments (standard of care, cognitive behavioral therapy, psychoeducation, support group, physical exercise, medication) Nineteen RCTs included a comparison between MBI and another treatment. The evidence was very uncertain about the effects of MBIs relative to other treatments on continuous abstinence rate at post-treatment (RR = 0.80, 95% CI 0.45 to 1.44, 1 RCT, 286 participants) and follow-up (RR = 0.57, 95% CI 0.28 to 1.16, 1 RCT, 286 participants), and on consumed amount at post-treatment (SMD = -0.42, 95% CI -1.23 to 0.39, 1 RCT, 25 participants) due to imprecision and risk of bias. The evidence suggests that MBIs reduce percentage of days with substance use slightly relative to other treatments at post-treatment (SMD = -0.21, 95% CI -0.45 to 0.03, 5 RCTs, 523 participants) and follow-up (SMD = -0.39, 95% CI -0.96 to 0.17, 3 RCTs, 409 participants). The evidence was very uncertain about the effects of MBIs relative to other treatments on craving intensity due to imprecision and inconsistency. Analysis of treatment acceptability indicated MBIs result in little to no increase in attrition relative to other treatments (RR = 1.06, 95% CI 0.89 to 1.26, 14 RCTs, 1531 participants). Data were unavailable to evaluate adverse events.

AUTHORS' CONCLUSIONS

In comparison with no treatment, the evidence is uncertain regarding the impact of MBIs on SUD-related outcomes. MBIs result in little to no higher attrition than no treatment. In comparison with other treatments, MBIs may slightly reduce days with substance use at post-treatment and follow-up (4 to 10 months). The evidence is uncertain regarding the impact of MBIs relative to other treatments on abstinence, consumed substance amount, or craving. MBIs result in little to no higher attrition than other treatments. Few studies reported adverse events.

The Role of Pretreatment Expectancy on Substance Use Outcomes in Women Mandated to Mindfulness-Based Relapse Prevention

Background: More than one-third of justice-involved individuals meet the criteria for substance use disorder (SUD). Many studies show that treatment expectancy predicts longitudinal SUD outcomes; however, results are inconsistent, and the role of treatment expectancy on SUD outcomes for individuals mandated to a mindfulness-based intervention (MBI) is unknown. Mindfulness-based relapse prevention (MBRP) has shown efficacy with justice-involved populations; however, enrollment in MBRP is typically voluntary. The current study assessed whether pretreatment expectancy predicted SUD- and affect-related outcomes in a sample of women (n = 54) mandated to MBRP as part of their residential SUD programming. Method: The authors employed a quasiexperimental design and administered measures at pre-, mid-, and postcourse. Results: Following mandatory participation in MBRP, significant reductions in craving and substance use were observed. However, contrary to hypotheses, higher pretreatment expectancy predicted greater substance dependence at postcourse. Conclusions: Positive treatment expectancy within the context of an MBI was not related to favorable posttreatment outcomes; in fact, it was related to higher postcourse substance dependence. This suggests that MBIs may be suitable for mandated individuals who may not have voluntarily chosen to participate in such an intervention, and thus may have lower expectancy for the treatment. This finding needs to be replicated in a larger sample to warrant a firmer conclusion.

Relevance of the dual systems model for predicting drug/alcohol dependence in early adulthood among previously adjudicated young adults

BACKGROUND

While the dual system model has been found to have utility for predicting drug use, examinations have yet to extend to the clinically relevant issue of drug/alcohol dependence. This study sought to provide better understanding of how the dual systems model constructs (impulse control and sensation-seeking) predicted risk for drug/alcohol dependence in early adulthood among a sample of young adults who were adjudicated for a serious offense as minors.

METHODS

Data from several waves of the Pathways to Desistance data were used in analyses. Logistic regression was used to model covariate effects on drug/alcohol dependence risk.

RESULTS

Findings indicated that lower impulse control predicted increased odds of meeting criteria for drug/alcohol dependence in early adulthood. Sensation-seeking was not a significant predictor of drug/alcohol dependence risk at follow-up.

CONCLUSIONS

Lower impulse control was predictive of drug/alcohol dependence risk. Prevention programming should seek to boost impulse control during adolescence to mitigate this risk and treatment programming should focus on impulse control training in order to treat drug/alcohol dependence in inpatient and outpatient contexts.

Multifaceted impulsivity as a moderator of social anxiety and cannabis use during pregaming

Individuals may drink or use cannabis to cope with social anxiety, and drinking or using cannabis prior to social situations (e.g., pregaming) may be a way to limit the experience of anxiety when entering social settings. However, theoretical and empirical work has reported mixed associations between social anxiety and substance use, specifically alcohol and cannabis. Little work has looked at how other variables, such as impulsivity (a central component to high risk drinking such as pregaming), may shed light onto these mixed findings. College students who reported past year pregaming (n = 363) completed self-report surveys. Supporting prior work, we found that social anxiety was associated with fewer pregaming days, even among those high in sensation seeking. However, those reporting higher social anxiety also reported higher cannabis use during pregaming, specifically among those who reported high sensation seeking and high positive urgency. Results suggest specific facets of impulsivity may affect the association between social anxiety and cannabis use during high risk drinking events.

Mindfulness-based programs for substance use disorders: a systematic review of manualized treatments

BACKGROUND

Substance use disorders are prevalent and returning to substance use (i.e., relapse) following treatment is common, underscoring the need for effective treatments that will help individuals maintain long-term reductions in substance use. Mindfulness-based interventions (MBIs) have been increasingly developed and evaluated for the treatment of substance use disorders. The aim of this article was to update a systematic review conducted by Li et al. in 2017 on the outcomes of randomized control trials of MBIs for substance use disorders. In addition, we provided a session-by-session examination of the most widely used MBI protocols.

METHODS

We conducted a comprehensive literature search of the PubMed, PsycINFO, and Web of Science databases from January of 2016 through April of 2020. Studies were included based on the following criteria: 1) examined the effects of an MBI, 2) employed a randomized controlled trial design with repeated measures, including secondary data analyses of randomized controlled trials, and 3) enrolled participants seeking treatment for substance use disorders.

RESULTS

The search identified 902 publications and 30 studies were eligible for inclusion and data extraction. MBIs appear to be as effective as existing evidence-based treatments for substance use disorders at reducing the frequency and quantity of alcohol and drug use, substance-related problems, craving for substance use, and at increasing the rate of abstinence.

CONCLUSIONS

Future directions include additional large scale randomized controlled trials, investigation of the most suitable settings and protocols, examination of patient populations that may benefit most from MBIs, and dissemination and implementation research.