Adherence to a Mindfulness Intervention Assists in Preventing Alcoholism Relapse
By John M. de Castro, Ph.D.
“Thoughts and feelings, including urges to use substances or activities, are always temporary. Through mindfulness and its related practices (including meditation) it is possible to learn how to face uncomfortable, painful thoughts, feelings, and physical sensations, and let them pass—without obsessing on or avoiding them.” – Dan Mager
Inappropriate use of alcohol is a major societal problem. In fact, about 25% of US adults have engaged in binge drinking in the last month and 7% have what is termed an alcohol use disorder. Alcohol abuse is very dangerous and frequently fatal. Nearly 88,000 people in the US and 3.3 million globally die from alcohol-related causes annually, making it the third leading preventable cause of death in the United States. Drunk driving accounted for over 10,000 deaths; 31% of all driving fatalities. Excessive alcohol intake has been shown to contribute to over 200 diseases including alcohol dependence, liver cirrhosis, cancers, and injuries. It is estimated that over 5% of the burden of disease and injury worldwide is attributable to alcohol consumption.
Obviously, there is a need to find effective methods to prevent and treat alcohol abuse. There are a number of programs that are successful at stopping the abuse, including the classic 12-step program emblematic of Alcoholics Anonymous. Unfortunately, the majority of alcohol abusers relapse and return to drinking. Hence, it is important to find an effective method to both treat alcohol abuse and to prevent relapse. Mindfulness practices have been shown to improve recovery from various addictions and reduce relapse. Mindfulness training has been successfully applied to treating alcohol abuse. It appears to increase the ability of the drinker to control alcohol intake. Since, mindfulness appears to hold promise as a treatment for excessive alcohol intake, there is a need to examine the ability of mindfulness training to reduce relapse after successful cessation.
In today’s Research News article “Mindfulness-based relapse prevention for alcohol dependence: Findings from a randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508889/), Zgierska and colleagues recruited alcohol dependent adults who were in early recovery in an alcohol treatment program. They were randomly assigned to either continue to receive their current treatment or to receive an 8 weekly 2-hour Mindfulness-Based Relapse Prevention (MBRP) program with home practice tailored for alcohol abuse. They were measured before and after treatment and a year later for alcohol consumption, drinking-related consequences, mindfulness, and perceived stress.
They reported that over the one-year follow-up period there were no significant differences between the treatment as usual or the Mindfulness-Based Relapse Prevention (MBRP) participants on any of the outcome measures. But, for the MBRP participants who attended at least 4 sessions, the greater the number of sessions attended, and the greater the amount of home practice the lower the percentage of drinking days and the fewer the heavy drinking days during the 1-year follow-up.
The results of the present study are surprising as prior research has consistently demonstrated that mindfulness training improves relapse prevention. The present findings may have been due to a ceiling effect. The participants in both groups were committed to stopping drinking and already had up to 14 days of sobriety prior to entry into the study. This was reflected in that 60% of the participants in both groups were abstinent at the 1-year follow-up. This is an exceptionally high success rate for alcohol relapse prevention. So, the treatment as usual group may have been so successful that it left little room for the Mindfulness-Based Relapse Prevention (MBRP) participants to show any further improvement.
The results of the present study indicate that participation in the program and adherence to the program requirements are exceptionally important. After taking out those non-adherent participants there was a positive relationship between adherence and relapse prevention.
So, adherence to a mindfulness intervention assists in preventing alcoholism relapse.
“We need to consider many different approaches to addiction treatment. It’s a tough problem,” Mindfulness therapy is “another possibility for people to explore,” – Sarah Bowen
CMCS – Center for Mindfulness and Contemplative Studies
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Zgierska, A. E., Burzinski, C. A., Mundt, M. P., McClintock, A. S., Cox, J., Coe, C. L., Miller, M. M., & Fleming, M. F. (2019). Mindfulness-based relapse prevention for alcohol dependence: Findings from a randomized controlled trial. Journal of substance abuse treatment, 100, 8–17. https://doi.org/10.1016/j.jsat.2019.01.013
MBRP-A plus usual care and usual care alone resulted in similar health benefits.
Addition of MBRP-A to usual care did not further improve drinking-related outcomes.
Greater MBRP-A intervention adherence was associated with better outcomes.
To assess the effects of mindfulness-based relapse prevention for alcohol dependence (MBRP-A) intervention on drinking and related consequences.
123 alcohol-dependent adults in early recovery, recruited from outpatient treatment programs, were randomly assigned to MBRP-A (intervention plus usual-care; N=64) or Control (usual-care-alone; N=59) group. MBRP-A consisted of eight-weekly sessions and home practice. Outcomes were assessed at baseline, 8 weeks and 26 weeks (18 weeks post-intervention), and compared between groups using repeated measures analysis.
Outcome analysis included 112 participants (57 MBRP-A; 55 Control) who provided follow-up data. Participants were 41.0±12.2 years old, 56.2% male, and 91% white. Prior to “quit date,” they reported drinking on 59.4±34.8% (averaging 6.1±5.0 drinks/day) and heavy drinking (HD) on 50.4±35.5% of days. Their drinking reduced after the “quit date” (before enrollment) to 0.4±1.7% (HD: 0.1±0.7%) of days. At 26 weeks, the MBRP-A and control groups reported any drinking on 11.5±22.5% and 5.9±11.6% of days and HD on 4.5±9.3% and 3.2±8.7% of days, respectively, without between-group differences (ps≥0.05) in drinking or related consequences during the follow-up period. Three MBRP-A participants reported “relapse,” defined as three-consecutive HD days, during the study. Subgroup analysis indicated that greater adherence to session attendance and weekly home practice minutes were associated with improved outcomes.
MBRP-A as an adjunct to usual-care did not show to improve outcomes in alcohol-dependent adults in early recovery compared to usual-care-alone; a return to drinking and relapse to HD were rare in both groups. However, greater adherence to MBRP-A intervention may improve long-term drinking-related outcomes.