Mindfulness-Based Relapse Prevention and Intervention for Substance Use Disorder
The Addiction Research Foundation
Brandi McNeely
“Mindfulness” is a term that can be heard echoed throughout recent culture, bringing to
mind different images and definitions for different people. Although ‘mindfulness” may be a
broad and possibly misunderstood term, there have been movements to better integrate practices
into mental health interventions. This movement is notably true within substance use disorder
treatment and intervention. Mindfulness is being integrated into community treatment centers
and group recovery programs for individuals suffering from substance use disorder. One
example of this integration is mindfulness-based relapse prevention (MBRP) (Penberthy et al.
2015).
Mindfulness based relapse prevention was developed at the University of Washington for
individuals struggling with, or in the process of recovering from addictive behaviors. According
to the Mindfulness Based Relapse Prevention for Addictive Behaviors clinicians guide, MBRP is
a combination of mindfulness and cognitive behavioral practices. It aims in helping individuals
gain awareness of habitual thought patterns, habitual reactions and behaviors, and triggers
(Bowen et al. 2010).
For an example of how these strategies are incorporated into recovery programs, Vrana et
al. (2017) integrated mindfulness-based Relapse Prevention into a community-based treatment
program for women suffering from both substance use disorder and pot-traumatic stress disorder.
The study consisted of two groups of randomized participants, with the intervention group
participating in an 8-week MBRP program, with PTSD symptom severity and substance use
outcomes measured at baseline, throughout the intervention, and at 3- and 6-months post
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treatment for both groups. These women were taught mindfulness meditation as a substance use
avoidance strategy, mindfulness techniques for approaching trauma thoughts, and participated in
guided meditation exercises (Vrana et al. 2017).
Incorporating MBRP into an individual’s substance use disorder treatment may allow
them to, “1. Develop awareness of personal triggers and habitual reactions and learn ways to
create a pause in the seemingly automatic process. 2. Change our relationship to discomfort,
learning to recognize challenging emotional and psychical experiences and responding to them in
skillful ways. 3. Foster a nonjudgmental, compassionate approach toward ourselves and our
experiences. 4. Build a lifestyle that supports both mindfulness practice and recovery” (Lucas,
2017). Since MBRP has been seen to help individuals deal with cravings and improve
mindfulness, it is also important to examine the impact these strategies have on community and
group-based recovery programs in order to better understand the influence of this type of
intervention from a mezzo perspective.
Methods
The information for this paper was gathered through an extensive review of the literature
on Mindfulness-Based Relapse Prevention being used on a mezzo level, for community or
group-based recovery programs. Gender and type of substance use was not specific or exclusive
criteria for the literature review. The University of Alabama at Birmingham Library database
was used in order to obtain peer-reviewed, relevant, and recent articles. Various search term
combinations were used in order to achieve a full overview of the available literature. These
terms included “Mindfulness,” “substance abuse treatment,” group therapy,” “MBRP,”
“meditation,” “community SUD treatment,” and “mezzo practice.” Articles were selected and
results were examined in order to evaluate the impact of MBRP on the participant populations.
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Results
According to Russell et al. (2016), mindfulness-based treatment techniques were
integrated into a treatment program for young adult males suffering from substance use disorder.
A within-subject study design was utilized, wherein all participants were able to participate in
the mindfulness-based intervention and a questionnaire was used to compare each individual’s
pre-intervention scores to their post treatment scores. According to the self-assessment
questionnaire, positive treatment outcomes were statistically significant in post-treatment
compared to pre-mindfulness-based treatment. Participant questionnaire answers also showed a
statistically significant improvement in nonjudging and non-reactivity skills, post-treatment
(Russell et al. 2016).
Davis et al. (2019), conducted a study examining the effects of MBRP intervention on
young adults in a substance use disorder treatment facility. Approximately half (n = 45) of the
participants were assigned to the intervention group and the other participants (n = 34) were
assigned to the “treatment as usual” group, wherein they continued 12-step and self-help meeting
related treatment. A 6-month-post treatment assessment was conducted as showed that
individuals in the MBRP intervention group reported significantly improved perceived stress,
craving, and substance use outcomes, compared to the “treatment as usual” group (Davis et al.
2019).
Bowen et al. (2014) performed a study where treatment results were examined 286
individuals who completed SUD treatment at a nonprofit treatment facility, undergoing 8 weekly
groups sessions of MBRP, cognitive- behavioral relapse prevention (RP), or treatment as usual
(TAU). Relapse, heavy drinking, and frequency of substance use was examined at baseline, 3-,
6-, and 12-month follow-up. According to self-report and uranalysis, MBRP significantly
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reduced relapse for drug use and drinking compared to TAU. Further, MBRP was shown to
produce significant reductions in heavy drinking compared to TAU and RP.
Amaro et al. (2014) conducted a study that examined the impact of MBRP in a minority,
low income, population of women in substance abuse treatment. A within subjects, repeated
measures study design was conducted, wherein all participants were able to undergo the MBRP
intervention and self-report data was compared pre-intervention and post-intervention.
According to the self-report data, participant satisfaction for the intervention was high.
Continually, MBRP was associated with reduced alcohol, drug severity, and perceived stress,
within the participant population (Amaro et al. 2014).
Zullig et al. (2018) conducted a study measuring the results of integrating MBRP into
treatment for individuals with opioid use disorder in an outpatient treatment, who are
concurrently using medication-assisted treatment. A within-subjects study design was conducted,
where each participant (n = 32) was able to undergo an 8-week MBRP intervention and their preintervention data was compared to post-intervention. According to post-treatment data,
significant increases in mindfulness were reported and significant decreases in anxiety and
depression were reported in the participant population compared to pre-intervention reports.
Discussion
Sancho et al. (2018) conducted a systematic review of articles examining mindfulnessbased interventions (MBI) for the treatment of substance use disorder and found that
mindfulness-based interventions were shown to be integrated into a large range of treatment
programs, with MBRP being one of the most commonly used interventions. MBI’s were shown
within the literature to reduce dependence and cravings, while improving mood states and
emotional dysregulation among participants. MBRP is a useful intervention for SUD treatment.
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References
Amaro, H., Spear, S., Vallejo, Z., Conron, K. & Black, D. (2014). Feasibility, acceptability, and
preliminary outcomes of a mindfulness-based relapse prevention intervention for culturally diverse, low income
women in substance use disorder treatment. Substance Use and Misuse, 49, 547-559.
Bowen, S., Chawla, N. & Marlatt, G. (2010). Mindfulness-Based Relapse Prevention for Addictive
Behaviors: A Clinician’s Guide. Psychology, Psychiatry, & Social Work, 1-179.
Bowen, S., Witkiewitz, K. & Clifasefi, S. (2014). Relative Efficacy of mindfulness-based relapse
prevention, standard relapse prevention, and treatment as usual for substance use disorders” a randomized
clinical trial. JAMA Psychiatry, 5, 547-556.
Davis, J., Barr, N., Dworkin, E., Dumas, T., Berey., B., Diguiseppi, G. & Cahn, B. (2019). Effect of
mindfulness-based relapse prevention on impulsivity trajectories among young adults in residential substance use
disorder treatment. Mindfulness, 10, 1997-2009.
Lucas, C. (2017). Alcohol Recovery: The Mindful Way. 1-112.
Penberthy, J., Konig, A., Gioia, C., Rodriguez, V., Starr, J., Meese, W., Stoneman, D., Fersting, K.
& Natanya, E. (2015). Mindfulness-Based Relapse Prevention: History, Mechanisms of Action, and Effects.
Mindfulness, (6) 151-158.
Russell, K., Gillis, H. & Heppner, W. (2016). An examination of mindfulness-based experiences
through adventure in substance use disorder treatment for young adult males: a pilot study. Mindfulness, 7, 320-
328.
Sancho, M., Gracia, M., Rodriguez, R., Bague, N., Gonzalez, J., Trujols, J., Sanches, I., Murcia, S.
& Menchon, J. (2018). Mindfulness-based interventions for the treatment of substance and behavioral addictions:
A systematic review. Frontiers in Psychiatry, 9, 1-9.
Vrana, C., Killeen, T., Brant, V., Mastrogiovanni, J & Baker, N. (2017). Rationale, design, and
implementation of a clinical trial of mindfulness-based relapse prevention protocol for the treatment of women
with comorbid post-traumatic stress disorder and substance use disorder. Contemporary Clinical Trials, 61, 108-
115.
Zullig, K., Lander, L., Sloan, S., Brumage, M., Hobbs, G. & Faulkenberry, L. (2018). Mindfulnessbased relapse prevention with individuals receiving medication-assisted outpatient treatment for opioid use
disorder. Mindfulness, 9, 423-429.