Are Mindfulness-Based Interventions Effective for Substance Use Disorders? A Systematic Review of the Evidence

Abstract

Mindfulness-based interventions (MBIs) are increasingly suggested as therapeutic approaches for effecting substance use and misuse (SUM). The aim of this article is to review current evidence on the therapeutic efficacy of MBIs for SUM. A literature search was undertaken using four electronic databases and references of retrieved articles. The search included articles written in English published up to December 2011. Quality of included trials was assessed. In total, 24 studies were included, three of which were based on secondary analyses of previously investigated samples. Current evidence suggests that MBIs can reduce the consumption of several substances including alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates to a significantly greater extent than waitlist controls, non-specific educational support groups, and some specific control groups. Some preliminary evidence also suggests that MBIs are associated with a reduction in craving as well as increased mindfulness. The limited generalizability of the reviewed findings is noted (i.e., small sample size, lack of methodological details, and the lack of consistently replicated findings). More rigorous and larger randomized controlled studies are warranted.

• Keywords mindfulness-based stress reduction
• mindfulness-based cognitive therapy
• dialectical behavioral therapy
• acceptance and commitment therapy
• mindfulness

THE AUTHORS

Alberto Chiesa, MD, is a psychiatrist, psychotherapist, instructor of mindfulness-based stress reduction and mindfulness-based cognitive therapy (MBCT), and a PhD student in clinical psychopharmacology. He is an author of more than 60 peer-reviewed articles, several of which deal with the topic of mindfulness-based interventions. He is also author of the scientific book “Gli interventi basati sulla mindfulness: cosa sono, come agiscono, quando utilizzarli” (English translation: “mindfulness-based interventions: what are they, how do they work, in which conditions they can be used”), and he has recently opened a section within the University of Bologna (Italy), which is aimed at investigating the usefulness of MBCT for the treatment of affective and anxiety disorders.

Alessandro Serretti, MD, PhD, is a psychiatrist. From 1999 to 2006, he was the Director of the Unit of Genetics in Mood Disorders, Department of Psychiatry, IRCCS S. Raffaele Hospital, Milan. From 2006, he is Associate Professor of Psychiatry and Director of the Mood Disorders Unit at the Bologna University, Bologna. He is author of more than 300 scientific papers published in peer-reviewed journals including over 50 systematic reviews and meta-analyses published in leading psychology and psychiatry journals. He recently started a collaboration with Dr. Chiesa aimed at developing thorough cooperation between his experimental and review expertise with the clinical and research expertise of Dr. Chiesa into the field of mindfulness-based interventions.

Notes

1 The reader is referred to Hills's criteria for causation, which were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated. (Hill, A. B. (1965). The environment and disease: associations or causation? Proceedings of the Royal Society of Medicine 58: 295–300.) Editor's note.

2 The reader is asked to consider the implications of the substance user treatment literature rarely exploring when a treatment technique is indicated or contra-indicated based upon theory-driven judgments and/or empirically informed ones. Editor's note.

3 Treatment can be briefly and usefully defined as a unique, planned, goal directed, temporally structured, multi-dimensional change process, of necessary quality, appropriateness and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA,NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users- of whatever types and heterogeneities- which aren't also used with non-substance users. Whether or not a treatment technique is indicated or contra-indicated, and its selection underpinnings (theory-based, empirically-based, “principle of faith-based, tradition-based, etc. continues to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) and wellbeing treatment-driven models there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Conflict-resolution models may stimulate an additional option for intervention. Each ideological model has its own criteria for success as well as failure. Treatment is implemented in a range of environments; ambulatory as well as within institutions which can include controlled environments Treatment includes a spectrum of clinician-caregiver-patient relationships representing various forms of decision-making traditions/models; (1) the hierarchical model in which the clinician-treatment agent makes the decision(s) and the recipient is compliant and relatively passive, (2) shared decision-making which facilitates the collaboration between clinician and patient(s) in which both are active, and (3) the ‘informed model’ in which the patient makes the decision(s). Editor's note.