Feasibility, Acceptability, and Preliminary Outcomes of a Mindfulness-Based Relapse Prevention Intervention for Culturally-Diverse, Low-Income Women in Substance Use Disorder Treatment

Abstract

We examined feasibility, acceptability, and benefits of a mindfulness-based relapse prevention (MBRP) intervention in a racially and ethnically diverse sample of 318 low-income women in substance use disorder treatment (2003–2006). The study used a single group, repeated measures design. Participant satisfaction was high (M = 3.4, SD = .3), but completion was modest (36%). Linear regressions examining change in addiction severity and psychological functioning by dosage showed that higher dosage was associated with reduced alcohol (β = −.07, p < .05), drug severity (β = −.04, p < .05), and perceived stress (β = −2.29, p < .05) at 12 months. Further research on MBRP efficacy for this population is warranted. The study's limitations are noted.

Keywords :

• mindfulness
• relapse prevention
• race/ethnicity
• women
• addiction
• stress

THE AUTHORS

Hortensia Amaro, Ph.D. is Associate Vice Provost for Community Research Initiatives and Dean's Professor of Social Work and Preventive Medicine at the University of Southern California. A psychologist and public health researcher, Dr. Amaro's work has focused on the translation of research to practice and development of innovative gender-specific and culturally-tailored interventions and treatment programs in addiction and co-occurring disorders treatment among inner city Latino and African American populations. Her interest in the application of mindfulness-based methods in addictions treatment emerged from her yoga practice, training in Mindfulness-Based Stress Reduction and collaboration with colleagues at the University of Massachusetts Center for Mindfulness.

Suzanne E. Spear, Ph.D. is a research associate in the School of Social Work at the University of Southern California. Dr. Spear has worked in the fields of community development and public health since 1995. Her research interests include substance use disorder treatment and prevention, program evaluation, implementation of evidence-based practices, and interorganizational networks among substance use disorder treatment providers.

Zayda Vallejo, M.Litt. is a certified senior teacher in Mindfulness-Based Stress Reduction (MBSR) at the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. She has co-developed specialized curricula for people with addictions, as well as trained MBSR trainers in Mindfulness-Based Relapse Prevention for Addictive Behavior. Her work teaching over the past decade has convinced her that MBSR can profoundly improve the life of anyone struggling to cope with stress and related health concerns.

Kerith Conron, Ph.D. is a Research Scientist at the Fenway Institute, Center for Population Research in LGBT Health and is an adjunct Assistant Professor in the Department of Health Sciences, Northeastern University and a Visiting Scholar at the Institute for Child, Youth, and Family Policy at Brandeis University. She is a social and psychiatric epidemiologist who is committed to identifying policy-relevant intervention strategies to address social determinants of health, with an emphasis on childhood. Her specific interests include preventing children's exposure to maltreatment, mitigating the consequences of exposure to maltreatment and other social adversity, and promoting healthy child development within families and communities.

David S. Black, Ph.D., M.P.H. is Assistant Professor in the Department of Preventive Medicine and member of the Norris Comprehensive Cancer Center at the University of Southern California. His research program focuses on the delivery and evaluation of mind-body therapeutic modalities, specifically mindfulness training, in order to modify mental and physical health symptoms and states. He is broadly interested in how integrative medicine approaches impact stress biology, specifically the interchange between neuroendocrine and immune system function. He is the Editor-in-Chief of Mindfulness Research Monthly, a web-based dissemination bulletin informing the latest advances in mindfulness research.

GLOSSARY

• Mindfulness: “The awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, 2003).

• Mindfulness training (MT): Instruction focused on the development of awareness and acceptance of moment-to-moment experiences. Common strategies taught in MT include breathing exercises, yoga, stretches, and meditation.

• Mindfulness-based relapse prevention (MBRP): An intervention that combines mindfulness strategies with relapse prevention techniques to help people with substance use disorders cope with cravings by increasing their awareness of thoughts, emotions, and environments that lead to using substances and developing coping skills to prevent relapse.

• Mindfulness-based stress reduction (MBSR): A mindfulness training method that combines mindfulness mediation and yoga. It was originally developed for populations with chronic pain and stress-related disorders. In addition to meditation and yoga, MBSR training teaches participants to practice mindfulness during ordinary activities like walking, standing, and eating.

Notes

3 Craving, a bounded (culture, time, place, etc.) mystified and empowered concept, continues to be debated, being conceptualized as encompassing a broad range of phenomena including anticipation of a drug's reinforcing effects, intention to engage in drug use, and desire for the drug. Its dimensions and the critical necessary conditions which are necessary for it to operate (begin, continue, become anchored and integrate, change as de facto realities change, cease, etc.) or not to and whether its underpinnings are theory-driven, empirically-based, individual, and/or systemic stake holder-bound, historically-bound, based upon “principles of faith” need to be delineated. “Craving,” which is pejorative in its socially constructed meanings and implications, is associated with selected populations and their behaviors, “desires”, which is a positive, “normed” term, with other populations and their behaviors. Editor's note

4 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

5 The reader is asked to consider that concepts and processes such as “risk” and “protective” factors are often noted in the literature, without adequately delineating their dimensions (linear, nonlinear, rates of development, sustainability and cessation, etc.), their “demands”, the critical necessary conditions (–endogenously as well as exogenously; micro to macro levels) which are necessary for them to operate (begin, continue, become anchored and integrate, change as de facto realities change, cease, etc.) or not to operate, and whether their underpinnings are theory-driven, empirically-based, individual, and/or systemic stake holder-bound, historically-bound, based upon “principles of faith” or what. This is necessary to clarify, if possible, if these terms are not to remain as yet additional shibboleths in a field of many stereotypes. Editor's note.