Cognitive and Affective Mechanisms Linking Trait Mindfulness to Craving Among Individuals in Addiction Recovery

Abstract

The present study aimed to identify affective, cognitive, and conative mediators of the relation between trait mindfulness and craving in data culled from an urban sample of 165 persons (in abstinence verified by urinalysis) entering into residential treatment for substance use disorders between 2010 and 2012. Multivariate path analysis adjusting for age, gender, education level, employment status, and substance use frequency indicated that the association between the total trait mindfulness score on the Five Facet Mindfulness Questionnaire and alcohol/drug craving was statistically mediated by negative affect (measured by the PANAS, beta = −.13) and cognitive reappraisal (measured by the CERQ, beta = −.08), but not by readiness to change (measured by the URICA, beta = −.001). Implications for mindfulness-oriented treatment of persons with substance use disorders are discussed. The study's limitations are noted.

Keywords :

• trait mindfulness
• craving
• negative affect
• reappraisal
• stages of change
• motivation
• addiction
• substance dependence
• mindlessness
• appetitive behaviors

THE AUTHORS

Eric Garland, Ph.D., LCSW, is an Associate Professor at University of Utah College of Social Work and Associate Director of Integrative Medicine in Supportive Oncology at Huntsman Cancer Institute. His bio-behavioral research agenda is focused on translating findings from cognitive and affective neuroscience into treatments for stress-related conditions. Dr. Garland is the developer of Mindfulness-Oriented Recovery Enhancement (MORE), a multimodal intervention designed to ameliorate transdiagnostic mechanisms underpinning addiction, emotion dysregulation, and chronic pain. Dr. Garland has received funding from the National Institutes of Health to conduct clinical trials of MORE as a treatment for alcohol dependence and prescription opioid misuse.

Amelia C. Roberts-Lewis, PhD, LCSW is an Associate Professor at the University of North Carolina at Chapel Hill School of Social Work. Her research expertise is in the applied science of evidence-based interventions within substance abuse treatment programs. Her primary area of translational research provides evidence-based interventions for substance abusing women, teen girls, and homeless men with co-occurring mental health disorders and trauma histories. Dr. Roberts-Lewis teaches classes in the area substance abuse, mental health, cultural diversity, and the integration of spirituality and counseling. She is developer of a dual degree MSW/MDIV program with Duke University Divinity School.

Karen Kelley is the Director of Clinical Operations at Triangle Residential Options for Substance Abusers (TROSA) and the liaison for Triangle Engage, a SAMHSA funded partnership with TROSA and the UNC School of Social Work. Ms. Kelley oversees the operations of the Intake, Medical, and Clinical departments at TROSA, an innovative, award-winning substance abuse treatment program based in Durham. Ms. Kelley is interested in supporting research that serves communities in real-world settings. She has 21 years of experience in the nonprofit sector and has been at TROSA for the past 10 years.

Christine Tronnier, M.S.W., LCSW, LCAS, is a doctoral student at the Smith College School for Social Work and an individual and group psychotherapist for the Triangle Engage project at Triangle Residential Options for Substance Abusers (TROSA). Ms. Tronnier is a Mindfulness-Oriented Recovery Enhancement (MORE) group facilitator.

Adam Hanley is a second year PhD student in Florida State University's Combined Counseling Psychology and School Psychology program. His primary research interest is focused on contemplative practices that engender mindfulness in daily life, and increasing the accessibility of contemplative practices in clinical and academic settings. Adam is also engaged in studying the relationship between mindfulness and positive reappraisal, as well as the role of mindfulness (both state and trait) in the facilitation of posttraumatic growth.

GLOSSARY

• Trait mindfulness: The dispositional propensity to exhibit mindful attitudes and behaviors in everyday life.

• Cognitive reappraisal: The process of reframing or reinterpreting the meaning of challenging life events as a way of decreasing their adverse psychological consequences.

• Conative: Of or pertaining to purposeful or motivated action.

Notes

1 The reader is reminded that the term and process “craving,” selectively distinguished from daily expressed and experienced “desire,” is a bounded (culture, time, place, etc.) mystified, and empowered concept. It 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. Editor's note

2 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

3 The reader is asked to consider that any diagnostic process, in simplistic terms, permits the collection of necessary and relevant data/information in order to facilitate decision making. From a medical-treatment perspective, a useful diagnosis “offers”, minimally, three critical, necessary types of information: etiology, process, and prognosis…which are not always known. The relatively recent SUD (American Psychiatric Association, 1994, 2013) and the related nosology of “dual diagnosis” are both inadvertently misleading. They are both based on consensualized perceptions and judgments and are not empirically informed, are part of a recent trend which mediicalizes a range of human behaviors and are insensitive to the heterogeneity of the range of types of people who are substance users. Any substance use and user, of whatever type(s) can be “tagged”/diagnosed in each area of his/her life: medically, psychiatrically, socially, gender identification, educationally, spiritually, morally, IQ, SES, ethnically, racially, legal-status, etc. depending upon the criteria used (whatever their underpinnings and validity) and the needs of the categorizers. Neither “substance use disorder” (in its variations) nor dual diagnosis, also in its variations offer, in a predictable sense, etiological, process, and prognostic information which can be or which are used for effective treatment planning, implementation, and evaluation of the range of heterogeneous drug users. Editor's note.

4 The term “dependence” is no longer included as a diagnostic criteria in the new and revised diagnostic manual. (American Psychiatric Association, 2013) Editor's note.