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ABSTRACT
Background: Many youth initiate opioid misuse with prescription opioids and transition over time to more severe substance-using behaviors, including injection. Trait mindfulness is a potentially protective factor. Objectives: This is a cross-sectional study characterizing a sample of opioid-using youth by level of mindfulness and examines the potential effect modification of emotion regulation on the relationship between mindfulness and progression to injection opioid use. Methods: A convenience sample of 112 youth (ages 14–24) was recruited during an episode of inpatient detoxification and residential treatment for opioid use disorders. We examined emotion regulation (Difficulties in Emotion Regulation Scale), mindfulness (Child Acceptance and Mindfulness Measure), and opioid use. We completed multivariable regressions stratified by degree of emotion regulation looking at relationship of mindfulness on time to injection use from age of first prescription opioid. Results: Youth had difficulties in emotion regulation (m = 104.2; SD = 2.41) and low mindfulness (m = 19.1;SD = 0.59). While we found overall that mindfulness was associated with time to progression to injection opioid use, there was significant effect modification. Among youth with high levels of difficulty in emotion regulation, those with high mindfulness trait had quicker progressions to injection (−1.31 years; p =.003). In contrast, youth with normal emotion regulation and high mindfulness trait had a slower progression to injection (1.67 years; p =.041). Conclusion/Importance: Our study showed a majority of youth presenting with opioid use disorders have impairments in emotion regulation and deficits in trait mindfulness. The relationship between mindfulness and opioid use is impacted by emotion regulation capacity. More research is needed to understand the various facets of mindfulness and how they interact with emotion regulation in youth.
Acknowledgments
Dr. Karin Tobin is acknowledged for her work in the initial stages of data analysis and support for early draft writing. Aspects of this work were presented as an oral presentation presented in May 2015 as MPH Capstone project at the Johns Hopkins Bloomberg School of Public Health. Aspects of the work were presented at the Society for Adolescent Health Meeting as an oral presentation in March 2015 and as a poster in March 2016.
Declaration of interest
Dr. Fishman is the Medical Director of Mountain Manor Treatment Center (MMTC) where patients were enrolled in this study, a part-time faculty member of the Johns Hopkins University, and a beneficiary of the trust that owns MMTC. Dr. Fishman also serves on the governing board of the trust and the Board of Directors of MMTC. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. No other authors have potential conflicts of interest.
Funding
Dr. Wilson received funding through the 2014 NIDA-SAHM Clinician Scientist Award for Adolescent Substance Abuse and Misuse, HRSA/MCH/T71MC08054, and T32HD052459-07. Dr. Matson received support through NICHD 5T32HD052459-07 and K01DA035387.