Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: neurocognitive mechanisms and clinical implications

Figures & data

Figure 1 PRISMA flow diagram.

Note: PLoS Medicine (OPEN ACCESS) Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097.¹⁰⁹
Abbreviations: SUD, substance use disorder; RCT, randomized controlled trials.

Table 1 Experimental studies of the impact of mindfulness on executive functioning

Study	SUD/addictive behavior (sample size)	MBI	Control condition	Results
Alfonso et al^Citation76	Alcohol and polysubstance use disorder (N=34)	Goal management training + Mindfulness	Standard treatment	Participants enrolled in GMT + mindfulness demonstrated significant improvement in performance on neuropsychological measures of working memory, response inhibition, and decision-making when compared to standard treatment.
Garland et al^Citation79	Opioid-misuse among chronic pain patients (N=115)	MORE (eight 2-hour group sessions)	Support group (eight 2-hour group sessions)	MORE participants demonstrated a decrease in opioid attentional bias when compared to support group participants.
Tang et al^Citation110	Tobacco use disorder (N=60)	IBMT: 30-minutes practice training every night for 10 consecutive nights	Relaxation training: 30-minutes practice training every night for 10 consecutive nights	Participants in the IBMT reported more efficacy in regulating emotions which were related to increased ACC/medial prefrontal cortex (mPFC) activity.
Valls- Serrano et al^Citation77	Polysubstance use disorder (N=32)	GMT + MM + TAU	TAU	Participants assigned to the GMT + MM condition demonstrated significant increases in reflective processes compared to TAU participants.

Abbreviations: SUD, substance use disorder; MBI, mindfulness-based interventions; GMT, goal management training; MORE, mindfulness-oriented recovery enhancement; IBMT, integrative body-mind training; ACC, anterior cingulate cortex; MM, mindfulness meditation; TAU, treatment-as-usual; mPFC, medial prefrontal cortex.

Table 2 Experimental studies of the impact of mindfulness on reward

Study	SUD/addictive behavior (sample size)	MBI	Control condition	Results
Froeliger et al^Citation89	Tobacco use disorder	MORE (ten 2-hour sessions)	No treatment	Compared to the comparison group, MORE participants demonstrated decreased BOLD response in ventral striatum (vs) and ventral prefrontal cortex (vPFC) during a craving regulation task and increased positive BOLD signal in vs and vPFC during an emotion regulation task.
Garland et al^Citation86	Opioid misuse among chronic pain patients (N=69)	MORE: 8 weekly, 2-hour group sessions	Support Group: 8 weekly, 2-hour, therapist-led social support groups based on the Matrix model IOP treatment manual	MORE participants demonstrated significantly greater reductions in opioid cue-reactivity on the dot probe task, enhancement in heart rate deceleration during attention to pleasure cues, and increases in HR variability from rest during emotional attention to pleasure cues.
Carroll et al^Citation96	Opioid misuse among chronic pain patients (N=29)	MORE: 8 weekly, 2-hour group sessions	Support Group: 8 weekly, 2-hour group sessions	Participation in MORE was associated with significant increases in LPP response to natural reward stimuli relative to neutral stimuli.
Kober et al^Citation98	Alcohol use disorder (N=53)	MORE: 10 weekly, 2-hour group sessions	Support Group: 10 weekly, therapist-led social support groups based on the Matrix model IOP tx manual	MORE participants demonstrated a significantly greater reduction in alcohol attentional bias and improvement in physiological recovery from alcohol cues after treatment when compared to support group participants.
Paz et al^Citation97	Opioid misuse among chronic pain patients (N=51)	MORE: 8 weekly, 2-hour group sessions	Support Group: 8 weekly, 2-hours group sessions	Compared to the support group, MORE participants demonstrated significantly greater increases in responsiveness to natural reward cues relative to drug cues.

Abbreviations: SUD, substance use disorder; MBI, mindfulness-based interventions; MORE, mindfulness-oriented recovery enhancement; BOLD, blood oxygen level dependent; LPP, late positive potential; IOP, intensive outpatient treatment.

Table 3 Experimental studies of the impact of mindfulness on stress reactivity

Study	SUD/addictive behavior (sample size)	MBI	Control condition	Results
Carroll & Lustyk^113	Polysubstance use (N=34)	MBRP: 8 weekly, 2-hour group sessions	Relapse prevention: 8 weekly, 2-hour group sessions TAU	Participation in MBRP was associated with higher cardiac vagal control and lower stress/anxious reactivity.
Kober et al^114	Tobacco use disorder (N=23)	Mindfulness training	Freedom from Smoking	Participants in mindfulness training demonstrated lower stress-reactivity compared to the control group.
Paz et al^115	Tobacco use disorder (N=104)	Present moment attention and awareness training	Cope-as-usual control condition	Present moment attention and awareness training was associated with reductions in psycho-physiological dysregulation in response to an axiogenic stressor.

Abbreviations: SUD, substance use disorder; MBI, mindfulness-based interventions; MBRP, mindfulness-based relapse prevention; TAU, treatment-as-usual.

MoherDLiberatiATetzlaffJAltmanDGThe PRISMA Group2009Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA StatementPLoS Med67e100009719621072

 PubMed Web of Science ®Google Scholar

AlfonsoJPCaracuelADelgado-PastorLCVerdejo-GarcíaACombined goal management training and mindfulness meditation improve executive functions and decision-making performance in abstinent polysubstance abusersDrug Alcohol Depend20111171788121277705

 PubMed Web of Science ®Google Scholar

GarlandELBakerAKHowardMOMindfulness-oriented recovery enhancement reduces opioid attentional bias among prescription opioid-treated chronic pain patientsJ Soc Soc Work Res20178311318

 Web of Science ®Google Scholar

TangYYTangRPosnerMIMindfulness meditation improves emotion regulation and reduces drug abuseDrug and Alcohol Dependence2016163S13827306725

 PubMed Web of Science ®Google Scholar

Valls-SerranoCCaracuelAVerdejo-GarciaAGoal management training and mindfulness meditation improve executive functions and transfer to ecological tasks of daily life in polysubstance users enrolled in therapeutic community treatmentDrug Alcohol Depend201616591427246405

 PubMed Web of Science ®Google Scholar

FroeligerBMathewARMcConnellPARestructuring reward mechanisms in nicotine addiction: a pilot fMRI study of mindfulness-oriented recovery enhancement for cigarette smokersEvid Based Complement Alternat Med20172017e7018014

 Web of Science ®Google Scholar

GarlandELFroeligerBHowardMONeurophysiological evidence for remediation of reward processing deficits in chronic pain and opioid misuse following treatment with mindfulness-oriented recovery enhancement: exploratory ERP findings from a pilot RCTJ Behav Med201538232733625385024

 PubMed Web of Science ®Google Scholar

CarrollHLustykMKBMindfulness-based relapse prevention for substance use disorders: effects on cardiac vagal control and craving under stressMindfulness201892488499

 Web of Science ®Google Scholar

KoberHBrewerJAHeightKLSinhaRNeural stress reactivity relates to smoking outcomes and differentiates between mindfulness and cognitive-behavioral treatmentsNeuroimage2017151Suppl C41327693614

 PubMed Web of Science ®Google Scholar

PazRZvielliAGoldsteinPBernsteinABrief mindfulness training de-couples the anxiogenic effects of distress intolerance on reactivity to and recovery from stress among deprived smokersBehav Res Ther201795Suppl C11712728624698

 PubMed Web of Science ®Google Scholar