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Mindfulness therapy helps prevent drug and alcohol relapse

By Andrew M. Seaman

NEW YORK (Reuters Health) - A treatment program incorporating mindfulness meditation is better over the long term than traditional approaches at preventing relapses of drug and alcohol abuse, according to a new study.

One year after treatment for substance abuse, far fewer participants who got relapse-prevention training including mindfulness techniques had used drugs or alcohol compared to those given relapse-prevention therapy alone or a standard 12-step program.

"Addiction is really a tough one," Sarah Bowen told Reuters Health. "The relapse rates remain really high even after decades of work by the best scientists out there. We need to keep looking at more options."

Bowen, from the Center for the Study of Health and Risk Behaviors at the University of Washington in Seattle, led the new research.

"We need to keep looking at innovative approaches of addiction treatment," she said. "I don't want to say mindfulness is better for everyone, but it's another option."

Bowen and her colleagues write in JAMA Psychiatry that about 11 percent of people in the U.S. with substance abuse problems seek treatment every year, but between 40 percent and 60 percent relapse.

Relapse prevention therapies are meant to help people avoid falling off the wagon after they're released from an intensive treatment, such as a rehabilitation program, or "rehab."

Traditional approaches to reducing a person's risk of using drugs and alcohol again include a 12-step program based within a support group structure that emphasizes abstinence.

Another popular approach to relapse prevention is based on cognitive-behavioral therapy, which teaches people how to confront and cope with particular situations, such as refusing drugs and alcohol.

The mindfulness-based approach builds on that kind of relapse prevention program by also teaching self-awareness through meditation. Those techniques allow people to understand what drives cravings and better deal with the discomfort they can create.

Another recent study determined that mindfulness meditation helped stave off chocolate cravings, for example, by letting people distance themselves mentally from the feeling of craving (see Reuters Health story of March 13, 2014 here: http://reut.rs/1m3Jr2P).

For the new study, Bowen and her colleagues recruited 286 people who had successfully completed substance abuse treatment and randomly assigned them to participate in one of three treatments for eight weeks.

One group did a standard 12-step program, another group did a cognitive-behavioral-based relapse prevention program and the third group did a program combining relapse-prevention with mindfulness techniques. All the therapies were administered through group sessions.

The researchers then followed the participants for 12 months to see how many used drugs or alcohol.

After three months, participants in all three groups were performing similarly. But after another three months, both of the relapse-prevention groups began performing better than the 12-step program participants. At the one-year mark, the mindfulness-based relapse-prevention therapy outperformed the other two approaches.

About 9 percent of the participants in the mindfulness group reported drug use after a year, compared to about 14 percent in the 12-step program group and 17 percent in the traditional relapse-prevention group.

Only about 8 percent of the participants in the mindfulness group also reported heavy drinking after a year, compared to about 20 percent in the other two therapy groups.

"Adding these skills to the training program clearly left a mark even if it wasn't discernible right away," Dr. Elias Dakwar, who was not involved in the new study, told Reuters Health.

Dakwar is a specialist in mindfulness training and substance abuse in the Division of Substance Abuse at Columbia Psychiatry in New York.

"What the finding suggests to me is that adding these mindfulness skills to the relapse platform has a measurable effect 12 months later," he said.

Bowen said it could be that the mindfulness meditation techniques are more applicable and adaptable than the techniques taught in traditional relapse prevention.

"In a relapse prevention group the skills are very specific," she said. "I think sometimes what happens is the skills are so specific to certain situations they may not generalize to what happens when you're out of treatment."

"In the mindfulness group, the practices that are learned are generalized to everything," Bowen added. "It's about paying attention to your experiences."

She cautioned, however, that not everyone did great in the mindfulness group, and the findings need to be confirmed by more studies.

"I think it's very exciting to see results like this a year out, but every study has caveats," Bowen said. "As with all science, we need to look further and be careful of absolutes."

SOURCE: http://bit.ly/OFd9Nj JAMA Psychiatry, online March 19, 2014.

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