Integrating Mindfulness-Based Skills Training Into Brief Outpatient Treatment for Substance Abusing Youth
Condition: Substance Abuse; Drug Addiction
MeSH terms: Substance-Related Disorders; Behavior, Addictive
Study type: Interventional

Summary: 
      The proposed study will evaluate the clinical effectiveness of integrating mindfulness-based
      skills training into a standardized brief group intervention for youth (ages 16 to 24)
      identified as having problematic substance use. Forty youth (N = 20 per group) will be
      randomized to one of two treatment conditions: 1) a standardized 4-week brief treatment for
      problematic substance use (treatment as usual; TAU) or 2) standardized brief treatment (TAU)
      augmented with a mindfulness skills training component based primarily on the mindfulness
      module described in Linehan's (1993b) Dialectical Behavior Therapy skills group training. It
      is expected that, compared to the TAU, the mindfulness-based group plus TAU will produce
      superior outcomes on the following primary outcome measures: number of substance use days,
      confidence to resist urges to use substances, and mindfulness skills. Secondary outcomes that
      will be examined include severity of consequences of use, general psychiatric symptoms,
      self-compassion, emotion dysregulation, and transfer to further treatment.
    

Detailed description: 
      For a wide range of clinical conditions (e.g., depression, anxiety, chronic pain, and
      stress-related health problems), the integration of mindfulness based interventions into
      clinical treatment has yielded positive benefits (e.g., Kabat-Zinn, 1990; Segal, Williams, &
      Teasdale, 2002; see Appendix II for a list of references for the study). Recently,
      researchers have found mindfulness skills training to have a number of beneficial treatment
      implications for substance abuse in adults (e.g., Alterman, A.I., Koppenhaver, J, Mulholland,
      E, Ladden, L, & Baime M. (2004); Breslin, Zack, & McMain, 2002; Marcus, 2005; Marlatt, 2005;
      Marlatt & Kristeller, 1999). Although researchers have recommended that mindfulness be
      implemented as an adjunctive treatment for addictions, including the early stages of
      substance use treatment (Breslin et al., 2002; Marcus, 2001; 2003; 2005), few studies have
      explored whether incorporating mindfulness skills training yields incremental benefits over
      standard treatments alone, or whether mindfulness skills have clinical utility during the
      early stages of substance abuse treatment. Moreover, no studies have explored the relative
      benefits of incorporating mindfulness skills training into the treatment of problematic
      substance use among transition-age youth, an age group at heightened risk for the development
      of addiction and mental health problems (Beitchman, Adlaf, Douglas, Atkinson, Young, et al.,
      2001). The integration of mindfulness into youth substance abuse treatment would be expected
      to yield beneficial effects given the developmental patterns of impulsivity and emotion
      dysregulation frequently characterizing this population (Winters, 1999). Researchers using
      the mindfulness paradigm have proposed that one of the key beneficial mechanisms produced by
      mindfulness is emotional regulation (e.g., Linehan, 1993a, 1993b; see Roemer, 2003). By
      increasing mindfulness, and thereby emotion regulation, therapy clients undergoing
      mindfulness skills training would be expected to experience an enhanced capacity to resist
      impulses to act on substance use urges (Breslin et al., 2002). Thus, when integrated into
      treatment as usual, mindfulness skills training would be expected to have positive,
      incremental effects on clients' abilities to reduce their level of substance use over the
      course of substance abuse treatment.

      This study will address the question: Does the integration of mindfulness-based skills
      training into a standardized brief substance abuse treatment (TAU) for youth enhance
      treatment outcomes compared to standardized treatment (TAU) alone? Clinical outcomes will be
      compared for youth randomized to one of two treatment conditions: a) a TAU control condition,
      consisting of an evidence-based, standardized brief treatment group delivered in
      approximately 2-hour sessions once per week over four weeks (i.e., the First Contact group;
      Breslin, Li, Sdao-Jarvie, Tupker, & Ittig-Delan, 2002), and b) an experimental treatment
      condition, consisting of the TAU enhanced with a mindfulness skills training component based
      primarily on the mindfulness module described in Linehan's (1993) Skills Training Manual for
      Treating Borderline Personality Disorder (Linehan, 1993b), and recent adaptations of these
      skills for substance use problems (McMain, Dimeff, Sayrs, Davis, & Linehan, 2005), and youth
      populations (Miller, Rathus, Landsman, & Linehan, in press). This study will explore whether,
      when compared to the TAU, the treatment augmented with mindfulness skills training will have
      a beneficial impact on clinical outcomes, including the confidence to resist substance use
      urges, number of substance use days, and the development of mindfulness skills.

      The primary hypotheses are that, compared to TAU, the group receiving treatment enhanced with
      mindfulness skills training will report the following: (1) a lower number of substance use
      days, (2) greater confidence to resist urges to use substances, (3) a higher level of
      mindfulness skills. Secondary analyses will explore the extent to which the experimental
      condition is related to beneficial effects on the following: (1) negative consequences of
      substance use, (2) psychiatric symptoms, (3) difficulties with emotion regulation, (4)
      self-compassion, (5) rates of transfer to further treatment, and (6) premature treatment
      termination.
    

Intervention name(s): MI Alone or Plus Mindfulness-Based Skills Training
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single
Primary purpose: Treatment
Keywords: youth; drug addiction; substance abuse; mindfulness; motivational interviewing; brief treatment; skills training; group therapy; emotion regulation