Mindfulness-Based Relapse Prevention for Alcohol Use Disorders in Remission
Condition: Alcohol Use Disorders
MeSH terms: Alcoholism; Alcohol Drinking
Study type: Interventional

Summary: 
      We propose to conduct a pilot study that will examine the utility and mechanisms of
      Mindfulness-Based Relapse Prevention in reducing alcohol consumption, relapse rates, and
      physiological arousal to stress in adults 21 years of age and older who have met DSM-IV-TR
      diagnostic criteria for alcohol dependence within the past year but have abstained from
      drinking for the last thirty days. MBRP is designed to improve one's ability to self-regulate
      emotions, thoughts and physical states, thus reducing the need to alleviate associated
      discomfort through substance use. Participants assigned to the intervention group will
      receive an 8-week training course of MBRP over a period of nine weeks; participants assigned
      to the Treatment As Usual (TAU) group will continue treatment as usual, which includes
      utilizing their own effective strategies to refrain from alcohol use. All participants will
      be assessed for pretreatment severity of psychological abuse/trauma as well as pre and
      posttreatment psychosocial functioning (e.g., alcohol consumption, symptoms of depression and
      anxiety, emotion regulation/coping). The outcome of treatment will be evaluated using a)
      Timeline Followback drinking data and b) self-report ratings of acquisition of MBRP skills
      (e.g., state/trait mindfulness, acceptance and awareness, and perceived stress) and
      depressive and anxiety symptom severity. We hypothesize that participants who receive MBRP
      training will demonstrate greater acceptance and awareness, reduced cravings, and have a
      lower likelihood of relapse than participants in the TAU group. It is also expected that MBRP
      participants will demonstrate greater improvements on psychological measures of depression,
      anxiety, emotion regulation and coping, and show less perceived stress and physiological
      arousal to stress compared to TAU participants. Finally, little is known about which types of
      individuals are most likely to benefit from MBRP. Thus, secondary analyses will help to
      clarify for whom MBRP may be most effective.
    

Detailed description: 
      Stress exposure increases psychological and physiological arousal and can lead to negative
      health outcomes. An impaired ability to self-regulate in response to stress contributes to
      the development of alcohol use disorders and relapse. Mindfulness, a state of present-focused
      attention and awareness, can be systematically learned through meditative practice to improve
      self-regulation of emotional, physiological and behavioral responses to stress. Mindfulness
      meditation further facilitates a balance of mind and body thereby increasing one's ability to
      respond proactively and effectively to daily events. Research evidence suggests a strong
      association between mindfulness and positive indicators of well-being which include
      reductions in fear, anxiety, anger, and better physiological recovery from stress.

      Given the importance of self-regulation in the development and progression of alcohol use
      disorders and relapse, a new approach to substance use treatment, Mindfulness-Based Relapse
      Prevention (MBRP), was developed. Traditionally, MBRP is an eight-week outpatient treatment
      program, which integrates core aspects of Relapse Prevention (RP) practices with practices
      adapted from Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive
      Therapy. The mindfulness practices in MBRP are designed to increase acceptance and tolerance
      of negative emotions, thoughts and physical states thus reducing the need to alleviate
      associated discomfort through substance use. MBRP also focuses on increasing awareness of
      triggers and developing more effective coping behaviors in high-risk situations. Among adults
      with substance use disorders, MBRP has been found to lead to significantly lower rates of
      substance use, greater decreases in cravings and greater increases in acceptance and acting
      with awareness than treatment as usual. MBRP has also been found to facilitate more effective
      coping and self-regulation of negative emotions during early abstinence.

      While research indicates that MBRP is effective in reducing substance use relapse, only
      preliminary research has examined the influence of MBRP on the physiological mechanisms
      involved in emotion regulation after exposure to stress. Examining these physiological
      mechanisms is essential because the central and autonomic nervous systems work together to
      coordinate the self-regulation of attention, cognition and emotion when stressful cues are
      encountered, such as when a substance dependent individual is exposed to stressful and/or
      substance related stimuli. Heart rate variability (HRV) is generally seen as an index of
      emotion regulation. High frequency HRV reflects parasympathetic activation of the autonomic
      nervous system and the body's ability to exert cognitive control over attention and emotional
      responding. Higher levels of HRV are associated with greater emotional and behavioral
      flexibility, and tend to be associated with better mental and physical health outcomes. In
      contrast, lower levels of HRV are associated with a wide range of medical and psychiatric
      disorders, including acute and chronic alcohol ingestion, anxiety and depression. Among
      alcohol dependent individuals, mindfulness training has been found to increase HRV and lower
      subjective levels of psychological distress in response to stressful cues in the short-term.
      The proposed study will be the first to examine the long-term effects of MBRP on HRV and
      self-reported psychological/behavioral functioning. The results will provide a better
      understanding of the interplay between the psychological and physical mechanisms involved in
      relapse and help determine whether MBRP has lasting psychological and physiological benefits.
      In other words, assessing both the psychological and physiological effects of MBRP will
      provide a more accurate and comprehensive understanding of how mindfulness aids in promoting
      self-regulation and relapse prevention. Finally, little is known about which types of
      individuals are most likely to benefit from MBRP. It is necessary to examine individual
      characteristics (i.e., baseline levels of HRV, trait mindfulness, substance use, anxiety,
      depression) to determine which characteristics are associated with positive treatment
      outcomes in both the short and long-term. This knowledge will enable more efficient and
      effective delivery of the MBRP treatment.
    

Intervention name(s): Mindfulness Based Relapse Prevention; Treatment as usual
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Mindfulness based relapse prevention therapy provided over eight sessions in person to prevent alcohol relapse.; Treatment usually provided by clinician
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Mindfulness; Alcohol use disorders