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Mindfulness meditation for substance use disorders: a systematic review

These notes document studies not able to be included in the featured review, usually because they were published after its time frame.

Randomised trials reporting substance use outcomes

In one US study, a mindfulness-based relapse prevention programme replaced the first eight weeks of usual 12-step-based aftercare for randomly allocated patients who had recently completed intensive inpatient or outpatient substance use treatment. Alcohol and cocaine were the most common substances used problematically by the 168 participants. The analysis statistically evened out the time spent in therapy by mindfulness and usual care patients, an attempt to isolate the relative impacts of the different types of therapy rather than their intensities. Over the first two months – roughly during the therapy period – the days on which substances were used had fallen significantly more among the mindfulness patients, but over the next two months (after mindfulness therapy had ended) scores converged. The authors argued that the usual care to which the patients had by then returned would not have promoted continuation of the meditation practices previously learnt. Craving too waned more steeply in the mindfulness patients who also experienced greater increases in acceptance and awareness, two qualities promoted by the intervention. A later report on the same study found that the mindfulness intervention seemed to reduce substance use more steeply partly because it helped the patients more vulnerable to depression not to react to those feelings by craving drugs or alcohol.

A smaller US trial randomly allocated 36 problem alcohol and/or cocaine using outpatients to group mindfulness training or cognitive-behavioural therapy. By the end of the therapies 12 weeks later just 14 patients were left in treatment to complete outcome measures, which not surprisingly revealed no significant impact on substance use. Use levels were on average higher after mindfulness training, but this might have been an artefact of more patients being retained in the treatment. Mindfulness patients did however react more favourably (less anxiety, drug craving and negative emotions) to artificially induced stress challenges.

104 methamphetamine users were the participants in an Australian trial comparing acceptance and commitment therapy with cognitive behavioural therapy. So few patients completed the 12-week programmes and supplied outcome data (either then or another 12 weeks later) that little can be concluded except that neither therapy exercised much 'holding power' over the participants.

Other studies

Notable among other studies was an Australian trial of a parenting intervention based on home visits and which strongly featured mindfulness techniques to help parents maintain focus on the child and regulate their own emotions. 64 methadone-maintained parents were randomly allocated either to this intervention, to less extensive conventional parenting skills training, or just to carry on with their usual care at the clinics. Six months later, on all the measures of parenting, child welfare risk, and child behaviour, families allocated to the intervention incorporating mindfulness techniques had improved substantially, while generally the others had not. They were also the only group who had been able to reduce their average doses of methadone.

A US residential therapeutic community tested whether adding a mindfulness-based stress reduction course to the programme would improve retention and reduce stress. It compared results from 295 residents who entered the community after the programme was established to those from 164 previous residents. Some subjective and biological tests showed that residents offered mindfulness training were less stressed, but this did not extend their retention in the community, which remained on average virtually unchanged from the pre-intervention era.

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