Mindfulness-based relapse prevention for substance craving

Abstract

Craving, defined as the subjective experience of an urge or desire to use substances, has been identified in clinical, laboratory, and preclinical studies as a significant predictor of substance use, substance use disorder, and relapse following treatment for a substance use disorder. Various models of craving have been proposed from biological, cognitive, and/or affective perspectives, and, collectively, these models of craving have informed the research and treatment of addictive behaviors. In this article we discuss craving from a mindfulness perspective, and specifically how mindfulness-based relapse prevention (MBRP) may be effective in reducing substance craving. We present secondary analyses of data from a randomized controlled trial that examined MBRP as an aftercare treatment for substance use disorders. In the primary analyses of the data from this trial, Bowen and colleagues (2009) found that individuals who received MBRP reported significantly lower levels of craving following treatment, in comparison to a treatment-as-usual control group, which mediated subsequent substance use outcomes. In the current study, we extend these findings to examine potential mechanisms by which MBRP might be associated with lower levels of craving. Results indicated that a latent factor representing scores on measures of acceptance, awareness, and nonjudgment significantly mediated the relation between receiving MBRP and self-reported levels of craving immediately following treatment. The mediation findings are consistent with the goals of MBRP and highlight the importance of interventions that increase acceptance and awareness, and help clients foster a nonjudgmental attitude toward their experience. Attending to these processes may target both the experience of and response to craving.

Copyright © 2012 Elsevier Ltd. All rights reserved.

Figures

Figure 1

Changes in self-reported craving scores over time by treatment group. MBRP = mindfulness-based relapse prevention.

Figure 2

Model of the “mindfulness” latent factor mediating the association between treatment and the craving growth factors with thicker black lines marking the significant mediated effect. As described in section 3.4 the craving intercept was centered at posttreatment by setting the linear slope coefficients to −1 for baseline, −0.5 at midtreatment, 0 at posttreatment, 1 at the two-month follow-up, and 2 at the four-month follow-up. AAQ = Acceptance and Action Questionnaire. * p; < 0.05, ** p < 0.001.