Article

Mindfulness Training and Stress Reactivity in Substance Abuse: Results from a Randomized, Controlled Stage I Pilot Study

Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
Substance Abuse (Impact Factor: 1.62). 10/2009; 30(4):306-17. DOI: 10.1080/08897070903250241
Source: PubMed

ABSTRACT

Stress is important in substance use disorders (SUDs). Mindfulness training (MT) has shown promise for stress-related maladies. No studies have compared MT to empirically validated treatments for SUDs. The goals of this study were to assess MT compared to cognitive behavioral therapy (CBT) in substance use and treatment acceptability, and specificity of MT compared to CBT in targeting stress reactivity. Thirty-six individuals with alcohol and/or cocaine use disorders were randomly assigned to receive group MT or CBT in an outpatient setting. Drug use was assessed weekly. After treatment, responses to personalized stress provocation were measured. Fourteen individuals completed treatment. There were no differences in treatment satisfaction or drug use between groups. The laboratory paradigm suggested reduced psychological and physiological indices of stress during provocation in MT compared to CBT. This pilot study provides evidence of the feasibility of MT in treating SUDs and suggests that MT may be efficacious in targeting stress.

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    • "The ability to cope with feelings of frustration that may arise as task difficulty increases is important in working memory training, as is maintaining focus for prolonged periods. Thus, augmenting working memory training with training of coping skills, emotional regulation , or mindfulness may enhance both cognitive performance and psychosocial treatment outcomes (Bowen et al., 2009; Brewer et al., 2009; Desbordes et al., 2012; Garland et al., 2010; Sahdra et al., 2011; Witkiewitz et al., 2013). This tactic may be especially relevant for individuals with substance use disorders, who often exhibit deficits in emotion regulation (Gerra et al., 2003; Witkiewitz et al., 2012; Wong et al., 2013). "
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    ABSTRACT: Objective: Working memory impairment in individuals with chronic opioid dependence can play a major role in cognitive and treatment outcomes. Cognitive training targeting working memory shows promise for improved function in substance use disorders. To date, cognitive training has not been incorporated as an adjunctive treatment for opioid dependence. Methods: Methadone maintenance patients were randomly assigned to experimental (n=28) or active control (n=28) 25-session computerized training and run in parallel. Cognitive and drug use outcomes were assessed before and after training. Results: Participants in the experimental condition showed performance improvements on two of four working memory measures, and both groups improved on a third measure of working memory performance. Less frequent drug use was found in the experimental group than in the control group post-training. In contrast to previous findings with stimulant users, no significant effect of working memory training on delay discounting was found using either hypothetical or real rewards. There were no group differences on working memory outcome measures that were dissimilar from the training tasks, suggesting that another mechanism (e.g., increased distress tolerance) may have driven drug use results. Conclusions: Working memory training improves performance on some measures of working memory in methadone maintenance patients, and may impact drug use outcomes. Working memory training shows promise in patients with substance use disorders; however, further research is needed to understand the mechanisms through which performance is improved and drug use outcomes are impacted.
    Full-text · Article · Sep 2015 · Drug and alcohol dependence
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    • "However ,the research on MBIs in the treatment of substance use disorders is still relatively unexplored (Bayles, 2014). Accounting for the finding of this body of work it is possible to conclude that MBIs are successful in treating a vast variety of substance use disorders, ranging from alcohol dependence (Zgierska et al., 2008; Garland, at al., 2010), alcohol and cocaine use disorders (Brewer et al, 2009) and nicotine dependence (Bowen & Marlatt, 2009; Davis, at al., 2007). Furthermore, the results of these studies are consistent with the current neurobiological research emphasizing the relation between mindful practices and changes in brain regions involved in modulation of arousal and emotional regulation (e.g., Hölzel et al., 2008; Hölzel et al., 2011; Lazar et al., 2000; Witkiewitz, Lustyk, & Bowen, 2013). "
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    ABSTRACT: Mindfulness and mindfulness-based interventions (MBIs) have been applied in numerous fields from behavioral medicine, nursing and psychiatry, to psychology and social work. Research on mindfulness and MBIs is increasingly providing evidence of the efficacy and benefits of MBIs for the treatment of a vast array of conditions. Yet, the application of mindfulness in the field of social work is still at its initial stages and among the most recent areas of its application includes the treatment of substance use disorders. However, the current research on mindfulness is based on epistemological and methodological stances that allow only a partial investigation of the phenomenon, as it is primary focused on the evaluation of the effectiveness of mindfulness and MBIs or in the search of its underlying neurological mechanism. The aim of this work is to employ the experience of five Swedish practitioners to understand the influence of mindfulness in the social work therapeutic relationship, and exploring the advantages and challenges that MBIs offer in the treatment of substance use disorders in the Swedish context. The aim is pursued relying on a descriptive phenomenological research design. The main findings of this work suggest: (a) the suitability of phenomenology in theorizing mindfulness and MBIs within the therapeutic encounter and in the treatment of substance use disorders; (b) the body is the main tool in the process of understanding one’s own emotional and cognitive life in the therapeutic work with mindfulness and MBIs; (c) the compassionate, accepting and non-judging features of mindfulness and MBIs offer a valuable ideological alternative to the zero tolerance model and the treatment methods that characterize the Swedish drug policy; (d) mindfulness is not merely a therapeutic tool but represents an overreaching aspect of the life of its practitioners, whether they are social workers or clients
    Full-text · Thesis · Jun 2015
    • "The ability to cope with feelings of frustration that may arise as task difficulty increases is important in working memory training, as is maintaining focus for prolonged periods. Thus, augmenting working memory training with training of coping skills, emotional regulation , or mindfulness may enhance both cognitive performance and psychosocial treatment outcomes (Bowen et al., 2009; Brewer et al., 2009; Desbordes et al., 2012; Garland et al., 2010; Sahdra et al., 2011; Witkiewitz et al., 2013). This tactic may be especially relevant for individuals with substance use disorders, who often exhibit deficits in emotion regulation (Gerra et al., 2003; Witkiewitz et al., 2012; Wong et al., 2013). "
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    ABSTRACT: Background: Cannabis and opioid use are associated with cognitive impairment, whether preexisting or substance-induced, but there have been few substance-specific assessments of cognitive functioning in adolescent substance users. Working memory impairment may be particularly important, as it has been linked to poorer performance in substance abuse treatment. Methods: Working memory (Wechsler Intelligence Scale for Children-IV or Adult Intelligence Scale-IV) and baseline substance use were assessed in 42 youth (mean age = 17.9 years, SD = 1.3, range: 16-20; 65% Caucasian, 30% female) 1-2 weeks after admission to residential treatment with supervised abstinence, 19 for primary cannabis dependence and 23 for primary opioid dependence. Results: There were substantial deficits in working memory in both groups, with significant differences (P < .001) between the opioid (M = 39.1th%ile, SD = 25.6) and cannabis (M = 16.3th%ile, SD = 13.6) groups. The primary opioid group had high rates of cannabis use, with no significant difference in past-month days of cannabis use from the primary cannabis group. The opioid group was older and had completed more years of formal education. Seventy-nine percent of the cannabis group had public health care coverage (mostly Medicaid), compared with 24% of the opioid sample. Conclusions: Working memory impairment was substantial in treatment-seeking youth with primary cannabis and opioid dependence (the latter actually having comparable rates of cannabis use), and significantly more pronounced in the primary cannabis-dependent group. Without an assessment of working memory prior to substance exposure, the differential contributions of substance-induced vs. preexisting impairment are unclear. Lower scores in the cannabis group may reflect lower socioeconomic status (SES), which is typically correlated with cognitive performance. These findings highlight underrecognized cognitive impairment in youth with SUDs, especially inner-city cannabis-dependent youth. Modification of treatments to account for cognitive capacity and/or cognitive remediation interventions may be indicated to improve treatment outcomes.
    No preview · Article · Aug 2014 · Substance Abuse
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