Manualised mindfulness-based programs for substance use disorders to reduce cravings

Manualised mindfulness-based interventions (i.e. structured programs of at least 8 sessions) were reviewed to assess the effets of different existing programs in a narrative review (Korecki et. al, 2020, 30 RCTs). The mindfulness-based programs analysed in the review were the following - from the most common and studied to the least:

1. Mindfulness-based relapse prevention (MBRP) - a manualized, structured protocol that integrates formal meditation practices with the cognitive behavioral approach of relapse prevention treatment.
2. Mindfulness oriented recovery enhancement (MORE) - is a protocol that integrates elements of mindfulness training, cognitive restructuring, and positive psychology to address the factors theorized to maintain a substance use disorder.
3. Mindful awareness in body-oriented therapy (MABT) - is a manualized, mindfulness-based approach that is designed to teach interoceptive skills for self-care. Interoception is the ability to process signals that originate in the body and is broadly described as the overall sensations, or state, of the body.
4. Mindfulness-based addiction treatment (MBAT) - is a protocol that closely follows the procedures and rationale of Mindfulness-Based Cognitive Therapy (MBCT) but with the depression focused content removed and replaced with information regarding substance use.
5. Mindfulness training for smoking cessation (MTS) - is a protocol built upon the foundational ideas outlined in both MBSR and MBRP, but was tailored specifically for individuals who are trying to stop smoking.
6. Moment-by-moment in Women’s recovery (MMWR) - developed as an adaptation of MBSR, specifically designed for low income, racially, and ethnically diverse women currently enrolled in residential SUD treatment.

Overall the review found structured mindfulness-based interventions to have beneficial effects on:

• cue-reactivity and thus reducing cravings
• reducing perceived stress

And promising effects on:

• psychiatric outcomes, including depression and anxiety symptoms

A more recent narrative systematic review (Ramadas et al., 2021) confirmed that, despite some heterogeneity regarding the type of MBRP program used, results support the effectiveness of these interventions in the SUD population, especially in reducing cravings, decreasing the frequency of use, and improving depressive symptoms.

A more recent systematic review (Félix-Junior et al., 2022, 21 studies, 11 studies focused on therapeutic communities and 9 in residential treatment) confirmed the effectiveness of Mindfulness-Based Interventions to:

• reduce cravings and improve treatment adherence

It is unclear whether the inpatient context could affect MBI. Only one study from 21 included showed data related to the impact of the context over the implementation. Future studies could further consider the influence of context on MBI.