Academic journal article Journal of Cognitive Psychotherapy

Mindfulness-Based Relapse Prevention for Alcohol and Substance Use Disorders

Academic journal article Journal of Cognitive Psychotherapy

Mindfulness-Based Relapse Prevention for Alcohol and Substance Use Disorders

Article excerpt

Cognitive-behavioral approaches to alcohol and drug use disorders have received considerable empirical support over the past 20 years. One cognitive-behavioral treatment, relapse prevention, was initially designed as an adjunct to existing treatments. It has also been extensively used as a stand-alone treatment and serves as the basis for several other cognitive and behavioral treatments. After a brief review of relapse prevention, as well as the hypothesized mechanisms of change in cognitive and behavioral treatments, we will describe a "new" approach to alcohol and drug problems called mindfulness-based relapse prevention. Preliminary data in support of mindfulness-meditation as a treatment for addictive behavior are provided and directions for future research are discussed.

Keywords: mindfulness; meditation; relapse prevention; substance abuse; substance abuse treatment

The excessive use of alcohol and other substances represents a significant public health problem worldwide (World Health Organization [WHO], 1999). The United Nations Office for Drug Control and Crime Prevention (UNODCCP, 2002) recently reported that approximately 185 million people worldwide are current drug users, which suggests the demand for treatment is on the rise. The lack of empirically supported treatments, and the minimal utilization of available treatments by those needing services indicates that brief, innovative treatments to serve those individuals with alcohol and drug use disorders are highly desired (Marlatt & Witkiewitz, 2002). Mutual support groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), are the most commonly available treatments in many developed countries worldwide (Room, 1998). However, these approaches may not be clinically indicated for certain drug and alcohol abusers (Marlatt, 1983; Marlatt & Witkiewitz, 2002). Given the substantial economic and individual costs of substance abuse worldwide (WHO, 1999), it is critical for cost-effective, empirically supported treatments to be developed, evaluated, and disseminated internationally (Marsden, Ogborne, Farrell, & Rush, 2000). Cognitive-behavioral approaches to substance use have received considerable attention in the research literature, with many studies demonstrating the efficacy and effectiveness of cognitive-behavioral treatments for a variety of addictive disorders across diverse populations (Carroll, 1996; Kadden, 2001; McCrady & Ziedonis, 2001). In this article we review existing cognitive-behavioral approaches to substance use disorders and introduce a novel cognitive-behavioral technique, mindfulness meditation, as an adjunct to existing treatments or as a stand-alone treatment of addictive disorders.

COGNITIVE BEHAVIORAL MODEL OF ADDICTION

Based on the premise that maladaptive drinking and drug use are learned behaviors, cognitive behavior therapy (CBT) provides a framework around which interventions attempt to identify situational, social, affective, and cognitive precipitants of pathological substance use. Once possible causes of maladaptive behavior are identified an individual may decide to reduce the quantity or frequency of substance use, or may decide to abstain from alcohol and drugs completely. Numerous studies have described the clinical and cost effectiveness of CBT in the promotion of abstinence rates, reduction of drinking quantity, frequency, and duration (Finney & Monahan, 1996; Kadden, 2001; Longabaugh & Morganstern, 1999), and prevention of relapse (Carroll, 1996; Irvin, Bowers, Dunn, & Wang, 1999).

CBT for alcohol and drug use disorders and the cognitive behavior (CB) model of alcohol and drug relapse was initially proposed by Marlatt and colleagues (Larimer, Palmer, & Marlatt, 1999; Marlatt & Gordon, 1985). As shown in Figure 1, the CB model of relapse is based on the linear progression of responses in high-risk situations. According to this model, if an effective coping strategy is used, then the individual will likely experience an increase in self-efficacy and is less likely to consume the previously desired substance. …

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