Research Article: Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research

Date Published: April 18, 2018

Publisher: BioMed Central

Author(s): Eric L. Garland, Matthew O. Howard.

http://doi.org/10.1186/s13722-018-0115-3

Abstract

Contemporary advances in addiction neuroscience have paralleled increasing interest in the ancient mental training practice of mindfulness meditation as a potential therapy for addiction. In the past decade, mindfulness-based interventions (MBIs) have been studied as a treatment for an array addictive behaviors, including drinking, smoking, opioid misuse, and use of illicit substances like cocaine and heroin. This article reviews current research evaluating MBIs as a treatment for addiction, with a focus on findings pertaining to clinical outcomes and biobehavioral mechanisms. Studies indicate that MBIs reduce substance misuse and craving by modulating cognitive, affective, and psychophysiological processes integral to self-regulation and reward processing. This integrative review provides the basis for manifold recommendations regarding the next wave of research needed to firmly establish the efficacy of MBIs and elucidate the mechanistic pathways by which these therapies ameliorate addiction. Issues pertaining to MBI treatment optimization and sequencing, dissemination and implementation, dose–response relationships, and research rigor and reproducibility are discussed.

Partial Text

Advances in biobehavioral science occurring over the past several decades have made significant headway in elucidating mechanisms that undergird addictive behavior. This large body of research suggests that addiction is best regarded as a cycle of compulsive substance use subserved by dysregulation in neural circuitry governing motivation and hedonic experience, habit behavior, and executive function [1]. Though findings from the basic science of addiction have yielded novel treatment targets that may inform the development of promising pharmacotherapies, the behavioral treatment development process often lags behind the ever-accelerating pace of mechanistic discovery. In that regard, the mainstays of behavioral addictions treatment, cognitive-behavioral therapy and motivational interviewing, were developed decades ago and prior to the current understanding of addiction as informed by neuroscience. Yet, to the extent that behavioral therapies target dysregulated neurocognitive processes underlying addiction, they may hold promise as effective treatments for persons suffering from addictive disorders.

A considerable body of findings has amassed supporting the capacity of MBIs to reduce substance use and attenuate factors promoting substance use, such as craving and stress. Over the past decade, multiple systematic reviews have been conducted to identify the effects of MBIs on addictive behaviors, and have found accumulated evidence for the positive effects of MBIs [61–63]. More recently, a meta-analysis focused on the broad clinical efficacy of MBIs for a range pf psychiatric disorders conducted subgroup analyses to examine the effects of MBIs on addiction/smoking and found MBIs to be superior to active control conditions and comparable to other evidence-based treatments [4]. In the only published meta-analysis solely focused on MBIs for substance misuse, Li, Howard, Garland, McGovern, and Lazar [64] identified 34 randomized controlled trials differing in terms of the types of MBI and comparison groups contrasted, sample demographics, and measures of outcomes and other constructs. Despite the notable methodological heterogeneity of these investigations, the authors concluded that “virtually all studies found that mindfulness treatments were associated with superior treatment outcomes at posttreatment and follow-up assessments compared to comparison conditions” (p. 69). Effects (Cohen’s d/odds ratios) ranged from moderate-to-large across the synthesized effect sizes computed for studies within the substance use (d = 0.33, − 0.49 to 0.17, p < 0.05), cigarette smoking (OR = 1.76, 0.99–3.15, p = 0.056), craving (d = 0.68, − 1.11 to − 0.025, p < 0.01), and stress (d = 1.12, − 2.24 to –0.01, p < 0.05) domains. The study of mindfulness as a treatment for stress and chronic pain is more than 30 years old, and researchers have investigated mindfulness as a treatment for depression for more than two decades, yet it is only in the past 10 years that research on MBIs for addiction has proliferated. This is a young scientific field, and more research is needed to elucidate the clinical outcomes and mechanisms of this promising new treatment approach for addictive disorders. One recent meta-analysis [64] indicates that MBIs produce statistically significant effects on craving (pooled Cohen’s d = 0.68) and substance misuse (pooled Cohen’s d = 0.33), suggesting that MBIs may be efficacious treatments for addiction. Overall, a number of RCTs with active control conditions have been conducted in the past decade—a sign that the methodological rigor of this field is increasing. However, with several notable exceptions (e.g., [40, 91, 92]), few studies of MBIs for addiction have had large enough sample sizes to ensure the robustness and reproducibility of clinical outcomes. Moreover, few long-term follow-ups have been conducted to assess the durability of observed treatment effects. In addition, as indicated earlier, little is known about mediators and moderators of MBIs for addiction, although understanding how and for whom MBIs work is crucial to the overall evolution of this therapeutic approach. Lastly, research is needed to situate MBIs into treatment sequences with high external validity that adaptively address the needs of responders and non-responders in a way that can be realistically implemented in community-based treatment settings. Thus, the nascent field of mindfulness treatment for addictive behaviors remains open to rigorous, scientific exploration and in need of innovative research questions and methodologies.   Source: http://doi.org/10.1186/s13722-018-0115-3

 

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