RAND researchers conducted a systematic review that synthesized evidence from randomized controlled trials of Mindfulness-Based Relapse Prevention (MBRP) — used as an adjunctive therapy or monotherapy — to provide estimates of its efficacy and safety for treating adults diagnosed with alcohol, opioid, stimulant, or cannabis use disorder.

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Mindfulness-Based Relapse Prevention for Substance Use Disorders

A Systematic Review

by Sean Grant, Susanne Hempel, Benjamin Colaiaco, Aneesa Motala, Roberta M. Shanman, Marika Booth, Whitney Dudley, Melony E. Sorbero

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Research Question

  1. What are the efficacy and safety of Mindfulness-Based Relapse Prevention (MBRP), as an adjunctive therapy or monotherapy, in reducing relapse, frequency and quantity of substance use, withdrawal/craving symptoms, treatment dropout, and adverse events and improving functional status and health-related quality of life for adults with alcohol, opioid, stimulant, or cannabis use disorders compared with treatment as usual, wait lists, no treatment, or other active treatments?

RAND researchers conducted a systematic review that synthesized evidence from randomized controlled trials of Mindfulness-Based Relapse Prevention (MBRP) — used as an adjunctive therapy or monotherapy — to provide estimates of its efficacy and safety for treating adults diagnosed with alcohol, opioid, stimulant, or cannabis use disorder.

Outcomes of interest included relapse, frequency and quantity of substance use, withdrawal/craving symptoms, treatment dropout, functional status, health-related quality of life, recovery outcomes, and adverse events. When possible, meta-analyses and meta-regressions were conducted using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.

Six trials (reported in 20 publications) with 685 participants were included. Evidence was insufficient to determine whether MBRP effects differ by type of substance use targeted. There were no significant effects for MBRP as an adjunctive therapy or a stand-alone monotherapy for most outcomes. There were statistically significant effects for MBRP as an adjunctive therapy for health-related quality of life and legal problems, yet this was based on very low quality of evidence from one randomized controlled trial. Effects did not appear to systematically differ by identified comparison group. The available evidence on adverse events is very limited.

There were no statistically significant differences between MBRP and any comparators for substance use outcomes. Given the quality of evidence, there is uncertainty in the magnitude or stability of effect estimates. To provide more firm conclusions about the efficacy and safety of MBRP, future RCTs on this intervention are needed.

Key Findings

There Were No Consistent Differences Between MBRP and Any of the Comparators for Substance Use Outcomes

  • Overall, the available evidence in support of MBRP is very limited, both in terms of the quantity of existing studies and the quality of the body of evidence.
  • The review indicates positive results for MBRP as an adjunctive therapy for health-related quality of life and legal problems; however, given that these results were based on one RCT without replication, there is uncertainty in the magnitude and stability of effect estimates.
  • The available evidence on adverse events is also very limited; two RCTs reported no adverse events, while a third reported that one participant receiving standard relapse prevention died, and another participant receiving MBRP was admitted to inpatient care for reasons unknown.
  • The overall pattern of the data does not suggest that MBRP is any more efficacious for substance use disorder outcomes than standard treatments, though future trials are needed to provide more firm conclusions about the efficacy and safety of MBRP.

Recommendations

  • To provide firmer conclusions about the efficacy and safety of MBRP, future RCTs on this intervention are needed.
  • Future trials should include larger sample sizes, use longer follow-up periods of at least 12 months, preregister their protocols and subsequently report all outcomes measured in trial manuscripts, and provide reports in compliance with guidance from the CONSORT (Consolidated Standards of Reporting Trials) Statement for reporting RCTs.
  • Researchers may also wish to consider equity issues with regard to MBRP and other mindfulness-based treatments, such as whether there are gender differences in the effects of these interventions.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Appendix A

    Search Strategy

  • Appendix B

    Excluded Full-Text Articles

Research conducted by

This research was sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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