Importance Relapse is highly prevalent following substance abuse treatments, highlighting the need for improved aftercare interventions. Mindfulness-based relapse prevention (MBRP), a group-based psychosocial aftercare, integrates evidence-based practices from mindfulness-based interventions and cognitive-behavioral relapse prevention (RP) approaches. Objective To evaluate the long-term efficacy of MBRP in reducing relapse compared with RP and treatment as usual (TAU [12-step programming and psychoeducation]) during a 12-month follow-up period. Design, Setting, and Participants Between October 2009 and July 2012, a total of 286 eligible individuals who successfully completed initial treatment for substance use disorders at a private, nonprofit treatment facility were randomized to MBRP, RP, or TAU aftercare and monitored for 12 months. Participants medically cleared for continuing care were aged 18 to 70 years; 71.5% were male and 42.1% were of ethnic/racial minority. Interventions Participants were randomly assigned to 8 weekly group sessions of MBRP, cognitive-behavioral RP, or TAU. Main Outcomes and Measures Primary outcomes included relapse to drug use and heavy drinking as well as frequency of substance use in the past 90 days. Variables were assessed at baseline and at 3-, 6-, and 12-month follow-up points. Measures used included self-report of relapse and urinalysis drug and alcohol screenings. Results Compared with TAU, participants assigned to MBRP and RP reported significantly lower risk of relapse to substance use and heavy drinking and, among those who used substances, significantly fewer days of substance use and heavy drinking at the 6-month follow-up. Cognitive-behavioral RP showed an advantage over MBRP in time to first drug use. At the 12-month follow-up, MBRP participants reported significantly fewer days of substance use and significantly decreased heavy drinking compared with RP and TAU. Conclusions and Relevance For individuals in aftercare following initial treatment for substance use disorders, RP and MBRP, compared with TAU, produced significantly reduced relapse risk to drug use and heavy drinking. Relapse prevention delayed time to first drug use at 6-month follow-up, with MBRP and RP participants who used alcohol also reporting significantly fewer heavy drinking days compared with TAU participants. At 12-month follow-up, MBRP offered added benefit over RP and TAU in reducing drug use and heavy drinking. Targeted mindfulness practices may support long-term outcomes by strengthening the ability to monitor and skillfully cope with discomfort associated with craving or negative affect, thus supporting long-term outcomes. Trial Registration clinicaltrials.gov Identifier:NCT01159535

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/1839290/yoi130117.pdf

Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders: A Randomized Clinical Trial

AIM: To provide a comprehensive overview of clinical studies on the clinical picture of Internet-use related addictions from a holistic perspective. A literature search was conducted using the database Web of Science. METHODS: Over the last 15 years, the number of Internet users has increased by 1000%, and at the same time, research on addictive Internet use has proliferated. Internet addiction has not yet been understood very well, and research on its etiology and natural history is still in its infancy. In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as condition that requires further research prior to official inclusion in the main manual, with important repercussions for research and treatment. To date, reviews have focused on clinical and treatment studies of Internet addiction and Internet Gaming Disorder. This arguably limits the analysis to a specific diagnosis of a potential disorder that has not yet been officially recognised in the Western world, rather than a comprehensive and inclusive investigation of Internet-use related addictions (including problematic Internet use) more generally. RESULTS: The systematic literature review identified a total of 46 relevant studies. The included studies used clinical samples, and focused on characteristics of treatment seekers and online addiction treatment. Four main types of clinical research studies were identified, namely research involving (1) treatment seeker characteristics; (2) psychopharmacotherapy; (3) psychological therapy; and (4) combined treatment. CONCLUSION: A consensus regarding diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for treatment seekers.

Internet addiction and problematic Internet use: A systematic review of clinical research.

Two-thirds of those with HIV worldwide live in sub-Saharan Africa. Alcohol use is associated with the HIV epidemic through risky sex and suboptimal ARV adherence. In western Kenya, hazardous drinking was reported by HIV (53%) and general medicine (68%) outpatients. Cognitive behavioral treatment (CBT) has demonstrated strong efficacy to reduce alcohol use. This article reports on a systematic cultural adaptation and pilot feasibility study of group paraprofessional-delivered CBT to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya. Following adaptation and counselor training, five pilot groups were run (n = 27). Overall attendance was 77%. Percent days abstinent from alcohol (PDA) before session 1 was 52–100% (women) and 21–36% (men), and by session 6 was 96–100% (women) and 89–100% (men). PDA effect sizes (Cohen’s d) between first and last CBT session were 2.32 (women) and 2.64 (men). Participants reported treatment satisfaction. Results indicate feasibility, acceptability and preliminary efficacy for CBT in Kenya.

/pdf/systematic-cultural-adaptation-of-cognitive-behavioral-47bgs757n3.pdf

Systematic Cultural Adaptation of Cognitive-Behavioral Therapy to Reduce Alcohol Use Among HIV-Infected Outpatients in Western Kenya

Alcohol addiction is one of the most prevalent and debilitating psychiatric disorders among the general population. Yet, little has been published on what it is like for men to actually experience this disorder. The purpose of this study was to identify commonalities in the experience of alcohol addiction among seven male members of Alcoholics Anonymous. Using a phenomenological approach, the participants completed an audio taped, unstructured, nondirective interview in which they were asked to describe their experience of alcohol addiction. The interviews were then transcribed and read by a phenomenological research team. Four themes were discovered: Emotions, Control, Awareness of Others, and The Turning Point, as well as a temporal ground. The authors conclude that mental health professionals should encourage alcohol addicted persons to talk about their experiences and to help them identify feelings and develop new coping skills.

The lived experiences of alcohol addiction: men of alcoholics anonymous

This study tested the hypothesis that patients could be matched to effective treatments on the basis of certain pretreatment characteristics. Specifically, it was hypothesized that those Ss who showed more sociopathy, more psychopathology, and greater neuropsychological impairment would have better outcomes when treated with coping skills training and, conversely, that those with less impairment in these areas would have better outcomes with interactional treatment. Ninety-six male and female Ss were recruited from an inpatient alcoholism treatment program and randomly assigned to 1 of these 2 types of aftercare group treatment. Linear and logistic regression analyses partially confirmed the hypotheses. Coping skills training was more effective for Ss higher in sociopathy or psychopathology, and interactional therapy was more effective for Ss lower in sociopathy. Generally, both treatments appeared equally effective for Ss lower in psychopathology. Contrary to expectations, those more neuropsychologically impaired appeared to have better outcomes after interactional therapy.

Matching Alcoholics to Coping Skills or Interactional Therapies

(1991). Treating Alcohol Dependence: A Coping Skills Training Guide. Journal of Psychoactive Drugs: Vol. 23, No. 1, pp. 89-90.

Israel Ndoro

Papers

Treating Alcohol Dependence: A Coping Skills Training Guide