Mindfulness in the T reatment of Opioid Use Disorder Laura R. - - PDF document

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Mindfulness in the T reatment of Opioid Use Disorder Laura R. - - PDF document

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10/ 13/ 2019 Mindfulness in the T reatment of Opioid Use Disorder Laura R. Lander, M SW Department of Behavioral Medicine and Psychiatry School of Medicine Keith J . Zullig, M SPH, PhD, FAAHB, FASHA Department of Social and Behavioral

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10/ 13/ 2019 1

Mindfulness in the T reatment of Opioid Use Disorder

Laura R. Lander, M SW Department of Behavioral Medicine and Psychiatry School of Medicine Keith J . Zullig, M SPH, PhD, FAAHB, FASHA Department of Social and Behavioral Sciences School of Public Health

Disclosures

  • This study is supported by Grant #, 6R49CE002109-05-06,

funded by the US CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the US DHHS .

  • We have no conflicts of interest

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Recruited (N=73)

Control Group, T reatment as Usual Participants Baseline(n= 40) 36 weeks total

1212 week data collection n=38

Dismissed before 2nd data collection (n= 2) Data collected at baseline, 12 weeks, 24 weeks and 36 weeks Dismissed before 2nd data collection (n=3 ) Dismissed before 3rd data collection (n= 2) M BRP Participants Baseline (n= 33) 24 week intervention, 12 week post intervention (36 weeks total) 24 week data collection n=31 36 week data collection n=29

1212 week data collection n=30 122424 week data collection n= 28 1236 week data collection n=26

Dismissed before 4thrd data collection (n= 2) Dismissed before 3rd data collection (n= 7) Dismissed before 4thrd data collection (n= 2) 36 week data still to be collected: n=11, C= 2, MBRP= 9 3

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The Study - Methods

  • Participants were recruited from West Virginia University’s Comprehensive

Opioid Addiction Treatment program who were at least 90 consecutive days substance free.

  • Participants self-selected into mindfulness (M BRP) or comparison groups

(treatment as usual, T AU).

  • In the MBRP group, participants attend a biweekly 60-minute session for 24

weeks led by a licensed therapist who is part of our research team. M easures are administered at baseline, 12 weeks, 24 weeks, and 36 weeks post- intervention.

  • In the comparison group, participants attend a biweekly 60-minute CBT based

process group for 24 weeks led by a licensed therapist. Measures are also administered at baseline, 12 weeks, 24 weeks, and 36 weeks post-intervention.

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Mindfulness Based Relapse Prevention (MBRP)

Nuts and Bolts of MBRP

  • Mindful skill building
  • Breathing
  • Meditation
  • Mindful movement- Gentle yoga practiced with mindful aw areness of

the body

  • Using all of your senses
  • Increasing awareness of breath, body sensations, emotional energy,

thoughts

  • Discussion of practice outside of group and/ or in class exercises
  • Daily home practice assignments- formal mindfulness meditation (30

min/ day, 5-6 days/ week)

  • Mindfulness in everyday life (informal practice)

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MBRP Mindfulness Experience

Sitting M editation: Sound, Breath, Sensation, Thought

Bowen S, Chawla N, Marlatt GA. Mindfulness-Based Release Prevention for Addictive Behaviors. NY : Guilford Press, 2011, pg.103

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10/ 13/ 2019 3

Study Outcomes

  • Participant outcomes tracked:

1. Retention 2. Relapse on any prohibited substance 3. Self-reported

1. Craving (via the Desire for Drugs Questionnaire, DDQ) 2. Anxiety (via the Overall Anxiety Severity & Impairment Scale, OASIS) 3. Depression (via the Overall Depression Severity & Impairment Scale, ODSIS) 4. Mindfulness (via the 5-Facet Mindfulness Questionnaire, FFMQ, alpha = .91)

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Data Analysis

  • Descriptive Statistics were used to analyze relapse

and retention

  • A linear mixed model with random effects was

performed on the self-report survey data.

  • Fixed effects are reported in the results
  • We selected the best model with the lowest Akaike

information criterion (AIC).

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Demographics

  • Using a Fisher’s Exact T

est, no significant differences were detected at baseline between MBRP and T AU participants within marital status (p=0.65), gender (p=.06), race (p=.21), employment (p=0.96), or insurance (p=0.62).

  • However, a significant difference

was detected between MBRP and T AU participants within education (p=.01).

Demographics M BRP TAU Total p-value M arital Status 0.65 Single 10 17 27 Married 2 5 7 Divorced or Separating 5 5 11 Gende r 0.06 Male 4 14 18 Female 11 13 24 Other 2 2 Race 0.21 White 17 27 44 Employment 0.96 Full Ti me 7 10 17 PartTime 3 5 8 Unemployed 7 14 2 19 Education 0.01 Did Not Finish High School 2 1 3 High School Grad/ GED 6 21 27 Some College or Greater 9 5 14 Insurance 0.62 Medicaid 15 21 36 Medicare 1 2 3 Medicaid 1 4 5

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Retention Results

  • 24 week data N=62 (T

AU group n = 38; MBRP group n = 24)

  • Retention at 24 weeks
  • T

AU group: 29/ 38 - 76%; MBRP group: 19/ 24 - 79%

  • Differences between groups not statistically significant (χ2 = .07, p = 0.79)
  • 36 week data N= 44 (T

AU group n = 27 ; MBRP group n = 17)

  • Retention 24-36 weeks
  • T

AU group: 25/ 27 -93%; MBRP group: 15/ 17 -88%

  • Differences between groups not statistically significant (χ2 = .24, p = 0.63)

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Relapse Results

  • Initial 24 week data N=62 (T

AU group n = 38; MBRP group n = 24)

  • Relapse (# people who relapsed at least 1x in 24 weeks including those

dismissed)

  • TAU group: 16/ 38 -42%; MBRP group: 8/ 24 - 33%
  • Differences between groups not statistically significant (χ2 = .48, p = 0.49)
  • 36 week data N= 44 (T

AU group n = 27 ; MBRP group n = 17)

  • Relapse (# people who relapsed at least 1x in 36 weeks of those w ho completed

the study)

  • TAU group: 10/ 27 - 37%; MBRP group: 7/ 17 - 41%
  • Differences between groups not statistically significant (χ2 = .08, p = 0.78)
  • # people who relapsed at least 1x between 24 and 36 only (post intervention), N=44
  • TAU group: 6/ 27 - 22%; MBRP group: 6/ 17 - 35%
  • Differences between groups not statistically significant (χ2 = .90, p = .34)

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Craving Results

22.89 20.74 19.65 19.18 23.93 22 22.16 19.15

5 10 15 20 25 30

Baseline 12 Weeks 24 Weeks 36 Weeks

Self-Report Mean Craving Scores Across Time by Group (Range 14-70)

MBRP TAU 12

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Anxiety Results

9.58 6.42 6.05 5.65 6.55 6.72 5.86 5.5

2 4 6 8 10 12

Baseline 12 Weeks 24 Weeks 36 Weeks

Self-Report Depression Scores Across Time by Group (Range 0-20)

MBRP TAU 13

Depression Results

7.42 4.21 4.05 3.35 5.62 5.1 4.28 4.08

1 2 3 4 5 6 7 8

Baseline 12 Weeks 24 Weeks 36 Weeks

Self-Report Mean Depression Scores Across Time by Group (Range 0-20)

MBRP TAU 14

Mindfulness Results

2.99 3.36 3.5 3.55 3.14 3.27 3.33 3.31

2.7 2.8 2.9 3 3.1 3.2 3.3 3.4 3.5 3.6

Baseline 12 Weeks 24 Weeks 36 Weeks

Self-Report Mean Mindfulness Scores Across Time by Group (Range 1-5)

MBRP TAU 15

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Discussion

  • No statistical differences in relapse and retention rates

between MBRP and T AU groups

  • Rates of relapse trending higher in MBRP

, post intervention

  • Significant decreases occurred in craving in both MBRP

and T AU groups

  • There were significantly greater reductions in

depression, anxiety in the MBRP group indicating an intervention effect

  • There were significantly greater increases in

mindfulness in the MBRP group compared to T AU

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Conclusions

  • MBRP can be successfully implemented in an out-

patient setting with as good as or better results as TAU

  • Future directions –
  • Larger scale study to determine significant effect on

relapse

  • Who benefits most from M BRP?
  • Those with co-occurring mood disorders

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