Review of the research

Several studies have examined the feasibility and efficacy of integrated, secularized, mindfulness-based treatment for alcohol and other substance use disorders (SUDs), as well as cigarette smoking and eating disorders. Several of these studies have found mindfulness-based approaches to be more effective than no treatment/wait-list/standard care control groups (Bowen et al. 2009; Brewer et al. 2011) and in some studies, more effective than existing evidence-based treatments (Bowen et al. 2014; Witkiewitz et al. 2014). In a review of 24 studies, Chiesa and Serretti (2014) concluded that mindfulness-based interventions can significantly decrease the consumption of alcohol and illicit drugs. Discussed here are a sample of the programs and studies of these interventions.

Findings from one pilot study by Zgierska and colleagues (2008) indicated that mindfulness-based outpatient intervention was feasible, well received by participants, and associated with significant improvements in stress, depression, and anxiety. Additionally, participants reported reduction in drinking behaviors that were maintained four months after the end of the course (Zgierska et al. 2008). A subsequent pilot study, conducted by Brewer et al. (2009), assessed a similar mindfulness-based approach, comparing the effect of mindfulness training to cognitive behavioral therapy for treatment of alcohol and/or cocaine use disorder. Results indicated that both treatments were acceptable, and there was no difference in alcohol or drug use between the groups. However, laboratory tests indicated a greater reduction in psychological and physiological stress during a protocol designed to elicit a stress reaction for participants in the mindfulness training condition compared to participants in the CBT group.

Mindfulness-oriented recovery enhancement (MORE) is a program developed by Garland and colleagues (2014) that provides individuals with opportunities to practice and develop awareness and acceptance ofmoment-to -moment experience. Uniquely, this model of mindfulness training targets mechanisms believed to drive chronic pain and problematic opioid use. In a study evaluating the efficacy of MORE, investigators found significant improvements in problematic pain symptoms post-treatment, but changes were not significant at a three-month follow-up (Garland et al. 2014).

While there have been a sizable number of preliminary investigations evaluating the feasibility, acceptability, and efficacy of mindfulness-based treatments for addiction, until recently few studies had investigated the relative effectiveness of mindfulness-based approaches compared to more conventional cognitive behavior therapy and traditional 12-Step treatment. Two recent randomized clinical trials by our research team (Bowen et al. 2014; Witkiewitz et al. 2014) provide evidence for the efficacy of mindfulness-based relapse prevention (MBRP) in treating SUDs. Bowen and colleagues (2014) examined the relative efficacy of group-based MBRP, cognitive behavioral RP, and treatment as usual (TAU; which consisted of 12-Step and psychoeducational components) among individuals (N = 286) who completed intensive outpatient or inpatient treatment for SUDs. At six-month follow-up, individuals randomly assigned to either RP or MBRP had significantly better outcomes (defined as fewer days of drug use and heavy drinking) than those assigned to TAU. However, at the 12-month follow-up MBRP participants had fewer drug use days and an increased rate of abstaining from heavy drinking than both RP and TAU.

Subsequently, Witkiewitz and colleagues (2014) examined the efficacy of group-based MBRP compared to RP within the context of residential treatment for female criminal offenders. Individuals (N = 105) were randomized to receive eight weeks of MBRP or RP during the course of a six-month residential addiction treatment program, and were later followed for 15 weeks post-release from the program. Individuals randomly assigned to MBRP had significantly lower rates of drug use, fewer drug-related consequences, and lower addiction severity at follow-up, compared to those assigned to RP.

In addition to reductions in substance use, studies indicate that mindfulness- based interventions are associated with other benefits. These include decreased craving (Bowen et al. 2009; Vieten et al. 2010), an attenuation of the association between depressive symptoms and craving (Witkiewitz and Bowen 2010), decreased cue reactivity (Brewer et al. 2010; Garland et al. 2010), and reduced shame (Luoma et al. 2012).

Recent evidence suggests that mindfulness-based and related interventions may also be effective for smoking cessation (Chiesa and Serretti 2014). Brewer and colleagues (2011) demonstrated that eight sessions of group-based mindfulness training was associated with significant reductions in cigarette use, as compared to the American Lung Association’s Freedom from Smoking Treatment. Moreover, in this study self-reported mindfulness meditation practice outside of treatment sessions was correlated with less cigarette use. Studies indicate that ACT may also be effective in treating nicotine dependence. For example, Hernandez-Lopez and colleagues (2009) found long-term benefits of ACT over CBT in reducing smoking, and Gifford and colleagues (2004) showed that participants who had received ACT had higher quit rates at one-year follow-up compared to those who had received only nicotine replacement therapy.

There is also preliminary, yet promising, empirical support for mindfulness- based and related interventions in the treatment of eating disorders and in the promotion of weight loss among obese or overweight individuals. These interventions similarly combine mindfulness practices, targeting awareness and tolerance of discomfort, with more traditional cognitive and behavioral approaches. Two small, wait-list controlled trials (Safer et al. 2001; Telch et al. 2001) and one sizeable randomized controlled trial (RCT; Safer et al. 2010) provided evidence for the efficacy of DBT in treating binge eating disorder (BED). Mindfulness- Based Eating Awareness Training (MB-EAT; Kristeller and Wolever 2011) also holds promise as a treatment for BED. In an RCT of 150 overweight and obese individuals with BED, both MB-EAT and a psychoeducational/cognitive behavioral intervention produced significant reductions in binge eating and depression over a wait-list control group (Kristeller et al. 2013).

Compared to BED, there has been considerably less research on MBIs for anorexia nervosa (AN) and bulimia nervosa (BN). Preliminary evidence suggests that a mindful eating group (Hepworth 2011) and ACT (Juarascio et al. 2013) may be effective adjunctive treatments for individuals with AN and BN. Moreover, Juarascio et al. (2010) found that ACT reduced disordered eating in a subclinical population to a greater extent than cognitive therapy, suggesting that ACT may be an effective treatment for subclinical eating pathology.

In relation to mindfulness-related interventions as weight loss interventions, several studies suggest that ACT may be effective. In a sizeable RCT, Forman and colleagues (2013) demonstrated that ACT produced significantly greater weight loss compared to a standard behavioral treatment when the interventionist was a weight control expert. Additionally, two open trials (Forman et al. 2009; Niemeier et al. 2012) and two smaller controlled trials of ACT for weight loss (Tapper et al. 2009; Weineland et al. 2012) provide evidence for ACT as a weight loss intervention.

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