Document Type: Original Article(s)
Department of Clinical Psychology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
Assistant Professor, Behavioral Sciences Research Center AND Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Assistant Professor, Department of Biostatistics and Epidemiology, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
Background: Impulsivity is one of the causes of relapse that can affect treatment outcomes. Studies have shown that addiction treatments can reduce impulsivity in drug-dependent individuals. Studies also have suggested that mindfulness is associated with impulsivity. However, no study has investigated the effectiveness of the mindfulness-based intervention on impulsivity in opioid-dependent individuals. This study aimed to compare the effectiveness of mindfulness-based relapse prevention (MBRP) with treatment as usual (TAU) in terms of impulsivity and relapse for methadone-treated patients.Methods: The present randomized controlled clinical trial was performed in Kashan, Iran, in 2015. The study population was opioid-dependent patients referred to Maintenance Treatment Centers. Seventy patients were selected by random sampling and were assigned in two groups (MBRP and TAU) randomly. The participants of two groups filled out Barratt impulsivity scale (BIS-11) as a pre-test and 8 weeks later as post-test and 2 months later as a follow-up. Both groups received methadone-therapy. The MBRP group received 8 sessions of group therapy, while the control group did not receive any group psychotherapy session. Finally, data from 60 patients were analyzed statistically.Findings: The MBRP group had decreased impulsivity significantly (P < 0.001). The mean impulsivity score was 74.76 ± 4.72 before intervention that was significantly decreased to 57.66 ± 3.73 and 58.86 ± 3.57 after the intervention and follow-up (P < 0.001), respectively. In addition, significant differences were observed between MBRP and TAU groups for relapse frequency (P < 0.050).Conclusion: This study showed that MBRP compared to TAU can decrease the mean impulsivity score in opioid-dependent and reduce relapse probability. These findings suggest that MBRP is useful for opioid-dependent individuals with high-level impulsivity, and relapse prevention.
- Alaghemandan H, Ghaffari Darab M, Khorasani E, Namazi E, Maniyan MH, Barati M. Personality traits and their relationship to demographic features in addicts referring to a drug rehabilitation center in the city of Isfahan, Iran. Iran J Public Health 2015; 44(4): 551-60.
- Naserbakht M, Djalalinia S, Tayefi B, Gholami M, Eftekhar Ardabili M, Shariat SV, et al. National and sub-national prevalence, trend, and burden of mental disorders and substance abuse in Iran: 1. Arch Iran Med 2014; 17(3): 182-8.
- Karajibani M, Montazerifar F, Shakiba M. Evaluation of nutritional status in drug users referred to the center of drug dependency treatment in Zahedan. High Risk Behav Addict 2012; 1(1): 18-21.
- McLellan AT, McKay JR, Forman R, Cacciola J, Kemp J. Reconsidering the evaluation of addiction treatment: From retrospective follow-up to concurrent recovery monitoring. Addiction 2005; 100(4): 447-58.
- Blume AW. Treating drug problems. New York, NY: John Wiley & Sons; 2005.
- Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: Neuroimaging findings and clinical implications. Nat Rev Neurosci 2011; 12(11): 652-69.
- Meil W, LaPorte D, Stewart P. Substance dependence as a neurological disorder Ken-Shiung Chen Dr, advanced topics in neurological disorders [Online]. [cited 2012]; Available from: URL: http://cdn.intechopen.com/pdfs/32484/InTech Substance_dependence_as_a_neurological_disorder.pdf
- Heinz AJ, Bui L, Thomas KM, Blonigen DM. Distinct facets of impulsivity exhibit differential associations with substance use disorder treatment processes: A cross-sectional and prospective investigation among military veterans. J Subst Abuse Treat 2015; 55: 21-8.
- Coskunpinar A, Dir AL, Cyders MA. Multidimensionality in impulsivity and alcohol use: A meta-analysis using the UPPS model of impulsivity. Alcohol Clin Exp Res 2013; 37(9): 1441-50.
- Dick DM, Smith G, Olausson P, Mitchell SH, Leeman RF, O'Malley SS, et al. Understanding the construct of impulsivity and its relationship to alcohol use disorders. Addict Biol 2010; 15(2): 217-26.
- Loree AM, Lundahl LH, Ledgerwood DM. Impulsivity as a predictor of treatment outcome in substance use disorders: Review and synthesis. Drug Alcohol Rev 2015; 34(2): 119-34.
- Stevens L, Verdejo-Garcia A, Goudriaan AE, Roeyers H, Dom G, Vanderplasschen W. Impulsivity as a vulnerability factor for poor addiction treatment outcomes: A review of neurocognitive findings among individuals with substance use disorders. J Subst Abuse Treat 2014; 47(1): 58-72.
- Streeter CC, Terhune DB, Whitfield TH, Gruber S, Sarid-Segal O, Silveri MM, et al. Performance on the Stroop predicts treatment compliance in cocaine-dependent individuals. Neuropsychopharmacology 2008; 33(4): 827-36.
- King KM, Fleming CB, Monahan KC, Catalano RF. Changes in self-control problems and attention problems during middle school predict alcohol, tobacco, and marijuana use during high school. Psychol Addict Behav 2011; 25(1): 69-79.
- Blonigen DM, Timko C, Moos BS, Moos RH. Treatment, alcoholics anonymous, and 16-year changes in impulsivity and legal problems among men and women with alcohol use disorders. J Stud Alcohol Drugs 2009; 70(5): 714-25.
- Blonigen DM, Timko C, Moos RH. Alcoholics anonymous and reduced impulsivity: A novel mechanism of change. Subst Abus 2013; 34(1): 4-12.
- Marlatt GA, Donovan DM. Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. 2nd ed. New York, NY: Guilford Press; 2005.
- Witkiewitz K, Alan MG, Denise W. Mindfulness-based relapse prevention for alcohol and substance use disorders. J Cogn Psychother 2005; 19(3): 211-28.
- Witkiewitz K, Bowen S, Douglas H, Hsu SH. Mindfulness-based relapse prevention for substance craving. Addict Behav 2013; 38(2): 1563-71.
- Hsu SH, Collins SE, Marlatt GA. Examining psychometric properties of distress tolerance and its moderation of mindfulness-based relapse prevention effects on alcohol and other drug use outcomes. Addict Behav 2013; 38(3): 1852-8.
- Imani S, Atef Vahid MK, Gharraee B, Habibi M, Bowen S, Noroozi A. Comparing mindfulness-based group therapy with treatment as usual for opioid dependents: A pilot randomized clinical trial study protocol. Iran J Psychiatry Behav Sci 2015; 9(1): e216.
- Tang YY, Tang R, Posner MI. Mindfulness meditation improves emotion regulation and reduces drug abuse. Drug Alcohol Depend 2016; 163(Suppl 1): S13-S18.
- Breslin FC, Zack M, McMain S. An Information-Processing Analysis of Mindfulness: Implications for Relapse Prevention in the Treatment of Substance Abuse. Clin Psychol 2002; 9(3): 275-99.
- Tiffany ST. A cognitive model of drug urges and drug-use behavior: Role of automatic and nonautomatic processes. Psychol Rev 1990; 97(2): 147-68.
- Axelrod SR, Perepletchikova F, Holtzman K, Sinha R. Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy. Am J Drug Alcohol Abuse 2011; 37(1): 37-42.
- Brewer JA, Elwafi HM, Davis JH. Craving to quit: Psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychol Addict Behav 2013; 27(2): 366-79.
- Barratt ES, Stanford MS, Kent TA, Felthous A. Neuropsychological and cognitive psychophysiological substrates of impulsive aggression. Biol Psychiatry 1997; 41(10): 1045-61.
- Naderi F, Haghshenas F. The relationship between impulsivity, loneliness and the mobile phone usage rate in male and female students of Ahvaz Islamic Azad University. Journal of Social Psychology 2009; 4(12): 111-21. [In Persian].
- Shorey RC, Elmquist J, Wolford-Clevenger C, Gawrysiak MJ, Anderson S, Stuart GL. The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation in a sample of women in residential substance use treatment. Psychiatry Res 2016; 238: 122-8.
- Holzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci 2011; 6(6): 537-59.
- Liu YP, Huang TS, Tung CS, Lin CC. Effects of atomoxetine on attention and impulsivity in the five-choice serial reaction time task in rats with lesions of dorsal noradrenergic ascending bundle. Prog Neuropsychopharmacol Biol Psychiatry 2015; 56: 81-90.
- Potenza MN, Sofuoglu M, Carroll KM, Rounsaville BJ. Neuroscience of behavioral and pharmacological treatments for addictions. Neuron 2011; 69(4): 695-712.
- Bowen S, Witkiewitz K, Clifasefi SL, Grow J, Chawla N, Hsu SH, et al. Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: A randomized clinical trial. JAMA Psychiatry 2014; 71(5): 547-56.
- Bowen S, Chawla N, Collins SE, Witkiewitz K, Hsu S, Grow J, et al. Mindfulness-based relapse prevention for substance use disorders: A pilot efficacy trial. Subst Abus 2009; 30(4): 295-305.
- Heeren A, Philippot P. Changes in Ruminative thinking mediate the clinical benefits of mindfulness: Preliminary findings. Mindfulness 2011; 2(1): 8-13.
- Shapiro SL, Carlson LE, Astin JA, Freedman B. Mechanisms of mindfulness. J Clin Psychol 2006; 62(3): 373-86.
- Grabovac AD, Lau MA, Willett BR. Mechanisms of mindfulness: A buddhist psychological model. Mindfulness 2011; 2(3): 154-66.
- Kalivas PW, Volkow ND. The neural basis of addiction: A pathology of motivation and choice. Am J Psychiatry 2005; 162(8): 1403-13.