Kerman University of Medical Sciences

Document Type: Original Article


1 Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Department of Psychiatry, School of Medicine AND Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Quality of life (QOL) is always considered as a final consequence of clinical trials, interventions, and health care. The results of studies indicate that addiction leads to lower QOL. However, studies have been conducted on the effectiveness of mindfulness-based interventions on improving QOL. The aim of this study was to investigate the efficacy of mindfulness-based relapse prevention (MBRP) on QOL and craving in methadone-treated patients.
Methods: This study was conducted in Qom, Iran, in 2017. A sample of 70 methadone-treated patients were randomly selected and assigned to two groups (intervention and control). Participants in both groups completed the 36-item Short Form (SF-36) QOL Questionnaire and Craving Beliefs Questionnaire (CBQ) at the beginning of the study (pre-test), 8 weeks after the study (post-test), and two months after the study (follow up). In this study, the experimental group received 8 training sessions on mindfulness prevention, while the control group did not receive general information about addiction and did not receive any psychological intervention. Finally, data of 63 patients were analyzed with the SPSS software, chi-square test, t-test, and repeated-measures ANOVA.
Findings: The results of repeated-measures ANOVA showed that there was no significant difference between intervention and control groups in the pre-test, but MBRP in the intervention group significantly increased the scores of QOL and decreased the scores of craving, significantly (P < 0.001).
Conclusion: The findings of present study indicate that MBRP training can increase the psychological and physical health in dependent methadone-treated patients and decrease craving. These findings suggest that mindfulness training can be used as an effective intervention for improving QOL and reducing craving.


  1. Gross JJ. Emotion regulation: Conceptual and empirical foundations. In: Gross JJ, editors. Handbook of emotion regulation. New York, NY: Guilford Press; 2014. p. 3-20.
  2. World Health Organization. Report of the WHO expert committee on national drug policies. Geneva, Switzerland: WHO; 1995.
  3. Askian P, Krauss SE, Baba M, Kadir RA, Sharghi HM. Characteristics of co-dependence among wives of persons with substance use disorder in Iran. Int J Ment Health Addict 2016; 14(3): 268-83.
  4. Wegman MP, Altice FL, Kaur S, Rajandaran V, Osornprasop S, Wilson D, et al. Relapse to opioid use in opioid-dependent individuals released
    from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study. Lancet Glob Health 2017; 5(2): e198-e207.
  5. Seo D, Sinha R. Neuroplasticity and predictors of alcohol recovery. Alcohol Res 2015; 37(1): 143-52.
  6. Yule AM, Martelon M, Faraone SV, Carrellas N, Wilens TE, Biederman J. Examining the association between attention deficit hyperactivity disorder and substance use disorders: A familial risk analysis. J Psychiatr Res 2017; 85: 49-55.
  7. Kober H. Emotion regulation in substance use disorders. In: Gross JJ, editor. Handbook of emotion regulation. New York, NY, US: Guilford Press; 2014. p. 428-46.
  8. Tull MT, Berghoff CR, Wheeless LE, Cohen RT,
    Gratz KL. PTSD symptom severity and emotion regulation strategy use during trauma cue exposure among patients with substance use disorders: Associations with negative affect, craving, and cortisol reactivity. Behav Ther 2018; 49(1): 57-70.
  9. Witkiewitz K, Bowen S, Douglas H, Hsu SH. Corrigendum to "Mindfulness-based relapse prevention for substance craving" [Addictive Behaviors 38 (2013) 1563-1571]. Addict Behav 2018; 82: 202.

10. Muller AE, Clausen T. Group exercise to improve quality of life among substance use disorder patients. Scand J Public Health 2015; 43(2): 146-52.

11. Pasareanu AR, Opsal A, Vederhus JK, Kristensen O, Clausen T. Quality of life improved following in-patient substance use disorder treatment. Health Qual Life Outcomes 2015; 13: 35.

12. Magnee EH, de Weert-van Oene GH, Wijdeveld TA, Coenen AM, de Jong CA. Sleep disturbances are associated with reduced health-related quality of life in patients with substance use disorders. Am J Addict 2015; 24(6): 515-22.

13. Lim DS, Reynolds MR, Feldman T, Kar S, Herrmann HC, Wang A, et al. Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol 2014; 64(2): 182-92.

14. Strada L, Vanderplasschen W, Buchholz A, Schulte B, Muller AE, Verthein U, et al. Measuring quality of life in opioid-dependent people: a systematic review of assessment instruments. Qual Life Res 2017; 26(12): 3187-200.

15. Nantes SG, Strand V, Su J, Touma Z. Comparison of the Sensitivity to Change of the 36-Item Short Form Health Survey and the Lupus Quality of Life Measure Using Various Definitions of Minimum Clinically Important Differences in Patients with Active Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2018; 70(1): 125-33.

16. Ahmadi G, Sohrabi F, Borjali A, Ghaderi M, Mohseni MS. Effectiveness of emotion regulation training on mindfulness and craving in soldiers with opioid use disorder. Journal of Military Psychology 2015; 6(22): 5-21. [In Persian].

17. Shapiro SL, Carlson LE. The art and science of mindfulness: Integrating mindfulness into psychology and the helping professions. Washington, DC: American Psychological Association; 2017.

18. Dunning DL, Griffiths K, Kuyken W, Crane C, Foulkes L, Parker J, et al. Research review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents - a meta-analysis of randomized controlled trials. J Child Psychol Psychiatry 2019; 60(3): 244-58.

19. Hendershot CS, Witkiewitz K, George WH, Marlatt GA. Relapse prevention for addictive behaviors. Subst Abuse Treat Prev Policy 2011; 6: 17.

20. 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.

21. Garrison KA, Pal P, Rojiani R, Dallery J, O'Malley SS, Brewer JA. A randomized controlled trial of smartphone-based mindfulness training for smoking cessation: A study protocol. BMC Psychiatry 2015; 15: 83.

22. Ruscio AC, Muench C, Brede E, Waters AJ. Effect of brief mindfulness practice on self-reported affect, craving, and smoking: A pilot randomized controlled trial using ecological momentary assessment. Nicotine Tob Res 2016; 18(1): 64-73.

23. Maglione MA, Maher AR, Ewing B, Colaiaco B, Newberry S, Kandrack R, et al. Efficacy of mindfulness meditation for smoking cessation: A systematic review and meta-analysis. Addict Behav 2017; 69: 27-34.

24. Brown S, Victor B, Hicks LM, Tracy EM. Recovery support mediates the relationship between parental warmth and quality of life among women with substance use disorders. Qual Life Res 2017; 26(5): 1327-35.

25. Bowen S, Chawla N, Witkiewitz K. Mindfulness-based relapse prevention for addictive behaviors. In: Baer R, editor. Mindfulness-based treatment approaches. 2nd ed. San Diego, CA: Elsevier Academic Press; 2014. p. 141-57.

26. Gellatly R, Beck AT. Catastrophic thinking: A transdiagnostic process across psychiatric disorders. Cognit Ther Res 2016; 40(4): 441-52.

27. Mohammadzadeh A, Khosravani V, Feizi R. The comparison of impulsivity and craving in stimulant-dependent, opiate-dependent and normal individuals. J Subst Abuse 2018; 23(3): 312-7.

28. Wang P, Chen C, Yang R, Wu Y. Psychometric evaluation of health related quality of life among rural-to-urban migrants in China. Health Qual Life Outcomes 2015; 13: 155.

29. Torkan B, Parsay S, Lamyian M, Kazemnejad A, Montazeri A. Postnatal quality of life in women after normal vaginal delivery and caesarean section. BMC Pregnancy Childbirth 2009; 9: 4.

30. Yaghubi M, Zargar F, Akbari H. Comparing effectiveness of mindfulness-based relapse prevention with treatment as usual on impulsivity and relapse for methadone-treated patients: A randomized clinical trial. Addict Health 2017; 9(3): 156-65.

31. Tang YY, Tang R, Posner MI. Mindfulness meditation improves emotion regulation and reduces drug abuse. Drug Alcohol Depend 2016; 163(Suppl 1): S13-S18.

32. 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.

33. Brewer JA, Bowen S, Smith JT, Marlatt GA, Potenza MN. Mindfulness-based treatments for co-occurring depression and substance use disorders: What can we learn from the brain? Addiction 2010; 105(10): 1698-706.

34. Habibi M, Imani S, Pashaei S, Zahiri Sorori M, Mirzaee J, Zare M. Effectiveness of mindfulness treatment on quality of life in opium abusers: Promotion of the mental and physical health. Health Psychology 2013; 2(5): 63-81. [In Persian].

35. 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.

36. 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):

37. Zgierska A, Rabago D, Zuelsdorff M, Coe C, Miller M, Fleming M. Mindfulness meditation for alcohol relapse prevention: A feasibility pilot study. J Addict Med 2008; 2(3): 165-73.

38. Cook JM, Walser RD, Kane V, Ruzek JI, Woody G. Dissemination and feasibility of a cognitive-behavioral treatment for substance use disorders and posttraumatic stress disorder in the Veterans Administration. J Psychoactive Drugs 2006; 38(1): 89-92.

39. Katz D, Toner B. A systematic review of gender differences in the effectiveness of mindfulness-based treatments for substance use disorders. Mindfulness 2013; 4(4): 318-31.

40. Davis DM, Hayes JA. What are the benefits of mindfulness? A practice review of psychotherapy-related research. Psychotherapy (Chic) 2011; 48(2): 198-208.

41. Gratz KL, Tull MT. Emotion regulation as a mechanism of change in acceptance- and mindfulness-based treatments. In: Baer RA, editors. Assessing mindfulness and acceptance processes in clients: Illuminating the theory and practice of change. Oakland, CA: Context Press/New Harbinger Publications; 2010. p. 107-33.