The current study is the first randomized-controlled trial evaluating the feasibility and initial efficacy of an 8-week outpatient Mindfulness-Based Relapse Prevention (MBRP) program as compared to treatment as usual (TAU). Participants were 168 adults with substance use disorders who had recently completed intensive inpatient or outpatient treatment. Assessments were administered pre-intervention, post-intervention, and 2 and 4 months post-intervention. Feasibility of MBRP was demonstrated by consistent homework compliance, attendance, and participant satisfaction. Initial efficacy was supported by significantly lower rates of substance use in those who received MBRP as compared to those in TAU over the 4-month post-intervention period. Additionally, MBRP participants demonstrated greater decreases in craving, and increases in acceptance and acting with awareness as compared to TAU. Results from this initial trial support the feasibility and initial efficacy of MBRP as an aftercare approach for individuals who have recently completed an intensive treatment for substance use disorders.

We describe a hybrid relational bureaucratic form with structures that embed three processes of reciprocal interrelating-relational coproduction, relational coordination, and relational leadership-into the roles of customers, workers, and managers. We show how these role-based relationships of shared goals, shared knowledge, and mutual respect foster participants' attentiveness to the situation and to one another, enabling the caring, timely, and knowledgeable responses found in the relational form, along with the scalability, replicability, and sustainability found in the bureaucratic form. Through these role-based relationships, relational bureaucracy promotes universalistic norms of caring for particular others.

The present study describes the development of the Mindfulness-Based Relapse Prevention Adherence and Competence Scale (MBRP-AC), a measure of treatment integrity for Mindfulness-Based Relapse Prevention (MBRP). MBRP is a newly developed treatment integrating core aspects of relapse prevention with mindfulness practices. The MBRP-AC was developed in the context of a randomized controlled trial (RCT) of MBRP efficacy and consists of two sections: Adherence (adherence to individual components of MBRP and discussion of key concepts), and Competence (ratings of therapist style/approach and performance). Audio recordings from 44 randomly selected group-treatment sessions (50%) were rated by independent raters for therapist adherence and competence in the RCT. Findings evinced high interrater reliability for all treatment adherence and competence ratings, and adequate internal consistency for Global Therapist Style/Approach and Global Therapist Competence summary scales. Ratings on the MBRP-AC showed that therapists in the recent RCT adhered to protocol, discussed key concepts in each session, and demonstrated the intended style and competence in treatment delivery. Finally, components of the Competence section were positively related to measures of therapeutic alliance, and overall ratings on the Adherence section were positively related to measures of change in mindfulness over the course of the treatment.