Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial

Abstract

In clinical settings, there is a high comorbidity between substance use disorders, psychiatric disorders, and traumatic stress. As such, transdiagnostic therapies are needed to address these co-occurring issues efficiently. The aim of the present study was to conduct a pragmatic randomized controlled trial comparing Mindfulness-Oriented Recovery Enhancement (MORE) to group Cognitive-Behavioral Therapy (CBT) and treatment-as-usual (TAU) for previously homeless men residing in a therapeutic community. Men with co-occurring substance use and psychiatric disorders, as well as extensive trauma histories, were randomly assigned to 10 weeks of group treatment with MORE (n=64), CBT (n=64), or TAU (n=52). Study findings indicated that from pre- to post-treatment MORE was associated with modest yet significantly greater improvements in substance craving, post-traumatic stress, and negative affect than CBT, and significantly greater improvements in post-traumatic stress and positive affect than TAU. A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed, suggesting that MORE may target these issues via enhancing mindful awareness in everyday life. This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders. Results suggest that MORE, as an integrative therapy designed to bolster self-regulatory capacity, may hold promise as a treatment for intersecting clinical conditions.

The Clinical Efficacy of Mindfulness-Based Treatments for Alcohol and Drugs Use Disorders: A Meta-Analytic Review of Randomized and Nonrandomized Controlled Trials

“…We observed great advantages in reducing the negative affectivity associated with MBIs, even though only one study [84] explained the pooled effect size. Generally speaking, this finding is principally consistent with the results from the empirical literature that demonstrated how mindfulness programs produced their benefits in clinical and nonclinical samples by decreasing the negative affect and by improving the positive affect (e.g., [26,145]), as well as by enhancing emotion regulation [146][147][148].…”

“…However, large heterogeneity was detected across the results. Specifically, only one study [84] demonstrated large differences between MBI and control condition in reducing negative affectivity. Conversely, the remaining 2 studies [91,97] showed no differences between treatment approaches.…”

Mindfulness Interventions

“…Mindfully attending to drug cues reduces neural and self-reported craving among smokers (Westbrook et al 2013), with some initial indication that mindfulness interventions reduce cravings more so than CBT treatment (Garland et al 2016). Moreover, mindfulness interventions can disrupt the effects cravings have on increasing suffering and substance abuse (Witkiewitz & Bowen 2010).…”

Achieve control: a pragmatic clinical trial of insulin glargine 300 U/mL versus other basal insulins in insulin-naïve patients with type 2 diabetes

“…Data from pragmatic RCTs, in contrast to explanatory RCTs, can potentially provide a much more generalizable picture of how interventions work in the real world and can be of greater interest to patients, providers, and payers. This type of study design has been used successfully by others to compare the effectiveness and costs of two alternative strategies for treating patients with elevated cholesterol levels [25], to compare the effect of interventions on decreasing craving and posttraumatic stress in patients with co-occurring substance abuse and psychiatric disorders [39], to assess interventions to improve adherence to pediatric asthma controller medication [40], and to examine whether a targeted pharmacist-led intervention might improve blood-pressure control among diabetes patients with persistent hypertension and poor refill adherence or insufficient medication intensification [41].…”