Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders: A Randomized Clinical Trial
Open accessAbstract
IMPORTANCE: Relapse is highly prevalent following substance abuse treatments, highlighting the need for improved aftercare interventions. Mindfulness-based relapse prevention (MBRP), a group-based psychosocial aftercare, integrates evidence-based practices from mindfulness-based interventions and cognitive-behavioral relapse prevention (RP) approaches. OBJECTIVE: To evaluate the long-term efficacy of MBRP in reducing relapse compared with RP and treatment as usual (TAU [12-step programming and psychoeducation]) during a 12-month follow-up period. DESIGN, SETTING, AND PARTICIPANTS: Between October 2009 and July 2012, a total of 286 eligible individuals who successfully completed initial treatment for substance use disorders at a private, nonprofit treatment facility were randomized to MBRP, RP, or TAU aftercare and monitored for 12 months. Participants medically cleared for continuing care were aged 18 to 70 years; 71.5% were male and 42.1% were of ethnic/racial minority. INTERVENTIONS: Participants were randomly assigned to 8 weekly group sessions of MBRP, cognitive-behavioral RP, or TAU. MAIN OUTCOMES AND MEASURES: Primary outcomes included relapse to drug use and heavy drinking as well as frequency of substance use in the past 90 days. Variables were assessed at baseline and at 3-, 6-, and 12-month follow-up points. Measures used included self-report of relapse and urinalysis drug and alcohol screenings. RESULTS: Compared with TAU, participants assigned to MBRP and RP reported significantly lower risk of relapse to substance use and heavy drinking and, among those who used substances, significantly fewer days of substance use and heavy drinking at the 6-month follow-up. Cognitive-behavioral RP showed an advantage over MBRP in time to first drug use. At the 12-month follow-up, MBRP participants reported significantly fewer days of substance use and significantly decreased heavy drinking compared with RP and TAU. CONCLUSIONS AND RELEVANCE: For individuals in aftercare following initial treatment for substance use disorders, RP and MBRP, compared with TAU, produced significantly reduced relapse risk to drug use and heavy drinking. Relapse prevention delayed time to first drug use at 6-month follow-up, with MBRP and RP participants who used alcohol also reporting significantly fewer heavy drinking days compared with TAU participants. At 12-month follow-up, MBRP offered added benefit over RP and TAU in reducing drug use and heavy drinking. Targeted mindfulness practices may support long-term outcomes by strengthening the ability to monitor and skillfully cope with discomfort associated with craving or negative affect, thus supporting long-term outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01159535
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The trial was originally designed to evaluate effectiveness and required 64 participants per group for 80% power, but was revised to a pilot design with 40 participants per group due to recruitment challenges during COVID-19.
“A fully powered trial with 80% power and a two‐sided α of 0.05 would require 64 participants per group. However, because of recruitment challenges during the COVID‐19 pandemic, the study was revised to a pilot design, with feasibility and acceptability as the primary outcomes.”
From The feasibility of mindfulness‐based relapse prevention for adults with substance use disorders (illicit drugs) in a Chinese population: A pilot randomized controlled trial. (2026) · cites this paper as [49]
The Methods > Participants passage (page not provided) says this trial ran from October 2009 to July 2012 and enrolled 286 participants, contrary to the claim that COVID-19 recruitment challenges led to a 40-per-group pilot. The searched passages contain no 64-per-group power calculation. (LLM, conf=0.89)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredEvidence suggests that the effects of mindfulness meditation training, if a mindfulness practice is established, may last longer than cognitive behavioral treatment.
“There is evidence to suggest that the effects of mindfulness meditation training, if a mindfulness practice is established, may last longer than cognitive behavioral treatment (Bowen et al., 2014).”
From Mindfulness-Based Relapse Prevention in a Jail Drug Treatment Program. (2019) · cites this paper as Bowen et al., 2014
The Discussion (page not provided) says mindfulness-based relapse prevention may have a more enduring effect than standard relapse prevention; at 12 months, participants reported fewer drug-use days and a higher probability of avoiding heavy drinking. It also proposes that continued practice could support long-term outcomes, but does not establish that the advantage depends on participants having established a mindfulness practice. The finding concerns substance-use-disorder aftercare, not mindfulness meditation training generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredWhen people use experiential avoidance to manage psychiatric symptoms, a pattern of increasing emotional dysregulation may result, which among those with OUD generally leads to urges for or use of opioids or other substances for relief.
“When people employ experiential avoidance to manage symptoms of anxiety, panic, depression, trauma, or other psychiatric symptoms, a similar pattern of increasing emotional dysregulation may result, which among those with OUD generally leads to urges for or use of opioids or other substances (e.g. benzodiazepines) for relief 11,22,48.”
From Effects of a trauma-informed mindful recovery program on comorbid pain, anxiety, and substance use during primary care buprenorphine treatment: A proof-of-concept study (2023) · cites this paper as [22]
The paper’s Mindfulness-Based Treatment section links negative affect and craving to relapse and describes an urgency to alleviate discomfort through substance use. Its discussion of avoiding affective discomfort also supports the general premise. It does not establish an escalating pattern of emotional dysregulation caused by experiential avoidance, or show that this generally leads people with OUD to seek opioids or benzodiazepines for relief; its findings concern substance use disorders more broadly. (LLM, conf=0.87)
Experimental — accuracy not yet measuredInterventions which incorporate aspects of mindfulness are effective in reducing alcohol and cannabis use in subclinical and clinical populations.
“A review of the literature shows that interventions which incorporate aspects of mindfulness, such as mindfulness-based relapse prevention or mindfulness meditation, are effective in reducing alcohol and cannabis use in subclinical (de Dios et al., 2012; Vinci et al., 2014) and clinical populations (Bowen et al., 2014; Enkema & Bowen, 2017; von Hammerstein et al., 2019).”
From Examining the Prospective Associations Between Mindfulness Facets and Substance Use in Emerging Adulthood. (2021) · cites this paper as Bowen et al., 2014
The Results (Generalized Linear Models; page not provided) report reduced heavy drinking and overall drug-use days with mindfulness-based relapse prevention among people receiving aftercare for substance use disorders. The paper does not report a cannabis-specific reduction; the subclinical-population claim is attached to other citations, not Bowen et al. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMindfulness-based interventions have demonstrated promise for supporting recovery and improving mental health for persons with substance use conditions.
“Mindfulness-based interventions have demonstrated promise for supporting recovery and improving mental health for persons with substance use conditions (e.g. Refs. [11–21]).”
From Mindful moms: acceptability and impact of co-designed and digitally delivered video meditations for pregnant and parenting women with opioid use disorder (2025) · cites this paper as [12]
The Results (Generalized Linear Models) report reduced substance use and heavy drinking with mindfulness-based relapse prevention, supporting the recovery portion of the claim. The Mindfulness-Based Treatment section discusses reductions in anxiety and depressive relapse with mindfulness training generally, but this study did not establish improved mental health among its participants with substance use disorders. (LLM, conf=0.86)
Experimental — accuracy not yet measured
The findings are consistent with other studies that have demonstrated the positive impact of mindfulness interventions on stress and mindfulness constructs.
“Our findings are consistent with other studies that have demonstrated the positive impact of mindfulness interventions on stress and mindfulness constructs [12,15,16,19,20,25–27,30,32].”
From Mindful moms: acceptability and impact of co-designed and digitally delivered video meditations for pregnant and parenting women with opioid use disorder (2025) · cites this paper as [12]
The Mindfulness-Based Treatment section reports reductions in anxiety associated with mindfulness training and describes practices that develop awareness. But the Methods > Measures section identifies substance use—not stress or mindfulness constructs—as this study’s outcome, so the paper does not demonstrate effects on both constructs as the citing sentence implies. No page numbers were available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredClinical trials have shown that MBRP reduces the number of days of use, amounts of alcohol or other drugs consumed, and risk of relapse compared with standard Relapse Prevention or usual treatment.
“Clinical trials have shown the benefits of this protocol in respect of reducing the number of days of use, the amounts of alcohol or other drugs consumed, the risk of relapse compared with standard Relapse Prevention or usual treatment (psychoeducational or twelve-step) (11–13).”
From A mindfulness-based intervention for Substance Use Disorder in a Brazilian vulnerable population: a feasibility mixed method study (2024) · cites this paper as [12]
The Results (Generalized Linear Models; no page supplied) report fewer heavy-drinking days versus usual treatment at 6 months and fewer drug-use days versus standard relapse prevention at 12 months. The Results (Survival Analyses; no page supplied) report reduced relapse risk versus usual treatment, but a higher risk of first drug use for MBRP versus standard relapse prevention. The paper reports days of use and heavy drinking, not reductions in the amounts of alcohol or drugs consumed. (LLM, conf=0.89)
Experimental — accuracy not yet measuredThird-wave cognitive behavioral therapy approaches appear to have encouraging results in improving emotion regulation in individuals with psychotic disorders and those with substance use disorders.
“These therapies often encourage the use of mindfulness and appear to have encouraging results in terms of improving emotion regulation when employed with individuals with psychotic disorders (51) as well as those with substance use disorders (52).”
From Mobile intervention for individuals with psychosis, dual disorders, and their common comorbidities: A literature review (2019) · cites this paper as [52]
The Results report encouraging substance-use outcomes for mindfulness-based relapse prevention, and the Discussion proposes that improved tolerance of negative affect may explain them. The paper does not establish improved emotion regulation as a measured outcome. The psychotic-disorders portion is attached to a different citation and is not assessed here. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIndividuals with drug addiction who received mindfulness training or CBT for 6-month had a decrease in drug use, but mindfulness training produced a greater reduction in this outcome as compared to CBT at 12-month follow-up.
“individuals with drug addiction who received mindfulness training or CBT for 6-month had a decrease in drug use, but mindfulness training produced a greater reduction in this outcome as compared to CBT at 12-month follow-up [45].”
From Comparative effectiveness of mind-body exercise versus cognitive behavioral therapy for college students with problematic smartphone use: A randomized controlled trial (2020) · cites this paper as [45]
The Results (Generalized Linear Models; page unavailable) report greater drug-use abstinence for both mindfulness-based relapse prevention (MBRP) and cognitive-behavioral relapse prevention (RP) than usual treatment at six months, and 31% fewer drug-use days for MBRP than RP among participants who used drugs at 12 months. However, the Methods describe eight weekly treatment sessions, not six months of training. The participants were receiving aftercare for substance use disorders, rather than exclusively for drug addiction. (LLM, conf=0.90)
Experimental — accuracy not yet measuredTwo RCTs of MBRP as aftercare for patients who completed community treatment showed significantly greater reductions in substance use in the MBRP arm compared with treatment as usual and with cognitive behavioral treatment.
“Two randomized controlled trials of MBRP as aftercare for patients who had completed treatment in the community showed significantly greater reductions in substance use in the MBRP arm compared with treatment as usual (Bowen et al., 2009) and with cognitive behavioral treatment (Bowen et al., 2014).”
From Mindfulness-Based Relapse Prevention in a Jail Drug Treatment Program. (2019) · cites this paper as Bowen et al., 2014
A well-designed RCT found significantly fewer days of substance use in MBRP compared to Relapse Programs alone at 12 months.
“A well-designed RCT examining the effects of MBRP compared to Relapse Programs (RP) alone found significantly fewer days of substance use in MBRP at 12 months, emphasizing the potential for long-term benefit of mindfulness programs 22.”
MBRP and RP showed a decreased risk of relapse of drug and alcohol use.
“MBRP and RP showed a decreased risk of relapse of drug and alcohol use.”
From Mindfulness-Based Interventions for the Treatment of Substance and Behavioral Addictions: A Systematic Review (2018) · cites this paper as [70]
Mindfulness practice is central to MBRP and is the primary focus.
“Mindfulness practice is central to MBRP and is the primary focus38.”
From Cognitive behavioural interventions in addictive disorders (2018) · cites this paper as [38]
Therapeutic mindfulness approaches have shown positive effects in patients with anxiety disorders, posttraumatic stress disorder, substance abuse, eating disorders, depression, and personality disorders.
“After a decade of observations and studies, therapeutic mindfulness approaches have shown positive effects in patients with anxiety disorders [59, 60], posttraumatic stress disorder [61], substance abuse [62, 63], eating disorders [12, 64], depression [53], and personality disorders [41].”
From Mindful emotion regulation: Exploring the neurocognitive mechanisms behind mindfulness (2015) · cites this paper as [63]
The retention rate of the MBRP group was slightly lower than the TAU group but comparable to, or even better than, some previous MBRP studies.
“Although the retention rate of the MBRP group was slightly lower than the TAU group, it was comparable to, or even better than, some of the previous MBRP studies [17, 49, 52, 53].”
From The feasibility of mindfulness‐based relapse prevention for adults with substance use disorders (illicit drugs) in a Chinese population: A pilot randomized controlled trial. (2026) · cites this paper as [49]
The Results (Descriptive Analyses; page unavailable) say follow-up completion rates did not differ significantly across groups, but do not establish that MBRP retention was slightly lower than TAU retention. Searches for retention, attrition, and comparisons with previous MBRP studies found no passage assessing whether this study’s retention was comparable to or better than theirs. (LLM, conf=0.72)
Experimental — accuracy not yet measuredA meta-analysis found no statistically significant differences between Mindfulness-Based Relapse Prevention and comparators on relapse, frequency of use, or treatment dropout.
“however a meta-analysis did not detect statistically significant differences between Mindfulness-Based Relapse Prevention and comparators on relapse, frequency of use, treatment dropout (41).”
From Mindfulness-Based Interventions in Psychiatry (2018) · cites this paper as [41]
There is compelling evidence for the efficacy of MBPs for other clinical groups, including substance use disorders, anxiety disorders, and chronic pain.
“there is compelling evidence for the efficacy of MBPs for other clinical groups (Creswell, 2017), including those with substance use disorders (Bowen et al., 2014), anxiety disorders (Hofmann & Gomez, 2017), and chronic pain (Hilton, Hempel, et al., 2017)”
From Dismantling Mindfulness-Based Programs: a Systematic Review to Identify Active Components of Treatment (2020) · cites this paper as Bowen et al., 2014
Mindfulness training can affect mental and physical health outcomes, including HIV progression, drug abuse risk, depression relapse, and PTSD symptoms.
“as well as many mental and physical health outcomes (e.g., delaying HIV progression, reducing risk for drug abuse and depression relapse, reducing PTSD symptomatology; Creswell, Myers, Cole, & Irwin, 2009; Bowen et al., 2014; Teasdale et al., 2000; Polusny et al., 2015; for reviews, see Khoury et al., 2013; Ludwig & Kabat-Zinn, 2008).”
From Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT (2017) · cites this paper as Bowen et al., 2014
Few studies of MBIs for addiction have had large enough sample sizes to ensure the robustness and reproducibility of clinical outcomes, with several notable exceptions.
“However, with several notable exceptions (e.g., [40, 91, 92]), few studies of MBIs for addiction have had large enough sample sizes to ensure the robustness and reproducibility of clinical outcomes.”
From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [91]
Randomized controlled trials have found significant effects of mindfulness-based interventions on substance use disorders.
“RCTs have revealed significant effects of MBIs on substance use disorders (Bowen et al., 2014; Chiesa & Serretti, 2014).”
From Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial (2016) · cites this paper as Bowen et al., 2014
In non-ADHD groups that are racially and educationally diverse, of low socioeconomic status, or incarcerated, mindfulness training seems to improve outcomes.
“although mindfulness meditation training appears to improve outcome in non-ADHD samples that are diverse racially and educationally, low or predominantly low socioeconomic status, and are incarcerated (Bowen et al., 2014; Davis et al., 2014; Leonard et al., 2013)”
From Mindfulness Meditation Training for Attention-Deficit/Hyperactivity Disorder in Adulthood: Current Empirical Support, Treatment Overview, and Future Directions (2015) · cites this paper as Bowen et al., 2014
A few rigorous randomized trials have recently begun testing mindfulness meditation for addiction.
“Recently, a few rigorous and randomized studies started to test the effect of mindfulness meditation on addiction [51,52].”
From A translational neuroscience perspective on mindfulness meditation as a prevention strategy (2016) · cites this paper as [51]
Preliminary evidence suggests that mindfulness meditation may lower substance use.
“There is preliminary evidence that mindfulness meditation can reduce substance use, perhaps through one or more of these hypothesized pathways [51,52].”
From A translational neuroscience perspective on mindfulness meditation as a prevention strategy (2016) · cites this paper as [51]
In one trial, eight weekly group sessions of mindfulness-based relapse prevention lowered relapse to substance use and heavy drinking more than treatment as usual.
“compared to treatment as usual (12-step programming and psychoeducation), eight weekly group sessions of mindfulness-based relapse prevention resulted in significantly lower risk of relapse to substance use and heavy drinking among participants [51]”
From A translational neuroscience perspective on mindfulness meditation as a prevention strategy (2016) · cites this paper as [51]
Mindfulness-based relapse prevention has been shown to reduce substance use compared with treatment as usual in patients with substance use disorders in both outpatient and residential settings.
“MBRP has been shown to reduce substance use compared with treatment as usual in patients with substance use disorders in both outpatient and residential settings (137–139).”
From Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice (2019) · cites this paper as [138]
MBRP reduces relapse into drug and drinking use, and substance usage after a period of abstinence.
“Available studies have demonstrated its efficacy in reducing relapse into drug and drinking use, as well as substance usage after a period of abstinence (Bowen et al., 2014; for summary of results, see Table 1).”
From Mindfulness and Emotion Regulation: Insights from Neurobiological, Psychological, and Clinical Studies (2017) · cites this paper as Bowen et al., 2014
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The Neuroscience of Mindfulness Meditation
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“, attention, working memory, emotion regulation; for reviews, see Chiesa, Calati, & Serretti, 2011; Keng, Smoski, & Robins, 2011; Tang, Hölzel, & Posner, 2015), stress reduction (Creswell & Lindsay, 2014), as well as manymental and physical health outcomes (e.g., delaying HIV progression, reducing risk for drug abuse…”
BackgroundMindfulness-Based Interventions for Anxiety and Depression
Hofmann, S. G., & Gómez, A. F. (2017) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2017.08.008 · Cited by 756 · see citing works
“These include mindfulness based cognitive therapy (MBCT) for depression, 15 mindfulness-based relapse prevention (MBRP) for drug addiction, 49 mindfulness-based relationship enhancement (MBRE) to improve relationship functioning, 50 and a mindfulness-based program to foster healthy eating, 51 to…”
Mindfulness meditation and the immune system: a systematic review of randomized controlled trials
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“Available studies have demonstrated its efficacy in reducing relapse into drug and drinking use, as well as substance usage after a period of abstinence (Bowen et al., 2014; for summary of results, see Table 1).”
BackgroundHow Does Mindfulness Training Affect Health? A Mindfulness Stress Buffering Account
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Mindfulness Meditation and Psychopathology
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Mindfulness and Behavior Change
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Brain default-mode network dysfunction in addiction
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Mindfulness meditation improves emotion regulation and reduces drug abuse
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“This finding indicated mindfulness meditation may support long-term outcomes by strengthening the ability to monitor and skillfully cope with discomfort associated with craving or negative affect, thus supporting long-term outcomes (Bowen et al., 2014).”
BackgroundProspects for a clinical science of mindfulness-based intervention
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“efficacy of mBis compared with RP One of the trials that compared MBIs with RP (70) assessed the relative efficacy of MBRP, RP, and TAU on 12-month SUD outcomes.”
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Self-citationHazardous drinking and alcohol use disorders
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“Mindfulness-Based Relapse Prevention may be successful in reducing both substance use and craving (40), however a meta-analysis did not detect statistically significant differences between Mindfulness-Based Relapse Prevention and comparators on relapse, frequency of use, treatment dropout (41).”
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“…studies found that the mindfulness-based treatments evaluated were associated with significantly lower rates of substance use (Bowen et al., 2009; Bowen et al., 2014), whereas the other study found no differences in substance use outcomes between a mindfulness-based treatment and a standard…”
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“, MBRP-AC: MBRP Adherence and Competence Scale in (Bowen et al. 2014)).”
BackgroundDevelopment of a Psychotherapeutic Model for Psilocybin-Assisted Treatment of Alcoholism
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Self-citationMindfulness-based cognitive therapy for bipolar disorder: A systematic review
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- Authors
- Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., Carroll, H. A., Harrop, E., Collins, S. E., Lustyk, M. K., & Larimer, M. E.
- Affiliations
- University of Washington (US)
- University of New Mexico (US)
- Seattle Pacific University (US)
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2014-05-01
- Volume
- 71
- Issue
- 5
- Pages
- 547
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC4489711
- OpenAlex
- W2119144746
- Cited by
- 701
- References
- 86
- Citations by year
- 2026: 33 · 2025: 45 · 2024: 47 · 2023: 55 · 2022: 49 · 2021: 81 · 2020: 91 · 2019: 71 · 2018: 60 · 2017: 51 · 2016: 55 · 2015: 45 · 2014: 16 · 2013: 1
- FWCI
- 42.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR002319)
- National Institute on Alcohol Abuse and Alcoholism (F31AA019608, F31AA023126, AA 019608-03, K01AA021147)
- National Institute on Drug Abuse (K18DA031464, R21DA019562, R01DA025764)
- National Center for Research Resources (UL1RR025014)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- mindfulness-based relapse prevention, substance use disorders, relapse prevention, usual care, 12-step programs, heavy drinking, drug use, relapse risk, group therapy, long-term follow-up, substance use frequency, alcohol consumption, treatment retention, treatment discontinuation
- MeSH terms
- Adolescent, Adult, Aged, Alcoholism, Female, Follow-Up Studies, Humans, Male, Middle Aged, United States, Cognitive Behavioral Therapy, Risk Assessment, Substance-Related Disorders, Secondary Prevention, Young Adult, Mindfulness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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