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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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“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]
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Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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
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“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.”
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In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“Mindfulness practice is central to MBRP and is the primary focus38.”
From Cognitive behavioural interventions in addictive disorders (2018) · cites this paper as [38]
The cited source says what the claim attributes to it.
In the citing paper
“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]
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In the citing paper
“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]
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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]
In the citing paper
“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 the citing paper
“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
In the citing paper
“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]
In the citing paper
“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 the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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“64 31 Included in 12-mo analysis Excluded from analysis Reasons for exclusion from analysis across all follow-up assessments for (1) mindfulness-based relapse prevention (MBRP): withdrew from the study, enrolled as inpatient, incarcerated, refused, and unable to contact; (2) standard relapse prevention (RP): withdrew…”
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Metadata
- 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
- 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
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