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Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention.
Open accessAbstract
OBJECTIVE: A strong relation between negative affect and craving has been demonstrated in laboratory and clinical studies, with depressive symptomatology showing particularly strong links to craving and substance abuse relapse. Mindfulness-based relapse prevention (MBRP), shown to be efficacious for reduction of substance use, uses mindfulness-based practices to teach alternative responses to emotional discomfort and lessen the conditioned response of craving in the presence of depressive symptoms. The goal in the current study was to examine the relation between measures of depressive symptoms, craving, and substance use following MBRP. METHOD: Individuals with substance use disorders (N = 168; mean age 40.45 years, SD = 10.28; 36.3% female; 46.4% non-White) were recruited after intensive stabilization, then randomly assigned to either 8 weekly sessions of MBRP or a treatment-as-usual control group. Approximately 73% of the sample was retained at the final 4-month follow-up assessment. RESULTS: Results confirmed a moderated-mediation effect, whereby craving mediated the relation between depressive symptoms (Beck Depression Inventory) and substance use (Timeline Follow-Back) among the treatment-as-usual group but not among MBRP participants. MBRP attenuated the relation between postintervention depressive symptoms and craving (Penn Alcohol Craving Scale) 2 months following the intervention (f(2) = .21). This moderation effect predicted substance use 4 months following the intervention (f(2) = .18). CONCLUSION: MBRP appears to influence cognitive and behavioral responses to depressive symptoms, partially explaining reductions in postintervention substance use among the MBRP group. Although results are preliminary, the current study provides evidence for the value of incorporating mindfulness practice into substance abuse treatment and identifies a potential mechanism of change following MBRP.
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“Furthermore, individuals with moderate depression in the MBRP group had a significantly lower probability of substance use, fewer drinks per drinking day, and fewer drinks per day than individuals with moderate depression in TAU.”
From Relapse prevention for addictive behaviors (2011) · cites this paper as [118]
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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“Evidence indicates that mindfulness interventions work through reducing stress and craving and improving mindfulness and interoceptive awareness [15,19,20,28–32].”
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 [32]
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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“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 [32]
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“Therapies that teach people to respond more flexibly in the presence of emotions increase healthy variation that can help them rise to the challenge of diverse problems such as chronic pain (e.g., Wicksell et al. 2009), substance use (e.g., Witkiewitz & Bowen 2010), tinnitus (e.g., Westin et al. 2011, worksite stress (Flaxman & Bond 2010), or suicidal behavior (Berking et al. 2009).”
From Evolving the future: Toward a science of intentional change (2014) · cites this paper as Witkiewitz & Bowen 2010
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“Secondary analyses [118] showed that compared to TAU, MBRP participants evinced a decreased relation between depressive symptoms and craving following treatment.”
From Relapse prevention for addictive behaviors (2011) · cites this paper as [118]
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“In addition, there was a significant moderated mediation effect such that craving partially mediated the relationship of depression to substance use frequency in the TAU condition, but did not in the MBRP condition.”
From Decoupling as a Mechanism of Change in Mindfulness and Acceptance: A Literature Review (2015) · cites this paper as Witkiewitz & Bowen, 2010
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“Post treatment depression was also less strongly related to substance use at follow up in the MBRP condition relative to TAU.”
From Decoupling as a Mechanism of Change in Mindfulness and Acceptance: A Literature Review (2015) · cites this paper as Witkiewitz & Bowen, 2010
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“Intervention condition moderated the relationship between depression severity at post treatment and cravings to use alcohol/drugs at 2-month follow up, such that this relationship was weaker among those in MBRP (i.e., depression was less strongly related to cravings to use).”
From Decoupling as a Mechanism of Change in Mindfulness and Acceptance: A Literature Review (2015) · cites this paper as Witkiewitz & Bowen, 2010
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“with benefits also found in subsequent studies.21,22”
From Mindfulness in psychiatry - Where are we now? (2016) · cites this paper as [21]
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“MBRP significantly reduced the association between postintervention depressive symptoms and craving 2 months following treatment, which in turn predicted reduced substance use at 4-months follow-up [41, 56].”
From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [56]
In the citing paper
“Substance craving was assessed with an adapted version of the Penn Alcohol Craving Scale (PACS) (Flannery, Volpicelli, & Pettinati, 1999), modified to assess craving for alcohol and other psychoactive substances. The original PACS includes five question items that assess the duration, frequency and intensity of craving for alcohol on a 7-point scale. In the version adapted for this study the item”
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 Witkiewitz & Bowen, 2011
In the citing paper
“the association of residual depression symptoms post-treatment predicted cravings and subsequent use in the treatment as usual group; however, the depression-craving association was attenuated in the group who received mindfulness training.”
From Dispositional Mindfulness Uncouples Physiological and Emotional Reactivity to a Laboratory Stressor and Emotional Reactivity to Executive Functioning Lapses in Daily Life (2016) · cites this paper as Witkiewitz & Bowen (2010)
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Metadata
- Authors
- Witkiewitz, K., & Bowen, S.
- Affiliations
- University of Washington (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2010-06
- Volume
- 78
- Issue
- 3
- Pages
- 362-374
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC3280693
- OpenAlex
- W2007429684
- Cited by
- 453
- References
- 78
- Citations by year
- 2026: 6 · 2025: 19 · 2024: 16 · 2023: 25 · 2022: 26 · 2021: 27 · 2020: 48 · 2019: 29 · 2018: 28 · 2017: 32 · 2016: 44 · 2015: 39 · 2014: 33 · 2013: 32 · 2012: 29
- FWCI
- 18.62
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R21 DA010562)
- 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, depressive symptoms, craving, alcohol craving, relapse prevention, negative affect, moderated mediation, mechanisms of change, addiction treatment
- MeSH terms
- Adolescent, Adult, Aged, Ethanol, Alcoholism, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Middle Aged, Motivation, Illicit Drugs, Substance Withdrawal Syndrome, Meditation, Substance-Related Disorders, Secondary Prevention, Young Adult
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