Mindfulness meditation for alcohol relapse prevention: a feasibility pilot study.

Alcohol dependence is a prevalent, chronic disorder that is associated with a wide variety of negative health outcomes, including significant morbidity, mortality, and disability, all with a significant societal burden.1,2 Treatment of alcohol dependence increases the probability of abstinence or nonproblematic drinking and can decrease alcohol-related harms.3,4 However, to date, no treatment has been uniformly effective; approximately 50% of treated alcohol-dependent individuals relapse by 1 year.3 Given the devastating individual, familial, and societal impact of alcohol dependence, and the results associated with “best practice” therapy, the development of alternative treatments to current modalities is needed. Meditation, a specific mind-body complementary and alternative medicine technique, may have application to the relapse problem. Meditation, defined as the intentional self-regulation of attention from moment to moment,5 can be divided into 2 major categories: concentrative, practiced by limiting the attention to a specific object (eg, breath, a sound, an image), and mindfulness. Mindfulness meditation helps practitioners to focus their attention intentionally and nonjudgmentally on experience in the present moment.6 This ancient method of attention control can facilitate an intentional, mindful response to a given situation,7 which may favor more conscious, less habitual behavioral choices. The current study implemented mindfulness meditation. In the United States, one of the most frequently cited methods of mindfulness meditation training is the Mindfulness Based Stress Reduction program (MBSR).6 Originally developed for stress and chronic pain management, MBSR as a therapy has shown positive results for a variety of mental health and medical disorders,8 including anxiety disorders9 and stress.10 In a well-designed, randomized, controlled trial, improved relapse prevention in recurrent depression has been reported after Mindfulness-Based Cognitive Therapy, a technique that combines Mindfulness-Based Stress Reduction-based training with cognitive therapy.11 Similarly, Mindfulness Based Relapse Prevention contains elements of traditional cognitive therapy and has been developed for relapse prevention in substance use disorders (SUDs).7,12 Mindfulness meditation (“meditation”) as adjunctive therapy for SUDs has met with anecdotal clinical success. Although only 6 pilot studies evaluated effects of meditation for SUDs, they provide encouraging preliminary data. Subjects recovering from SUDs in therapeutic community settings reported improvement in stress, as evaluated by awakening salivary cortisol level and Perceived Stress Scale survey and coping behaviors measures.13,14 Nicotine-dependent subjects, hospital employees,15 or individuals from a preexisting smoking study recruitment list16 reported 41%15 and 56%16 smoking-cessation rates compared with 24% among controls at 6 months.15 A small, pilot, randomized, controlled trial noted positive changes at 5 months in medical symptoms but not in psychopathology or substance use, among SUD-affected residents of a recovery house.17 A 10-day intensive course in meditation in a low-security prison resulted in a reduction of alcohol, marijuana, and crack cocaine use, an improvement in alcohol-related problems and internal drinking-related locus of control and optimism, and a decrease in psychiatric symptoms, as measured by the Brief Symptom Inventory.18 There are several ongoing larger clinical trials assessing efficacy of meditation-based approaches, including Mindfulness Based Relapse Prevention, for adults with SUDs.19 No studies have assessed meditation as an adjunct for treatment of alcohol-dependence in an outpatient setting. Therefore, we conducted a 16-week long prospective case series to test the hypothesis that a Mindfulness Meditation Relapse Prevention course (modeled on the Mindfulness Based Relapse Prevention, S. Bowen et al, unpublished observations, 2007)7,12 used as adjunct to “best practice” standard therapy, could be effective for relapse prevention for alcohol-dependent adults in early recovery. Specifically, that subjects will reduce their drinking, experience lessening in the severity of alcohol relapse triggers (anxiety, depression, stress, craving20), and improve on 2 biomarker measures of health and stress (interleukin-6 and cortisol). The study also tested the feasibility of the methods for use in a future, randomized, controlled trial.