A Meta-Analysis of Mindfulness- and Meditation-Based Intervention for Substance Use Problems

Background: This study used meta-analysis to evaluate the effectiveness of mindfulness and meditation-based interventions on substance use outcomes.  Alan Marlatt and his colleagues first developed the mindfulness-based relapse prevention approach in treating substance use problems with positive outcomes (Witkiewitz, Marlatt, & Walker, 2005; Zgierska et al., 2008). Because of the impact of meditation on the physiological, neurobiological, psychological and emotional processes; meditation practice should be helpful in: (1) Enhancing clients’ ability to be aware of the triggers of craving, observe and accept the urge, let it go without giving in or repressing the urge for substance use; (3) Enhancing clients’ emotional regulation abilities and reducing negative thoughts; and (4) Fostering clients’ capacity to recognize and attend to current experiences as well as to differentiate them addiction-influenced emotional and behavioral responses so they can make choices that are responsive and beneficial to their current needs and situations. The problem statement for this research study was to quantitatively examine the effectiveness of mindfulness- and meditation-based interventions on substance use outcomes.

Methods: Studies were identified through electronic databases including EBSCOhost, PubMed, Cochrane systematic review, Campbell Systematic Review, SSCI, and Evidence-Based Medicine Reviews using the keywords mindful* OR meditat* AND substance*. Inclusion criteria were: (1) experimental or quasi-experimental studies with controlled groups, (2) English language articles; (3) published studies in peer-reviewed journals; and (4) articles published between 2004 and 2013. Meta-analysis was used to estimate an average effect across studies. The final effect size was calculated from the sample size, the effect size and its confidence interval in each study. Considering that the true effect might vary across samples and studies, this study used random effects models to conduct the final calculation.

Results: Initial search yielded 19 studies dealing with problems including alcohol dependency, nicotine dependency, cocaine addiction, and co-occurring disorders. Abstract and full article review resulted in 7 studies that used experimental design with control groups. Meta-analyses were conducted on these 7 studies. All these studies examined outcomes on abstinence, depression, and craving for substances. Four studies examined abstinence outcomes. Mindfulness meditation increased the participants’ abstinence days in three studies. The pooled effect size (Cohen’s d) for abstinence was 0.39 [C.I. 0,13, 0.65]. Three studies examined depression outcomes. Mindfulness meditation reduced levels of depression in all three studies. The pooled effect size for depression was -0.43[C.I. -0.73, -0.13]. Four studies examined craving for substances. Mindfulness meditation reduced participants’ level of craving in three studies. The pooled effect size for craving was -0.20 [C.I. -0.48, 0.08].  Results of this meta-analysis indicated that mindfulness meditation have moderate positive effects on participants with substance use problems on abstinence, depression and craving outcomes.

Implications: Findings of this meta-analyses provided support for mindfulness- and meditation-based interventions as promising treatments for improving affective and behavioral functions of people with substance abuse problems. Significance of this study was discussed in reference to the increasing adoption of mindfulness- and meditation-based practice as an empowering and complementary intervention for treatment of substance use problems as well as other mental health problems.