Mindfulness in the T reatment of Opioid Use Disorder Laura R. - PDF document

10/ 13/ 2019 Mindfulness in the T reatment of Opioid Use Disorder Laura R. Lander, M SW Department of Behavioral Medicine and Psychiatry School of Medicine Keith J . Zullig, M SPH, PhD, FAAHB, FASHA Department of Social and Behavioral Sciences School of Public Health Disclosures • This study is supported by Grant #, 6R49CE002109-05-06, funded by the US CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the US DHHS . • We have no conflicts of interest 2 Recruited (N=73) Control Group , T reatment as Usual M BRP Participants Baseline (n= 33) Participants Baseline( n = 40) 24 week intervention, 12 week post intervention (36 36 weeks total weeks total) Dismissed before 2 nd data Dismissed before 2nd data collection (n= 2) collection (n=3 ) 12 12 week data collection n=38 12 12 week data collection n=30 Dismissed before 3 rd data Dismissed before 3 rd data collection ( n = 7) collection ( n = 2) 24 week data collection n=31 1224 24 week data collection n= 28 Dismissed before 4th rd Dismissed before 4th rd data data collection ( n = 2) collection ( n = 2) 36 week data collection n=29 1 236 week data collection n=26 Data collected at baseline, 12 weeks, 24 weeks and 36 weeks 36 week data still to be collected: n=11, C= 2, MBRP= 9 3 1

10/ 13/ 2019 The Study - Methods • Participants were recruited from West Virginia University’s Comprehensive Opioid Addiction Treatment program who were at least 90 consecutive days substance free. • Participants self-selected into mindfulness (M BRP) or comparison groups (treatment as usual, T AU). • In the MBRP group, participants attend a biweekly 60-minute session for 24 weeks led by a licensed therapist who is part of our research team. M easures are administered at baseline, 12 weeks, 24 weeks, and 36 weeks post- intervention. • In the comparison group, participants attend a biweekly 60-minute CBT based process group for 24 weeks led by a licensed therapist. Measures are also administered at baseline, 12 weeks, 24 weeks, and 36 weeks post-intervention. 4 Mindfulness Based Relapse Prevention (MBRP) Nuts and Bolts of MBRP • Mindful skill building • Breathing • Meditation • Mindful movement- Gentle yoga practiced with mindful aw areness of the body • Using all of your senses • Increasing awareness of breath, body sensations, emotional energy, thoughts • Discussion of practice outside of group and/ or in class exercises • Daily home practice assignments- formal mindfulness meditation (30 min/ day, 5-6 days/ week) • Mindfulness in everyday life (informal practice) 5 MBRP Mindfulness Experience Sitting M editation : Sound, Breath, Sensation, Thought Bowen S, Chawla N, Marlatt GA. Mindfulness-Based Release Prevention for Addictive Behaviors. NY : Guilford Press, 2011, pg.103 6 2

10/ 13/ 2019 Study Outcomes • Participant outcomes tracked: 1. Retention 2. Relapse on any prohibited substance 3. Self-reported 1. Craving (via the Desire for Drugs Questionnaire, DDQ) 2. Anxiety (via the Overall Anxiety Severity & Impairment Scale, OASIS) 3. Depression (via the Overall Depression Severity & Impairment Scale, ODSIS) 4. Mindfulness (via the 5-Facet Mindfulness Questionnaire, FFMQ, alpha = .91) 7 Data Analysis • Descriptive Statistics were used to analyze relapse and retention • A linear mixed model with random effects was performed on the self-report survey data. • Fixed effects are reported in the results • We selected the best model with the lowest Akaike information criterion (AIC). 8 Demographics Demographics M BRP TAU Total p-value M arital Status 0.65 Single 10 17 27 Married 2 5 7 • Divorced or Separating 5 5 11 Using a Fisher’s Exact T est, no Gende r 0.06 significant differences were Male 4 14 18 detected at baseline between Female 11 13 24 MBRP and T AU participants within Other 2 0 2 marital status (p=0.65), gender Race 0.21 (p=.06), race (p=.21), employment White 17 27 44 (p=0.96), or insurance (p=0.62). Employment 0.96 Full Ti me 7 10 17 PartTime 3 5 • 8 However, a significant difference Unemployed 7 14 2 19 was detected between MBRP and Education 0.01 T AU participants within education Did Not Finish High 2 1 3 (p=.01). School High School Grad/ GED 6 21 27 Some College or 9 5 14 Greater 0.62 Insurance Medicaid 15 21 36 Medicare 1 2 3 Medicaid 1 4 5 9 3

10/ 13/ 2019 Retention Results • 24 week data N=62 (T AU group n = 38; MBRP group n = 24) • Retention at 24 weeks • T AU group: 29/ 38 - 76%; MBRP group: 19/ 24 - 79% • Differences between groups not statistically significant ( χ 2 = .07, p = 0.79) • 36 week data N= 44 (T AU group n = 27 ; MBRP group n = 17) • Retention 24-36 weeks • T AU group: 25/ 27 -93%; MBRP group: 15/ 17 -88% • Differences between groups not statistically significant ( χ 2 = .24, p = 0.63) 10 Relapse Results • Initial 24 week data N=62 (T AU group n = 38; MBRP group n = 24) • Relapse (# people who relapsed at least 1x in 24 weeks including those dismissed) • TAU group: 16/ 38 -42%; MBRP group: 8/ 24 - 33% • Differences between groups not statistically significant ( χ 2 = .48, p = 0.49) • 36 week data N= 44 (T AU group n = 27 ; MBRP group n = 17) • Relapse (# people who relapsed at least 1x in 36 weeks of those w ho completed the study) • TAU group: 10/ 27 - 37%; MBRP group: 7/ 17 - 41% • Differences between groups not statistically significant ( χ 2 = .08, p = 0.78) • # people who relapsed at least 1x between 24 and 36 only (post intervention), N=44 • TAU group: 6/ 27 - 22%; MBRP group: 6/ 17 - 35% Differences between groups not statistically significant ( χ 2 = .90, p = .34 ) • 11 Craving Results Self-Report Mean Craving Scores Across Time by Group (Range 14-70 ) 30 23.93 25 22 22.16 22.89 19.18 20 20.74 19.65 19.15 15 10 5 0 Baseline 12 Weeks 24 Weeks 36 Weeks MBRP TAU 12 4

10/ 13/ 2019 Anxiety Results Self-Report Depression Scores Across Time by Group (Range 0-20) 12 9.58 10 8 6.72 6.55 6.05 5.65 6 6.42 5.86 5.5 4 2 0 Baseline 12 Weeks 24 Weeks 36 Weeks MBRP TAU 13 Depression Results Self-Report Mean Depression Scores Across Time by Group (Range 0-20) 8 7.42 7 5.62 6 5.1 5 4.28 4.08 4 4.21 4.05 3 3.35 2 1 0 Baseline 12 Weeks 24 Weeks 36 Weeks MBRP TAU 14 Mindfulness Results Self-Report Mean Mindfulness Scores Across Time by Group (Range 1-5) 3.6 3.55 3.5 3.5 3.36 3.4 3.33 3.31 3.3 3.27 3.2 3.14 3.1 2.99 3 2.9 2.8 2.7 Baseline 12 Weeks 24 Weeks 36 Weeks MBRP TAU 15 5

10/ 13/ 2019 Discussion • No statistical differences in relapse and retention rates between MBRP and T AU groups • Rates of relapse trending higher in MBRP , post intervention • Significant decreases occurred in craving in both MBRP and T AU groups • There were significantly greater reductions in depression, anxiety in the MBRP group indicating an intervention effect • There were significantly greater increases in mindfulness in the MBRP group compared to T AU 16 Conclusions • MBRP can be successfully implemented in an out- patient setting with as good as or better results as TAU • Future directions – • Larger scale study to determine significant effect on relapse • Who benefits most from M BRP? • Those with co-occurring mood disorders 17 6