Sarah Bowen

Background: Globally, approximately 8.6% of people will meet criteria for alcohol use disorder (AUD) in their lifetimes, with 2.2% meeting criteria for AUD in the past 12 months. In the United States, AUD prevalence is even greater, with 13.9% meeting criteria in the past 12 months. Effective treatments for AUD exist, although most people receive help through mutual support groups (ie, Alcoholics Anonymous [AA]). However, AA and other mutual support programs may not be desirable for all individuals, particularly those who do not seek abstinence-based approaches. Treatments that support reductions in drinking have been shown to be as effective as abstinence-based treatments in reducing alcohol-related harms, and may be more appealing to a broader range of people. Mindfulness-based interventions may be particularly effective in supporting long-term recovery, whole-person health, and functioning for those with abstinent and nonabstinent recovery goals. Objective: This study is designed to test a novel rolling group-based mindfulness-based relapse prevention (MBRP) delivered via videoconferencing, focused on drinking reduction goals and whole-person functioning. Methods: This study is a hybrid type 1 effectiveness-implementation design to prospectively test the effectiveness of MBRP and to identify barriers and facilitators of group participation to inform future implementation of MBRP as continuing care. Individuals with AUD (n=470) interested in stopping or reducing their drinking, meet criteria for AUD based on a symptom checklist, report heavy drinking at least once in the past 6 months, consent and understand study procedures in English, and provide a valid US mailing address are recruited nationwide via online sources in the United States. Participants are randomized to either MBRP groups via Zoom (Zoom Video Communications, Inc) or referral to online mutual support (eg, AA). All participants receive an individual orientation session delivered via Zoom that includes brief motivational interviewing and an overview of their assigned condition and next steps (MBRP condition: overview of the MBRP groups and instructions on participating in MBRP via Zoom; referral condition: referral to online mutual support groups). Participants provide blood samples for phosphatidylethanol testing at baseline and 3-year follow-up and complete self-report measures of psychosocial functioning, alcohol and other drug use, addiction cycle domains, and previously established predictors of recovery every 6 months for 3 years. Results: Recruitment began on September 13, 2023, and the last recruited participant was randomized on March 20, 2025. Follow-up data collection is ongoing with all 6-month follow-ups completed (86% retention). Conclusions: This study evaluates the effectiveness and mechanisms of MBRP delivered via videoconferencing, compared with referral to online mutual support groups, in supporting recovery among individuals with AUD. It also examines the reach, effectiveness, adoption, implementation, and maintenance of MBRP as an accessible, freely available continuing care option to support long-term recovery from AUD.

BACKGROUND Globally, approximately 8.6% of people will meet criteria for alcohol use disorder (AUD) in their lifetimes, with 2.2% meeting criteria for AUD in the past 12-months. In the United States, AUD prevalence is even greater with 13.9% meeting criteria in the past 12-months. Effective treatments for AUD exist, although most people receive help through mutual support groups (i.e., Alcoholics Anonymous (AA)). However, AA and other mutual support programs may not be desirable for all individuals, particularly those who do not seek abstinence-based approaches. Treatments that support reductions in drinking have been shown to be as effective as abstinence-based treatments in reducing alcohol-related harms and may be more appealing to a broader range of people. Mindfulness-based interventions may be particularly effective in supporting long-term recovery and whole person health and functioning for those with abstinent and non-abstinent recovery goals. OBJECTIVE This study is designed to test a novel rolling group-based mindfulness-based relapse prevention (MBRP) delivered via video conferencing, focused on drinking reduction goals and whole-person functioning. METHODS This study is a hybrid Type 1 effectiveness-implementation design to prospectively test the effectiveness of MBRP, and to identify barriers and facilitators of group participation to inform future implementation of MBRP as continuing care. Individuals with AUD (n=470) interested in stopping or reducing their drinking, meet criteria for AUD based on a symptom checklist, report heavy drinking at least once in the past 6 months, consent and understand study procedures in English, and provide a valid United States mailing address are recruited nationwide via online sources in the United States. Participants are randomized to either MBRP groups via Zoom or referral to online mutual support (e.g., AA). All participants receive an individual orientation session delivered via Zoom that includes brief motivational interviewing and an overview of their assigned condition and next steps (MBRP condition: overview of the MBRP groups and instructions on participating in MBRP via zoom; Referral condition: referral to online mutual support groups). Participants provide blood samples for phosphatidylethanol testing at baseline and 3-year follow-up and complete self-report measures of psychosocial functioning, alcohol and other drug use, addiction cycle domains, and previously established predictors of recovery every 6 months for 3 years. RESULTS Recruitment began on September 13, 2023 and the last recruited participant was randomized on March 20, 2025. Follow-up data collection is ongoing with all 6-month follow-ups completed (86.0% retention). CONCLUSIONS This study evaluates the effectiveness and mechanisms of MBRP delivered via video conferencing, compared with referral to online mutual support groups, in supporting recovery among individuals with AUD. It also examines the reach, effectiveness, adoption, implementation, and maintenance of MBRP as an accessible, freely available continuing care option to support long-term recovery from AUD. CLINICALTRIAL This trial is registered on ClinicalTrials.gov under study record NCT06074341 with initial registration date of October 06, 2023.

Background: Law enforcement officers (LEOs) are exposed to significant stressors that can impact their mental health, increasing risk of posttraumatic stress disorder, burnout, at-risk alcohol use, depression, and suicidality. Compromised LEO health can subsequently lead to aggression and excessive use of force. Mindfulness training is a promising approach for high-stress populations and has been shown to be effective in increasing resilience and improving mental health issues common among LEOs. Methods: This multi-site, randomized, single-blind clinical feasibility trial was intended to establish optimal protocols and procedures for a future full-scale, multi-site trial assessing effects of mindfulness-based resilience training (MBRT) versus an attention control (stress management education [SME]) and a no-intervention control, on physiological, attentional, and psychological indices of stress and mental health. The current study was designed to enhance efficiency of recruitment, engagement and retention; optimize assessment, intervention training and outcome measures; and ensure fidelity to intervention protocols. Responsiveness to change over time was examined to identify the most responsive potential proximate and longer-term assessments of targeted outcomes. Results: We observed high feasibility of recruitment and retention, acceptability of MBRT, fidelity to assessment and intervention protocols, and responsiveness to change for a variety of putative physiological and self-report mechanism and outcome measures. Conclusions: Results of this multi-site feasibility trial set the stage for a full-scale, multi-site trial testing the efficacy of MBRT on increasing LEO health and resilience, and on decreasing more distal outcomes of aggression and excessive use of force that would have significant downstream benefits for communities they serve. Trial registration: ClinicalTrials.gov, NCT03784846. Registered on December 24th, 2018.

Background: Substance use disorder (SUD) is a significant issue in the United States, characterized by chronic relapse following periods of abstinence. One of the primary precursors to relapse is craving. Findings from several studies have shown a negative association between trait mindfulness and craving in clinical samples; however, further research is needed to understand mechanisms underlying this relationship. Purpose/Objectives: The current study assessed thought suppression as a partial mediator of the relationship between trait mindfulness and craving. Methods: The current study used data from a previous randomized controlled trial of adults (N = 244) enrolled in community-based treatment for substance use disorder (SUD). Results: Analyses showed a significant moderate positive association between thought suppression and craving, a significant moderate negative association between thought suppression and trait mindfulness, and a significant moderate negative association between trait mindfulness and craving. Subsequent analyses confirmed a partial mediating role of thought suppression in the relationship between trait mindfulness and craving, indicating the inverse relationship between trait mindfulness and craving was partially explained by thought suppression. Conclusions/importance: These findings may inform treatment for SUD. Specifically, targeting thought suppression through mindfulness-based treatment approaches may be a mechanism through which craving can be reduced.

Background: Comorbid post-traumatic stress disorder and substance use disorder (PTSD-SUD) among women receiving substance use treatment are common. Few evidence-based interventions target PTSD-SUD, however, fewer are gender responsive. Mindfulness-based relapse prevention (MBRP) has shown effectiveness for women with SUD, although it does not explicitly target PTSD. Integration of trauma-focused and gender-responsive treatments into MBRP may address the limited availability of PTSD-SUD interventions for women. This study assessed feasibility and acceptability of trauma-integrated MBRP (TI-MBRP). Methods: A single-blind computer-generated cluster-randomized design was employed in which women with PTSD-SUD (N = 83) received either TI-MBRP (k = 5) or MBRP (k = 5). Measures of PTSD symptom severity and craving were administered at pre-, post-, 1-, 3-, 6-, 9-, and 12-month follow-up and assessed at the individual level. Results: TI-MBRP demonstrated acceptability among participants; however, attrition was high (64%) at 12-month follow-up. Reductions in PTSD were greater in the MBRP than in the TI-MBRP group at postcourse and 1-month follow-up, and there were significant reductions in PTSD severity and craving over the 12-month period in both conditions. Conclusions: Integrating trauma- and gender-focused interventions into MBRP was feasible and acceptable. MBRP alone may be effective in reducing both PTSD and SUD symptoms in women with PTSD-SUD; however, confirmatory studies are warranted. Clinical Trial Registration number NCT03505749.

Background: More than one-third of justice-involved individuals meet the criteria for substance use disorder (SUD). Many studies show that treatment expectancy predicts longitudinal SUD outcomes; however, results are inconsistent, and the role of treatment expectancy on SUD outcomes for individuals mandated to a mindfulness-based intervention (MBI) is unknown. Mindfulness-based relapse prevention (MBRP) has shown efficacy with justice-involved populations; however, enrollment in MBRP is typically voluntary. The current study assessed whether pretreatment expectancy predicted SUD- and affect-related outcomes in a sample of women (n = 54) mandated to MBRP as part of their residential SUD programming. Method: The authors employed a quasiexperimental design and administered measures at pre-, mid-, and postcourse. Results: Following mandatory participation in MBRP, significant reductions in craving and substance use were observed. However, contrary to hypotheses, higher pretreatment expectancy predicted greater substance dependence at postcourse. Conclusions: Positive treatment expectancy within the context of an MBI was not related to favorable posttreatment outcomes; in fact, it was related to higher postcourse substance dependence. This suggests that MBIs may be suitable for mandated individuals who may not have voluntarily chosen to participate in such an intervention, and thus may have lower expectancy for the treatment. This finding needs to be replicated in a larger sample to warrant a firmer conclusion.

Background Hypnotics are one of the most frequently prescribed drugs worldwide, especially for women, and their chronic use may lead to tolerance, dosage escalation, dependence, withdrawal syndrome, and cognitive impairments, representing a significant public health problem. Consistent evidence from previous studies shows benefits of mindfulness-based interventions (MBIs) for substance use disorders (SUD) and insomnia. However, to date, there is a lack of research about effects of MBIs on reduction/cessation of chronic hypnotic use among women with insomnia. Method The present randomized trial evaluated the efficacy of the 8-week group-delivered mindfulness-based relapse prevention (MBRP) program in an intervention group (IG, n = 34) compared with weekly phone monitoring only in the control group (CG, n = 36) in reducing hypnotic use and insomnia severity over a 6-month follow-up period. Results There were significant differences between groups at baseline regarding hypnotic use but not insomnia. Group effects on hypnotic use were found immediately after the intervention (bT1 = 2.01, p < 0.001) and at the 2-month follow-up (bT2 = 2.21, p < 0.001), favoring the IG. The IG also had a greater reduction from baseline levels than the control group in insomnia severity at the 4-month (bT3 = 0.21, p = 0.045) and 6-month (bT4 = 0.32, p = 0.002) follow-ups. Conclusions The findings provide preliminary evidence of benefits of MBRP for reducing insomnia severity and potentially chronic hypnotic use. However, IG effects on chronic hypnotic use may have resulted from IG and control group differences in chronic hypnotic use at baseline. Trial Registration ClinicalTrials.gov Identifier: NCT02127411