Key DFM Personnel
Aleksandra Zgierska, MD, PhD – Principal Investigator
Jennifer Wiegel – Project Coordinator
Mark Remiker – Project staff
- G. Alan Marlatt, PhD (deceased, Mar 14, 2011) – the Addictive Behaviors Research Center, Department of Psychology, University of Washington, Seattle
- Zindel V. Segal, PhD – the Centre for Addiction and Mental Health, Departments of Psychiatry and Psychology, University of Toronto, Canada
Collaborating Treatment Centers
- NewStart Outpatient Clinic
- UW Health Gateway Recovery
- Connections Counseling
- Mental Health Center of Dane County
- W.S. Middleton Memorial Veterans Hospital
- Tellurian Ucan Inc.
- Lutheran Social Services
- OceanHawk Counseling
National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism (NIH NIAAA)
Relapse prevention is one of the most challenging issues in the treatment of alcohol dependence as well as addictive disorders in general, and calls for the development of new therapeutic modalities. Mindfulness meditation, a popular mind-body therapy, is a promising treatment for substance use disorders. However, there have been no published rigorous studies evaluating the effects of meditation in alcohol dependence.
“Mindfulness Meditation for Health” study addresses this knowledge gap and is a part of Dr. Zgierska’s broader research focused on new therapies for substance use disorders. This ongoing study evaluates mindfulness based relapse prevention, an innovative behavioral intervention, as a therapy for alcohol dependence. It will allow development of the final manuals and protocols for mindfulness based intervention for alcohol-dependent adults in early recovery, and its evaluation in the settings of a randomized controlled trial. If proven effective, this intervention may benefit the community and society at large as well as the individual study participants affected by alcohol dependence, a chronic, disabling and costly disorder.
The overarching goal of this ongoing randomized controlled trial (RCT) is to provide rigorous evidence about the efficacy of meditation-based therapy for alcohol relapse prevention, and to further our understanding of relapse and the potential mechanisms of meditation action, with the hope that findings of this study will help direct future research and guide clinical decision-making.
The specific aims of this two-arm RCT are to test whether the Mindfulness Based Relapse Prevention, combined with “standard of care” therapy (“meditation” arm), is more effective for relapse prevention and improvement of related mental health problems than “standard of care” alone (“delayed meditation” comparison arm) among recovering alcohol dependent adults:
1) primary aim: meditation-based intervention will improve participant’s self-reported drinking (fewer drinks, lower lapse and relapse rate);
2) secondary aim: meditation-based intervention will improve participant’s self-reported alcohol-related harms (negative consequences), adherence to addiction-related treatment, and will be viewed as helpful for relapse prevention;
3) tertiary aim: meditation-based intervention will improve stress-sensitive measures, both self-reported relapse risk factors (severity of stress, depression, anxiety, craving, and emotion dysregulation) and biomarkers (interleukin-6, IL-6, and liver enzymes) – all potential mediators of meditation action.
Study intervention: The 8-week long study intervention, Mindfulness Based Relapse Prevention for Alcohol Dependence (MBRP-A) is based on existing models, and combines mindfulness and traditional cognitive-behavior therapy (CBT-based relapse prevention) strategies. The MBRP-A’s mindfulness component is specifically tailored for alcohol dependent adults and has been based on the Mindfulness Based Relapse Prevention for substance use disorders therapy (MBRP), developed by G. Alan Marlatt, PhD and his colleagues at the University of Washington. The MBRP therapy in turn, originated from the Mindfulness Based Cognitive Therapy (MBCT) developed for relapse prevention in depression by Zindel Segal and colleagues. Both Drs. Marlatt and Segal have consulted on this ongoing project. The MBCT intervention has its roots in the Mindfulness Based Stress Reduction program, developed by Jon Kabat-Zinn, which is one of the best-studied and most popular mindfulness-based programs in medical settings and for self-improvement. The MBRP-A’s relapse prevention component is based on CBT techniques, derived from the work of Dr. Alan Marlatt, and is a part of “standard of care” treatment for alcohol dependence.
The ‘real-life’ application of meditation to relapse prevention can be illustrated in a description of two brief meditative techniques, developed by Dr. Marlatt and his team, and designed for use as ‘acute’ coping strategies in the face of high-risk situations. Each technique was rated as ‘very useful’ for coping with daily stressors and urges in our pilot study and is taught in the ongoing RCT.
- Mini-Meditation follows the ‘SOBER’ acronym: S – Stop whatever you are doing, feeling or thinking; O – Observe what is happening in your body and mind; B – Breathe: focus on the breath as an ‘anchor’ to help stay present in the moment; E – Expand awareness to your whole body and surroundings; R – Respond ‘mindfully’, as opposed to ‘habitually’ or automatically.
- Urge surfing encourages to ‘observe and accept.’ One visualizes an urge as an ocean wave that begins small and gradually builds to a large cresting wave. Using the awareness of one’s breath as a ‘surfboard,’ the goal is to ‘surf the urge’ by allowing it to first rise, and then fall without being ‘wiped out’ by giving into it. As with a wave, the urge grows in intensity until it reaches its peak, then subsides on its own. Successfully ‘surfing the urge’, weakens addictive conditioning and enhances coping skills.
Study design: This RCT will enroll 112 alcohol dependent adults from Madison-area based collaborating treatment centers, and follow them up for 52 weeks (total 5 brief meetings to collect study data). Study participants are randomly assigned to one of two study arms: meditation group or delayed meditation group (able to receive the meditation intervention after completing their 26-week follow-up). Both baseline (enrollment) and four follow-up assessments consist of filling out questionnaires on substance use and related harms, and psychological well-being (see Study Aims for more details), and a venous blood draw for the level of stress-sensitive biomarkers at the University Hospital research division.
Interested alcohol dependent adults must fulfill certain criteria to be eligible for study participation. Main eligibility criteria include: a) English-speaking adults, age 18 years or older; b) current or recent treatment for alcohol dependence at an approved treatment center (the number of study-collaborating centers have been increasing over time) consisting of at least 2 treatment sessions per week for a minimum of 2 weeks; c) drinking-quit date within 14 weeks of study enrollment; d) no history of professionally-diagnosed bipolar or delusional disorder; and e) no active drug use.
A detailed description of study related activities and participant-relevant information is provided in the study brochure.
Results of a pilot study, Mindfulness Meditation for Alcohol Relapse Prevention, that led to this current project were published in Journal of Addiction Medicine.
Publications directly related to this project
Zgierska A, Marcus MT. Mindfulness-Based Therapies for Substance Use Disorders: Part 2 (Editorial). Substance Abuse 2010;31(2):77-78. NIHMSID166193
Marcus MT, Zgierska A. Mindfulness-Based Therapies for Substance Use Disorders: Part 1 (Editorial). Substance Abuse 2009;30:263-264. PMCID: PMC2818765
Zgierska A, Rabago D, Chawla N, Kushner K, Kohler R, Marlatt A. Mindfulness Meditation for Substance Use Disorders: A Systematic Review. Substance Abuse; 2009;30:266-294. PMCID: PMC2800788
Zgierska A, Rabago D, Zuelsdorff M, Miller M, Coe C, Fleming MF. Mindfulness Meditation for Relapse Prevention in Alcohol Dependence: a feasibility pilot study. Journal of Addiction Medicine 2008;2(3):165-173.