Study protocol for a randomized controlled trial of mindfulness-based relapse prevention for opioid use disorders.

The opioid misuse epidemic has reached a crisis level in the United States. Though mindfulness-based relapse prevention (MBRP) has been shown as effective in treating substance use disorders, there is limited research on its application to opioid use disorders specifically, and there is a need to understand the underlying mechanisms. This paper outlines a protocol for a randomized controlled trial of MBRP for opioid use disorders. MBRP is a group aftercare program that integrates mindfulness skills training with cognitive-behavioral relapse prevention strategies. We will recruit 240 participants who have completed opioid use disorder treatment, and randomize them to an 8-week MBRP group intervention or treatment as usual (TAU) control group. The TAU control group will complete the intervention after 8 weeks. Assessments will take place at baseline, 8 weeks, and 16 weeks. The primary outcome is frequency of opioid use. The secondary outcomes include craving and withdrawal symptoms, time to first opioid use, adherence to medication-assisted treatment plans, perceived stress, quality of life, posttraumatic stress symptoms, and chronic pain. We will also examine the following potential moderators and correlates of intervention outcomes: comorbid diagnoses, life events history, and MBRP intervention adherence. In addition, we will examine the following mediators of intervention outcome: mindfulness skills, emotion regulation skills, executive functioning skills, savoring, and positive and negative affect. This study will contribute to the evidence base regarding MBRP's efficacy in reducing opioid use, as well as contribute to the understanding of the causal mechanisms and factors that modify treatment outcome for MBRP for substance use disorders.

Perceptions about mindfulness-based interventions among individuals recovering from opioid and alcohol use disorders: Findings from focus groups.

OBJECTIVES: Mindfulness-based interventions (MBIs) have been used as an intervention to support recovery from alcohol use disorder (AUD) and opioid use disorder (OUD). We sought to identify attitudes and experiences toward standardized MBIs among individuals recovering from these substance abuse disorders (SUD) through a qualitative approach. DESIGN: We conducted three 60-minute focus groups among people with history of SUD (6-months to 3 years in recovery): two groups with those with alcohol use disorder (AUD) history and one with individuals with history of opioid use disorder (OUD). Each group had eight participants. RESULTS: Most participants of the OUD focus group had tried some variations on mindfulness training or meditation-like therapies during treatment. Participants expressed perceived benefits for MBIs' non-pharmacological property, while expressing concerns related to perceived barriers of cost, scheduling conflicts with work and child/family care needs, and possible lack of provider empathy. Gift cards and other rewards were recognized as useful participation and retention incentives for completing the described program; the training itself was perceived as an "incentive" if able to deliver significant benefits related to supporting continued recovery from SUD. An overarching theme across all groups was that participants reported their own altruistic behavior and social connectedness as important motivators to help them maintain recovery. CONCLUSION: The importance of perceived provider empathy and the patient's social connectedness in SUD interventions was underscored as incentives for participation and retention, providing valuable information for the implementation of MBIs among patients recovering from SUD.