Craving management: Exploring factors that influence momentary craving-related risk of cannabis use among young adults.

Young adult frequent cannabis use has increased in prevalence and some frequent users have problems reducing their use. A strong link between momentary craving and subsequent use behaviors among individuals with problematic cannabis use has been reported in the literature, including young adults. In treatment contexts, interventions based on associative learning and reinforcement aim to reduce the prevalence of problematic substance use by altering the association between craving and use by increasing craving management skills such as mindfulness and reducing unhelpful responding such as avoidance or suppression. However, this model has not been tested among young adult cannabis users. The current study examined the influence of trait and state craving management strategies (mindfulness, coping style, experiential avoidance, and craving beliefs) on the link between momentary craving and use, using ecological momentary assessment in a sample of young adults with problematic use interested in reducing their use. Results demonstrated that two craving management constructs were associated with use: non-reactivity (p = 0.02) and non-judgment (p < 0.01). Interactions with momentary craving were observed for two constructs: non-judgmentalness (p = 0.02) and craving beliefs (p < 0.01). Findings suggest that treatments that increase non-reactivity and non-judgmentalness may reduce the occurrence of cannabis use for young adults contemplating reduction during an important period of biopsychosocial development by mitigating the impact of craving or directly reducing use. Additionally, negative beliefs about craving may serve a protective function during acute periods of elevation in momentary craving, an unexpected finding deserving further investigation.

Disrupting the path to craving: Acting without awareness mediates the link between negative affect and craving.

Low treatment utilization, relapse, and chronicity are characteristic of substance use disorders (SUDs). Craving is an important predictor of relapse. Individuals with an SUD report using various coping strategies in response to negative affect, two of which are investigated in the current study: suppression and acting with awareness. Suppression is typically understood to be avoidance of unwanted experience through turning attention away from unwanted stimuli. Acting with awareness (AWA) is a facet of mindfulness, which includes turning toward experience with kindness and curiosity, even when the experience is unwanted. Evidence suggests mindfulness may reduce craving, while suppression has been associated with increased craving. In the current study, participants (N = 210) had recently completed inpatient or intensive outpatient SUD treatment followed by a randomized controlled trial of aftercare. Participants completed measures within 2 weeks following the completion of the aftercare intervention. Negative affect and severity of dependence were both positively associated with craving. Structural equation modeling evaluated AWA and suppression as partial mediators of the link between negative affect and craving. Suppression was positively associated and AWA was negatively associated with craving. Mediation analyses revealed the indirect effect of negative affect on craving through AWA was significant, but the path through suppression was not. These findings suggest that AWA may inhibit the development of craving from negative affect, but further research is needed. Future research should investigate the path from negative affect to craving with greater temporal resolution to evaluate how these phenomena function with increased ecological validity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Moderation of relation between psychological risk factors and alcohol use by sex.

Alcohol consumption is a significant public health concern among young adults, with most recent research suggesting that the sex gap in alcohol consumption among young adults is closing. Thus, the present study tested sex as a moderator for known risk factors for alcohol use (impulsivity, sensation seeking, mindfulness). We examined sex differences by surveying young adults (n = 1,437) from across Washington state between 2011 and 2013 on alcohol risk factors (impulsivity, sensation seeking, mindfulness), alcohol consumption (quantity and frequency), and alcohol related negative consequences. Zero inflated Poisson and Zero inflated Negative Binomial models revealed that sex moderated the relationship between Peak Blood Alcohol Content (BAC) and impulsivity such that higher impulsivity was more strongly related to higher Peak BAC for women than for men. Overall, these results suggest that very few sex differences exist in alcohol consumption and alcohol-related negative consequences. Future research should look beyond the risk factors studied here to identify other important mechanisms that vary by sex that may be important targets for clinical or prevention efforts related to alcohol consumption.

Associations between mindfulness and mental health outcomes: A systematic review of ecological momentary assessment research.

Objectives: Psychological science has taken up investigations of the effectiveness of mindfulness-based programs (MBPs) and mechanisms through which people benefit from mindfulness. Reliable and valid psychometric tools are essential components of psychological science, and efforts have been made to produce tools for the accurate measurement of mindfulness as a construct. However, trait measurement methods, which are commonly used, may not adequately assess mindfulness and mental health outcomes in a way that allows for mechanisms to be adequately tested. Intensive longitudinal assessment methods sample behavior and experience multiple times over a brief period of several days or weeks, and may be more appropriate methods for testing mechanisms of action. We provide a systematic review of published, peer-reviewed studies that used intensive longitudinal methods to investigate the effects of mindfulness on mental health outcomes. Methods: Articles were included in the systematic review if mindfulness measures and/or mindfulness interventions were a part of the study design and if intensive longitudinal methods were used to assess mindfulness or mental health outcomes. Results: Findings consistently demonstrated a positive association between mindfulness and mental health. Only two studies collected both trait and state measurements of either mindfulness or mental health outcomes, and results indicated that EMA produced larger effect sizes between mindfulness and mental health outcomes. Conclusions: Theorized associations between mindfulness and mental health are supported by the current EMA literature. Intensive longitudinal methods may produce more consistent and reliable results through increased sensitivity and ecological validity in that they examine the momentary relationships between mindfulness and mental health outcomes. Thus, intensive longitudinal assessment may be a more appropriate method for investigating hypothesized mechanisms of action in MBPs.

Feasibility pilot of a brief mindfulness intervention for college students with posttraumatic stress symptoms and problem drinking.

OBJECTIVE: A significant subset of college students experience PTSD symptoms, and many engage in problematic alcohol use. Some college students with PTSD symptoms may use alcohol and other substances to cope with their symptoms, and those with PTSD experience more negative alcohol and drug consequences than those without PTSD. Mindfulness-Based Interventions (MBIs) have been successfully utilized for individuals with PTSD or substance use disorders. However, to date, no studies have evaluated MBIs for college students with co-occurring PTSD symptoms and problem drinking. METHOD: This study was a feasibility pilot of a 4-week group loving-kindness meditation (LKM) intervention, a practice of intentionally directing well wishes to oneself and others. LKM was compared to referral to treatment as usual (RTAU) for non-treatment seeking college students (N=75) with PTSD symptoms and problem drinking. RESULTS: Overall, the LKM group had low to moderate feasibility and acceptability among college students, as recruitment was lower than expected and attendance at LKM groups was modest. Participants' PTSD symptoms, drinking quantity, and negative drinking consequences decreased, and state mindfulness increased over the course of the study, but there were no significant differences between LKM and RTAU on these outcomes. Additionally, higher coping drinking motives predicted greater PTSD symptoms and more drinking consequences over the course of the study. CONCLUSIONS: Effective interventions for college students with PTSD symptoms and problematic alcohol use are needed, especially for individuals who drink to cope with their PTSD symptoms. Future research on LKM that addresses the limitations of the current study is warranted.

Brief motivational interventions for college student drinking may not be as powerful as we think: an individual participant-level data meta-analysis.

BACKGROUND: For over 2 decades, brief motivational interventions (BMIs) have been implemented on college campuses to reduce heavy drinking and related negative consequences. Such interventions include in-person motivational interviews (MIs), often incorporating personalized feedback (PF), and stand-alone PF interventions delivered via mail, computer, or the Web. Both narrative and meta-analytic reviews using aggregate data from published studies suggest at least short-term efficacy of BMIs, although overall effect sizes have been small. METHODS: This study was an individual participant-level data (IPD) meta-analysis of 17 randomized clinical trials evaluating BMIs. Unlike typical meta-analysis based on summary data, IPD meta-analysis allows for an analysis that correctly accommodates the sampling, sample characteristics, and distributions of the pooled data. In particular, highly skewed distributions with many zeroes are typical for drinking outcomes, but have not been adequately accounted for in existing studies. Data are from Project INTEGRATE, one of the largest IPD meta-analysis projects to date in alcohol intervention research, representing 6,713 individuals each with 2 to 5 repeated measures up to 12 months postbaseline. RESULTS: We used Bayesian multilevel over dispersed Poisson hurdle models to estimate intervention effects on drinks per week and peak drinking, and Gaussian models for alcohol problems. Estimates of overall intervention effects were very small and not statistically significant for any of the outcomes. We further conducted post hoc comparisons of 3 intervention types (individual MI with PF, PF only, and group MI) versus control. There was a small, statistically significant reduction in alcohol problems among participants who received an individual MI with PF. Short-term and long-term results were similar. CONCLUSIONS: This study questions the efficacy and magnitude of effects of BMIs for college drinking prevention and intervention and suggests a need for the development of more effective intervention strategies.

Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial.

IMPORTANCE: Relapse is highly prevalent following substance abuse treatments, highlighting the need for improved aftercare interventions. Mindfulness-based relapse prevention (MBRP), a group-based psychosocial aftercare, integrates evidence-based practices from mindfulness-based interventions and cognitive-behavioral relapse prevention (RP) approaches. OBJECTIVE: To evaluate the long-term efficacy of MBRP in reducing relapse compared with RP and treatment as usual (TAU [12-step programming and psychoeducation]) during a 12-month follow-up period. DESIGN, SETTING, AND PARTICIPANTS: Between October 2009 and July 2012, a total of 286 eligible individuals who successfully completed initial treatment for substance use disorders at a private, nonprofit treatment facility were randomized to MBRP, RP, or TAU aftercare and monitored for 12 months. Participants medically cleared for continuing care were aged 18 to 70 years; 71.5% were male and 42.1% were of ethnic/racial minority. INTERVENTIONS: Participants were randomly assigned to 8 weekly group sessions of MBRP, cognitive-behavioral RP, or TAU. MAIN OUTCOMES AND MEASURES: Primary outcomes included relapse to drug use and heavy drinking as well as frequency of substance use in the past 90 days. Variables were assessed at baseline and at 3-, 6-, and 12-month follow-up points. Measures used included self-report of relapse and urinalysis drug and alcohol screenings. RESULTS: Compared with TAU, participants assigned to MBRP and RP reported significantly lower risk of relapse to substance use and heavy drinking and, among those who used substances, significantly fewer days of substance use and heavy drinking at the 6-month follow-up. Cognitive-behavioral RP showed an advantage over MBRP in time to first drug use. At the 12-month follow-up, MBRP participants reported significantly fewer days of substance use and significantly decreased heavy drinking compared with RP and TAU. CONCLUSIONS AND RELEVANCE: For individuals in aftercare following initial treatment for substance use disorders, RP and MBRP, compared with TAU, produced significantly reduced relapse risk to drug use and heavy drinking. Relapse prevention delayed time to first drug use at 6-month follow-up, with MBRP and RP participants who used alcohol also reporting significantly fewer heavy drinking days compared with TAU participants. At 12-month follow-up, MBRP offered added benefit over RP and TAU in reducing drug use and heavy drinking. Targeted mindfulness practices may support long-term outcomes by strengthening the ability to monitor and skillfully cope with discomfort associated with craving or negative affect, thus supporting long-term outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01159535

Brief motivational feedback and cognitive behavioral interventions for prevention of disordered gambling: a randomized clinical trial.

AIMS: The purpose of the current study was to evaluate feasibility and efficacy of two promising approaches to indicated prevention of disordered gambling in a college population. DESIGN: Randomized clinical trial with assignment to a personalized feedback intervention (PFI), cognitive-behavioral intervention (CBI) or assessment-only control (AOC). PFI was delivered individually in a single session and included feedback regarding gambling behavior, norms, consequences and risk-reduction tips, delivered in a motivational interviewing style. CBI was delivered in small groups over four to six sessions and included functional analysis and brief cognitive correction, as well as identification of and alternatives for responding to gambling triggers. SETTING: College campus. PARTICIPANTS: At-risk or probable pathological gamblers (n = 147; 65.3% male; group assignment: PFI, n = 52; CBI, n = 44; AOC, n = 51). MEASUREMENTS: Self-reported gambling quantity, frequency, consequences, psychopathology, normative perceptions and beliefs. FINDINGS: Relative to control, results at 6-month follow-up indicated reductions in both interventions for gambling consequences (PFI d = 0.48; CBI d = 0.39) and DSM-IV criteria (PFI d = 0.60; CBI d = 0.48), reductions in frequency for PFI (d = 0.48). CBI was associated with reduced illusions of control, whereas PFI was associated with reduced perceptions of gambling frequency norms. Reductions in perceived gambling frequency norms mediated effects of PFI on gambling frequency. CONCLUSIONS: A single-session personalized feedback intervention and a multi-session cognitive-behavioral intervention may be helpful in reducing disordered gambling in US college students.

Mindfulness-based relapse prevention for substance use disorders: a pilot efficacy trial.

The current study is the first randomized-controlled trial evaluating the feasibility and initial efficacy of an 8-week outpatient Mindfulness-Based Relapse Prevention (MBRP) program as compared to treatment as usual (TAU). Participants were 168 adults with substance use disorders who had recently completed intensive inpatient or outpatient treatment. Assessments were administered pre-intervention, post-intervention, and 2 and 4 months post-intervention. Feasibility of MBRP was demonstrated by consistent homework compliance, attendance, and participant satisfaction. Initial efficacy was supported by significantly lower rates of substance use in those who received MBRP as compared to those in TAU over the 4-month post-intervention period. Additionally, MBRP participants demonstrated greater decreases in craving, and increases in acceptance and acting with awareness as compared to TAU. Results from this initial trial support the feasibility and initial efficacy of MBRP as an aftercare approach for individuals who have recently completed an intensive treatment for substance use disorders.

Identification with mainstream culture and preference for alternative alcohol treatment approaches in a community sample.

Although various treatment approaches are available for alcohol problems, less than 25% of individuals with alcohol use disorders obtain treatment. The purpose of this study is to evaluate interest in attending alternative alcohol treatments, such as meditation and acupuncture, compared to Alcoholics Anonymous (AA). A community sample of 156 adult participants concerned about their drinking were recruited through flyers and newspaper advertisements to complete a Web-based survey assessing identification with mainstream culture, sexual identity, and likelihood to attend alternative alcohol treatments. Participants reported higher likelihood of attending alternative treatments as compared to AA, and lesbian, gay, and bisexual participants (28.2% of the sample) were more likely to attend alternative treatments than heterosexual participants. A series of regression analyses were conducted to test whether the relationship between sexual identity and likelihood to attend alternative treatments was mediated by identification with mainstream culture. Participants who were less strongly identified with mainstream culture, regardless of sexual identity, reported higher likelihood of attending alternative treatments. These findings highlight that, for certain subgroups of the population, alternative treatments for alcohol misuse are appealing and suggest the need for future research testing the efficacy of alternative treatments for alcohol problems.

Identification, prevention, and treatment revisited: individual-focused college drinking prevention strategies 1999-2006.

This paper serves to update a prior review of the literature on individual-focused prevention and treatment approaches for college drinking [Larimer, M.E. & Cronce, J.M. (2002). Identification, prevention and treatment: A review of individual-focused strategies to reduce problematic alcohol consumption by college students. Journal of Studies on Alcohol Suppl. 14, 148-163.], and covers the period from late 1999 through 2006. No support was found for information/knowledge approaches alone, or for brief values clarification approaches alone or with other informational content. Evidence was found in support of skills-based interventions and motivational interventions that incorporated personalized feedback, with or without an in-person intervention. Normative re-education interventions received mixed support, though personalized normative feedback was associated with positive outcomes. Significant advances have been made over the past seven years with respect to mailed and computerized feedback interventions, and interventions with mandated students. Much of the research reviewed suffered from significant limitations, particularly small sample sizes, attrition, and lack of appropriate control groups. More research is needed to determine the best methods for disseminating such interventions on college campuses, as well as additional research on interventions with high-risk groups of students.

Mindfulness meditation and substance use in an incarcerated population.

Despite the availability of various substance abuse treatments, alcohol and drug misuse and related negative consequences remain prevalent. Vipassana meditation (VM), a Buddhist mindfulness-based practice, provides an alternative for individuals who do not wish to attend or have not succeeded with traditional addiction treatments. In this study, the authors evaluated the effectiveness of a VM course on substance use and psychosocial outcomes in an incarcerated population. Results indicate that after release from jail, participants in the VM course, as compared with those in a treatment-as-usual control condition, showed significant reductions in alcohol, marijuana, and crack cocaine use. VM participants showed decreases in alcohol-related problems and psychiatric symptoms as well as increases in positive psychosocial outcomes. The utility of mindfulness-based treatments for substance use is discussed.