How effective are mindfulness-based relapse prevention, cognitive behavioural relapse prevention and usual treatment in relapse prevention among post-treatment substance abuse patients?
Date of publication of the randomized controlled trial: May 2014
Design
Randomized controlled trial (RCT).
Participants
286 adults (mean age: 38.4 years, male %: 71.5%) who had completed initial treatment for substance abuse disorders at a private, non-profit treatment facility.
Intervention
286 adults (mean age: 38.4 years, male %: 71.5%) who had completed initial treatment for substance abuse disorders at a private, non-profit treatment facility.
Comparator
Comparison 1: MBRP versus cognitive behavioural relapse prevention (RP);
Comparison 2: MBRP plus RP versus abstinence based 12-step aftercare (i.e. treatment as usual (TAU)).
Major Outcomes
Outcome 1: Risk of relapse of first drug use by self-reported calendar-formatted time-line follow-back;
Outcome 2: Risk of relapse of first alcohol use assessed by self-reported calendar-formatted time-line follow-back.
Settings
This trial was performed in an outpatient setting.
Comparison    MBRP versus RP
Main Results
MBRP group was associated with significantly higher risk of leading to relapse of first drug use over RP group (Hazard ratio (HR): 1.21, 95% CI: 1.10 to 1.33). Difference between MBRP group and RP group in terms of risk of first alcohol use relapse was insignificant (HR: 0.72, 95%CI: 0.91 to 1.15).
Comparison 1: MBRP versus RP among post-treatment substance abuse patients
Outcomes No. of studies (Total number of participants) Mean score (SD)/ No. of participants HR (95% Cl) Heterogeneity test (I2) Overall quality of evidence*
Intervention Comparator
1 1 (191) Not reported Not reported 1.21 (1.10 to 1.33) Not applicable as there is only 1 study. Moderate
2 1 (191) Not reported Not reported 0.72 (0.91 to 1.15) Not applicable as there is only 1 study. Low
Keys: HR = hazard ratio; CI = confidence interval.
Comparison    MBRP plus RP versus TAU
Main Results
MBRP plus RP group was associated with significantly lower risk of relapse on first drug use (HR: 0.46, 95% CI: 0.42 to 0.51) and first alcohol use (HR: 0.41, 95% CI: 0.37 to 0.46) compared to TAU group.
Comparison 2: MBRP and RP versus TAU among post-treatment substance abuse patients
Outcomes No. of studies (Total number of participants) Mean score (SD)/ No. of participants HR (95% Cl) Heterogeneity test (I2) Overall quality of evidence*
Intervention Comparator
1 1 (286) Not reported Not reported 0.46 (0.42 to 0.51) Not applicable as there is only 1 study. Moderate
2 1 (286) Not reported Not reported 0.41 (0.37 to 0.46) Not applicable as there is only 1 study. Low
Keys: HR = hazard ratio; CI = confidence interval
Comparison    MBRP versus RP
Main Results
MBRP group was associated with significantly higher risk of leading to relapse of first drug use over RP group (Hazard ratio (HR): 1.21, 95% CI: 1.10 to 1.33). Difference between MBRP group and RP group in terms of risk of first alcohol use relapse was insignificant (HR: 0.72, 95%CI: 0.91 to 1.15).
Comparison 1: MBRP versus RP among post-treatment substance abuse patients
Outcomes 1 2
No. of studies (Total number of participants) 1 (191) 1 (191)
Mean score (SD)/ No. of participants Intervention Not reported Not reported
Comparator Not reported Not reported
Heterogeneity test (Isuperscript[2]) Not applicable as there is only 1 study. Not applicable as there is only 1 study.
Overall quality of evidence* Moderate Low
Keys: HR = hazard ratio; CI = confidence interval.
Comparison    MBRP plus RP versus TAU
Main Results
MBRP plus RP group was associated with significantly lower risk of relapse on first drug use (HR: 0.46, 95% CI: 0.42 to 0.51) and first alcohol use (HR: 0.41, 95% CI: 0.37 to 0.46) compared to TAU group.
Comparison 2: MBRP and RP versus TAU among post-treatment substance abuse patients
Outcomes 1 2
No. of studies (Total number of participants) 1 (286) 1 (286)
Mean score (SD)/ No. of participants Intervention Not reported Not reported
Comparator Not reported Not reported
Heterogeneity test (Isuperscript[2]) Not applicable as there is only 1 study. Not applicable as there is only 1 study.
Overall quality of evidence* Moderate Low
Keys: HR = hazard ratio; CI = confidence interval
Conclusion
Benefits
Compared to MBRP, RP is associated with lower risk of first drug use relapse. Both MBRP and RP group have lower risk of first drug use and first alcohol use relapse. For Comparison 1, the overall quality of evidence of Outcome 1 is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. The overall quality of evidence of Outcome 2 is low. Further research is likely to have an important impact on our confidence in this estimate of effect. For Comparison 2, the overall quality of evidence of Outcome 1 is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. The overall quality of evidence of Outcome 2 is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/24647726
The synopsis is based on the following article:
Bowen S, Witkiewitz K, Clifasefi SL, Grow J, Chawla N, Hsu SH, et al. Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA Psychiatry. 2014 May


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.