Women's Treatment and Early Recovery

NCT ID: NCT02977988

Last Updated: 2026-01-13

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-10-15

Study Completion Date

2019-06-30

Brief Summary

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Approximately 25 million Americans struggle with alcohol or drug problems annually. Abuse of alcohol and drugs is costly to our nation, exacting more than $428 billion in costs related to crime, lost work productivity and health care. While effective treatments exist, over half of those who enter treatment for substance use disorders drop out early in treatment and return to alcohol or drug abuse. Psychological stress is a causal factor in the pathogenesis of substance use disorder (SUD) and relapse risk. Low-income women report high levels of stress in SUD residential treatment stemming from significant economic and family stressors in addition to challenges of adjusting to residential treatment demands. Unmanaged stress, especially in early stages of residential treatment, is a major concern because it can increase dropout. Dropout from residential treatment places women at risk of substance use relapse. A gap in knowledge persists regarding the use of mindfulness-based interventions with racially/ethnically diverse low-income women with SUDs, especially regarding the efficacy of adapted (Mindfulness-based interventions) MBIs for preventing residential dropout and decreasing relapse. We have fully adapted, developed, and pilot tested a novel MBI, Moment-by-Moment in Women's Recovery: Mindfulness Based Relapse Prevention for Women (MBRP-W), that supports the needs of women in residential treatment. This MBI integrates relapse prevention, addresses literacy level, and is relevant to issues surrounding treatment- and relapse-related stressors of disadvantaged women. The current project has three specific aims: (1) to test the efficacy of MBRP-W on residential treatment retention and substance use relapse in racially/ethnically diverse low-income women; (2) to determine the mechanisms of change underlying the MBRP-W program; and (3) to explore neural changes associated with program effects. A rationale for MBRP-W is the need for self-initiated stress management skills in women with SUDs during the early stressful periods of residential treatment that increase risk of dropout and relapse.

Detailed Description

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* This randomized clinical trial will deliver two interventions as add-ons to residential substance use disorder (SUD) treatment: (1) Moment-by-Moment in women's Recovery: Mindfulness-Based Approach to Relapse Prevention (MBRP-W) and (2) Brain and Recovery (B\&R) which serves as an active psychoeducational attention control group.
* Participants (N=165) who meet study eligibility criteria based on intake assessment will be recruited and complete baseline assessments during weeks 3-6 after entry into a residential treatment program. Participants will be randomly assigned to interventions using Urn randomization. All participants (MBRP-W and B\&R) will receive SUD treatment as normally provided by the treatment program. Fifteen participants from each intervention group (N=30) will be selected to participate in a brain imaging (MRI and fMRI) substudy.
* Participants will be adult females who have been admitted to a residential treatment center in an urban area of California and who are diagnosed with a SUD based on clinical intake Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) diagnostic assessment.
* MBRP-W is delivered in 12 bi-weekly 80-minute group sessions with SUD clinical populations. Facilitators will have previous experience in MBSR facilitation and will be trained in MBRP-W. Each session has a central theme and is divided into five segments consisting of (a) a welcome meditation or other mindfulness practice, (b) a review of session objectives, (c) a brief didactic psycho-educational presentation and discussion based on the session's theme, (d) experiential and formal meditation or other practices, and (e) readings and practice assignments for the next class.
* B\&R is delivered in 12 bi-weekly 80-minute group sessions with SUD clinical populations. Facilitators will be trained in B\&R. The B\&R group will receive didactic education on the neurobiology of addiction. B\&R contains no information on behavior change, relapse prevention, stress reduction, or mindfulness-based or relapse-related content. The intervention was developed over three years with a population similar to that of the current study (i.e., racially/ethnically diverse and low-income women in SUD treatment) with input and review from focus group participants, care providers in SUD treatment, and three experts on the neurobiology of addiction. Topics include: (1) brain structure and function related to addiction, (2) effects of various types of substance use on the brain, and (3) rewarding effects of substance use and how these rewarding effects can lead to addiction.
* There are three data collection points, 1) baseline, 2) immediate post-intervention, and 3) 8-months post-intervention completion. Data will be collected in-person by research interviewers via computer-assisted interviews, which includes administration of an alcohol Breathalyzer test to assess alcohol use and collection of a urine sample to assess drug use. Interviews will be conducted at the treatment program (for those who remain in residential treatment) or at convenient locations for participants no longer in treatment. Baseline interview will occur prior to randomization, post-intervention interview will occur within 1-2 weeks of the last group session, and the follow-up interview will occur at an 8-months post-intervention completion window. Brain imaging for a subsample of participants will be completed at baseline and immediate post-intervention.
* Number of intervention program class sessions attended will be collected for all enrolled participants.
* Participant Satisfaction Surveys measuring acceptability, credibility, and perceived utility of the study arms will be administered to both groups at two class sessions.
* Applied Mindfulness Practice Scale (AMPS) measuring the participant's application of mindfulness skills to address life challenges, will be administered to the MBRP-W participants at four class sessions as well as at follow-up. Mindfulness practice effort will also be assessed at these same four class sessions.
* An in-treatment clinical record review of services will be collected weekly for the duration of residential treatment.

Conditions

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Substance-related Disorders

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Mindfulness Meditation

Mindfulness-Based Relapse Prevention-Women (MBRP-W)

Group Type EXPERIMENTAL

Mindfulness Meditation

Intervention Type BEHAVIORAL

MBRP-W is delivered in 12 bi-weekly 80-minute group sessions. Facilitators with previous experience in MBSR and trained in MBRP-W will deliver each group. Each session has a central theme and is divided into five segments consisting of: (a) a welcome meditation or other mindfulness practice, (b) a review of session objectives, (c) a brief didactic psycho-educational presentation and discussion based on the session's theme, (d) experiential and formal meditation or other practices, and (e) readings and assignments for the next class. Participants are expected to learn skill building techniques to reducing stress using mindfulness-based principles to complement their recovery treatment program.

Active Comparator

Brain and Recovery (B\&R)

Group Type ACTIVE_COMPARATOR

Brain and Recovery (B&R)

Intervention Type BEHAVIORAL

B\&R is delivered in 12 bi-weekly 80-minute group sessions delivered by two trained interventionists. The B\&R group will receive didactic education on the neurobiology of addiction. B\&R contains no information on behavior change, stress reduction, or mindfulness-based or relapse-related content. The intervention was developed over three years with a population similar to those in the study and with input from patients and experts on neurobiology of addiction. Topics include: (1) brain structures and functions related to addiction, (2) effects of various types of substances on the brain, and (3) rewarding effects and how these lead to addiction. Participants are expected to gain knowledge pertaining to the effects of drugs on the brain.

Interventions

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Mindfulness Meditation

MBRP-W is delivered in 12 bi-weekly 80-minute group sessions. Facilitators with previous experience in MBSR and trained in MBRP-W will deliver each group. Each session has a central theme and is divided into five segments consisting of: (a) a welcome meditation or other mindfulness practice, (b) a review of session objectives, (c) a brief didactic psycho-educational presentation and discussion based on the session's theme, (d) experiential and formal meditation or other practices, and (e) readings and assignments for the next class. Participants are expected to learn skill building techniques to reducing stress using mindfulness-based principles to complement their recovery treatment program.

Intervention Type BEHAVIORAL

Brain and Recovery (B&R)

B\&R is delivered in 12 bi-weekly 80-minute group sessions delivered by two trained interventionists. The B\&R group will receive didactic education on the neurobiology of addiction. B\&R contains no information on behavior change, stress reduction, or mindfulness-based or relapse-related content. The intervention was developed over three years with a population similar to those in the study and with input from patients and experts on neurobiology of addiction. Topics include: (1) brain structures and functions related to addiction, (2) effects of various types of substances on the brain, and (3) rewarding effects and how these lead to addiction. Participants are expected to gain knowledge pertaining to the effects of drugs on the brain.

Intervention Type BEHAVIORAL

Other Intervention Names

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Mindfulness-Based Relapse Prevention-Women (MBRP-W)

Eligibility Criteria

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Inclusion Criteria

* Female
* Adult in California (18 years or older)
* Diagnosed with a substance use disorder (SUD)
* Speaks fluent English
* Client at study site, substance use disorder residential facility at time of recruitment

Exclusion Criteria

* Inability to comprehend informed consent
* Unwilling to sign informed consent
* Cognitive impairment, psychotic disorder or severe chronic mental health condition based on clinical intake DSM-V assessment
* Older than 65 years of age
* Reported suicidality in last 30 days
* Current prisoner
* Pregnant in the 3rd trimester
* Pregnant (MRI subsample only)
* Not willing to be audio recorded
* Not willing to have data stored for research purposes


* Older than 50 years of age
* Not in good general health
* Left handed (with a mean item score \>1 on the handedness scale)
* Currently pregnant
* Current medical devices (cardiac pacemaker, implanted cardiac defibrillator, carotid artery vascular clamp, neurostimulator, cochlear implant, metal fragments (including shrapnel) in the head, eyes, or skin, vascular stent, ocular implant, penile implant, vascular filter for clots (including Greenfield, Umbrella, or Birds Nest filters)
* Other non-removable devices (IUD, dental braces or retainer, piercings that cannot be removed prior to resting, permanent eye-liner)
* Body Mass Index (BMI) greater than 36
* History of head trauma resulting in loss of consciousness for more than 5 minutes
* Documented or subjectively reported claustrophobia
* Having hair extensions or a wig connected by wire
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Drug Abuse (NIDA)

NIH

Sponsor Role collaborator

University of Southern California

OTHER

Sponsor Role lead

Responsible Party

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David S Black, PhD

Associate Professor of Public Health Sciences

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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David S Black, PhD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of Southern California

Locations

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Prototypes' Pomona Women's Center

Pomona, California, United States

Site Status

Countries

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United States

References

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Amaro H, Spear S, Vallejo Z, Conron K, Black DS. Feasibility, acceptability, and preliminary outcomes of a mindfulness-based relapse prevention intervention for culturally-diverse, low-income women in substance use disorder treatment. Subst Use Misuse. 2014 Apr;49(5):547-59. doi: 10.3109/10826084.2013.852587.

Reference Type BACKGROUND
PMID: 24611850 (View on PubMed)

Black DS, O'Reilly GA, Olmstead R, Breen EC, Irwin MR. Mindfulness-based intervention for prodromal sleep disturbances in older adults: design and methodology of a randomized controlled trial. Contemp Clin Trials. 2014 Sep;39(1):22-7. doi: 10.1016/j.cct.2014.06.013. Epub 2014 Jul 1.

Reference Type BACKGROUND
PMID: 24993561 (View on PubMed)

Hanley A, Garland EL, Black DS. Use of mindful reappraisal coping among meditation practitioners. J Clin Psychol. 2014 Mar;70(3):294-301. doi: 10.1002/jclp.22023. Epub 2013 Jul 1.

Reference Type BACKGROUND
PMID: 23818289 (View on PubMed)

Li MJ, Black DS, Garland EL. The Applied Mindfulness Process Scale (AMPS): A process measure for evaluating mindfulness-based interventions. Pers Individ Dif. 2016 Apr 1;93:6-15. doi: 10.1016/j.paid.2015.10.027.

Reference Type BACKGROUND
PMID: 26858469 (View on PubMed)

Black DS, Slavich GM. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann N Y Acad Sci. 2016 Jun;1373(1):13-24. doi: 10.1111/nyas.12998. Epub 2016 Jan 21.

Reference Type BACKGROUND
PMID: 26799456 (View on PubMed)

Galla BM, O'Reilly GA, Kitil MJ, Smalley SL, Black DS. Community-Based Mindfulness Program for Disease Prevention and Health Promotion: Targeting Stress Reduction. Am J Health Promot. 2015 Sep-Oct;30(1):36-41. doi: 10.4278/ajhp.131107-QUAN-567. Epub 2014 Aug 27.

Reference Type BACKGROUND
PMID: 25162319 (View on PubMed)

Garland EL, Black DS. Mindfulness for chronic pain and prescription opioid misuse: novel mechanisms and unresolved issues. Subst Use Misuse. 2014 Apr;49(5):608-11. doi: 10.3109/10826084.2014.852801. No abstract available.

Reference Type BACKGROUND
PMID: 24611857 (View on PubMed)

Peltz L, Black DS. The thinking mind as addiction: mindfulness as antidote. Subst Use Misuse. 2014 Apr;49(5):605-7. doi: 10.3109/10826084.2014.852803. No abstract available.

Reference Type BACKGROUND
PMID: 24611856 (View on PubMed)

Witkiewitz K, Black DS. Unresolved issues in the application of mindfulness-based interventions for substance use disorders. Subst Use Misuse. 2014 Apr;49(5):601-4. doi: 10.3109/10826084.2014.852797. No abstract available.

Reference Type BACKGROUND
PMID: 24611855 (View on PubMed)

Black DS. Mindfulness-based interventions: an antidote to suffering in the context of substance use, misuse, and addiction. Subst Use Misuse. 2014 Apr;49(5):487-91. doi: 10.3109/10826084.2014.860749.

Reference Type BACKGROUND
PMID: 24611846 (View on PubMed)

Black DS. Mindfulness and substance use intervention. Subst Use Misuse. 2012 Feb;47(3):199-201. doi: 10.3109/10826084.2011.635461. No abstract available.

Reference Type BACKGROUND
PMID: 22217122 (View on PubMed)

Amaro H, Black DS. Mindfulness-Based Intervention Effects on Substance Use and Relapse Among Women in Residential Treatment: A Randomized Controlled Trial With 8.5-Month Follow-Up Period From the Moment-by-Moment in Women's Recovery Project. Psychosom Med. 2021 Jul-Aug 01;83(6):528-538. doi: 10.1097/PSY.0000000000000907.

Reference Type BACKGROUND
PMID: 34213858 (View on PubMed)

Amaro H, Black DS. Moment-by-Moment in Women's Recovery: Randomized controlled trial protocol to test the efficacy of a mindfulness-based intervention on treatment retention and relapse prevention among women in residential treatment for substance use disorder. Contemp Clin Trials. 2017 Nov;62:146-152. doi: 10.1016/j.cct.2017.09.004. Epub 2017 Sep 14.

Reference Type RESULT
PMID: 28918120 (View on PubMed)

Black DS, Amaro H. Moment-by-Moment in Women's Recovery (MMWR): Mindfulness-based intervention effects on residential substance use disorder treatment retention in a randomized controlled trial. Behav Res Ther. 2019 Sep;120:103437. doi: 10.1016/j.brat.2019.103437. Epub 2019 Jul 7.

Reference Type RESULT
PMID: 31419610 (View on PubMed)

Kechter A, Amaro H, Black DS. Reporting of Treatment Fidelity in Mindfulness-Based Intervention Trials: A Review and New Tool using NIH Behavior Change Consortium Guidelines. Mindfulness (N Y). 2019 Feb;10(2):215-233. doi: 10.1007/s12671-018-0974-4. Epub 2018 Jun 22.

Reference Type RESULT
PMID: 30854147 (View on PubMed)

Rivera D, Dueker D, Amaro H. Examination of referral source and retention among women in residential substance use disorder treatment: a prospective follow-up study. Subst Abuse Treat Prev Policy. 2021 Mar 2;16(1):21. doi: 10.1186/s13011-021-00357-y.

Reference Type DERIVED
PMID: 33653374 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Related Links

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https://goamra.org

American Mindfulness Research Association

Other Identifiers

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5R01DA038648-04

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UP-14-00391-AM001

Identifier Type: -

Identifier Source: org_study_id

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