Research on Mindfulness and Substance Use
Our team at UW has been involved in several studies over the past decade on effects of mindfulness and meditation on substance use and relapse. Below are a sample of papers resulting from these studies, and related work by our colleagues.
Bowen, S.& Vieten, C. (2012). A Compassionate Approach to the Treatment of
Addictive Behaviors: The Contributions of Alan Marlatt to the Field of
Mindfulness-Based Interventions. Addiction
Research and Theory, 20 (3), 243-249. ABSTRACT: Dr Alan Marlatt dedicated the last decade of his research
career to development and assessment of mindfulness-based treatments for
addictive behaviors. From his research in the 1970s on effects of
transcendental meditation to several recent trials of vipassana and
other mindfulness-based practices, Alan inspired and laid the foundation
for the development of numerous interventions and studies on
mindfulness and acceptance-based treatments for substance use disorders.
In collaboration with his colleagues, Alan developed Mindfulness-Based
Relapse Prevention (MBRP), an outpatient program that integrates skills
from cognitive behavioral relapse prevention (RP) and training in
mindfulness meditation practices. MBRP is designed to help clients
increase awareness of triggers and subsequent physical, emotional, and
cognitive experiences, learning to respond skillfully rather than react
habitually. Aligned with Alan’s previous work in harm reduction and RP,
this approach offers a nonjudgmental, client-centered, and
acceptance-based approach to the treatment of addictive behaviors.
Research and foundational theory behind MBRP and similar
mindfulness-based programs developed by other researchers in the field
of addictive behaviors are reviewed.
Marlatt, G. A., Bowen, S., &
Lustyk, M. K. B. (2012). Substance Abuse and Relapse Prevention. In C. K. Germer & R. D. Siegel (Eds), Compassion and Wisdom in Psychotherapy. New
York: Guilford Press.ABSTRACT: (from the chapter) As many of the contributors to this book
have pointed out, mindfulness provides an entry into making more
skillful choices. In that mindful moment of a choice point, there is the
potential to decide differently, even if we don't do this every time.
Step by step, we can slowly create for ourselves a path that leads to
less destructive behavior, accruing along the way a better sense of
self-efficacy, positive growth, and confidence. The authors begin with a
case that illustrates how mindfulness meditation can enhance treatment
outcomes by offering a metacognitive coping strategy for relapse
prevention. They then describe a variety of strategies used in
Mindfulness Based Relapse Prevention that are consistent with the
principles of compassion and wisdom. Interwoven in this section are
neurobiological findings that help to illuminate mechanisms by which
mindfulness meditation may be helpful in reducing the risk of relapse
among individuals who have struggles with addiction.
& Kurz, A. S. (2012). Between-session practice and therapeutic alliance as
predictors of mindfulness after mindfulness-based relapse prevention. Journal of Clinical Psychology 68 (3): 236-245.
ABSTRACT: Objectives: Mindfulness-based treatments have demonstrated
efficacy in reducing symptoms in clinical populations. Not surprisingly,
research suggests increases in client mindfulness might be a mechanism
of change in these treatments. However, little is known about specific
factors that lead to increased mindfulness. Design: The present study is
a secondary analysis of 93 adults in outpatient treatment for substance
abuse, assessing effects of between-session mindfulness practice and
therapeutic alliance on levels of mindfulness after an 8-week
Mindfulness-Based Relapse Prevention (MBRP) program. Results:
Between-session practice over the course of the 8 weeks was predictive
of mindfulness at postcourse, although not at the 2-month or 4-month
follow-up assessments. Client rated therapeutic alliance was a
significant predictor at the 2-month follow-up, although not at 4
months. Conclusions: These findings suggest that between-session
practice and therapeutic alliance might be important factors in the
initial increases in mindfulness after mindfulness-based treatments, but
factors supporting longer term mindfulness might shift over time.
Witkiewitz, K., Bowen, S., Douglas, H., & Hsu, S. H. (2012). Mindfulness-Based
Relapse Prevention for Substance Craving. Addictive
ABSTRACT: Craving, defined as the subjective experience of an urge or
desire to use substances, has been identified in clinical, laboratory,
and preclinical studies as a significant predictor of substance use,
substance use disorder, and relapse following treatment for a substance
use disorder. Various models of craving have been proposed from
biological, cognitive, and/or affective perspectives, and, collectively,
these models of craving have informed the research and treatment of
addictive behaviors. In this article we discuss craving from a
mindfulness perspective, and specifically how mindfulness-based relapse
prevention (MBRP) may be effective in reducing substance craving. We
present secondary analyses of data from a randomized controlled trial
that examined MBRP as an aftercare treatment for substance use
disorders. In the primary analyses of the data from this trial, Bowen
and colleagues (2009) found that individuals who received MBRP reported
significantly lower levels of craving following treatment, in
comparison to a treatment-as-usual control group, which mediated
subsequent substance use outcomes. In the current study, we extend these
findings to examine potential mechanisms by which MBRP might be
associated with lower levels of craving. Results indicated that a latent
factor representing scores on measures of acceptance, awareness, and
nonjudgment significantly mediated the relation between receiving MBRP
and self-reported levels of craving immediately following treatment. The
mediation findings are consistent with the goals of MBRP and highlight
the importance of interventions that increase acceptance and awareness,
and help clients foster a nonjudgmental attitude toward their
experience. Attending to these processes may target both the experience
of and response to craving.
Witkiewitz, K., Lustyk, M. K., & Bowen, S. (2012). Re-Training the
Addicted Brain: A Review of Hypothesized Neurobiological Mechanisms of
Mindfulness-Based Relapse Prevention. Psychology
of Addictive Behaviors.
ABSTRACT: Addiction has generally been characterized as a chronic
relapsing condition (Leshner, 1999). Several laboratory, preclinical,
and clinical studies have provided evidence that craving and negative
affect are strong predictors of the relapse process. These states, as
well as the desire to avoid them, have been described as primary motives
for substance use. A recently developed behavioral treatment,
mindfulness-based relapse prevention (MBRP), was designed to target
experiences of craving and negative affect and their roles in the
relapse process. MBRP offers skills in cognitive–behavioral relapse
prevention integrated with mindfulness meditation. The mindfulness
practices in MBRP are intended to increase discriminative awareness,
with a specific focus on acceptance of uncomfortable states or
challenging situations without reacting “automatically.” A recent
efficacy trial found that those randomized to MBRP, as compared with
those in a control group, demonstrated significantly lower rates of
substance use and greater decreases in craving following treatment.
Furthermore, individuals in MBRP did not report increased craving or
substance use in response to negative affect. It is important to note,
areas of the brain that have been associated with craving, negative
affect, and relapse have also been shown to be affected by mindfulness
training. Drawing from the neuroimaging literature, we review several
plausible mechanisms by which MBRP might be changing neural responses to
the experiences of craving and negative affect, which subsequently may
reduce risk for relapse. We hypothesize that MBRP may affect numerous
brain systems and may reverse, repair, or compensate for the
neuroadaptive changes associated with addiction and addictive-behavior
S., Chawla, N., Collins, S.,
Witkiewitz, K., Hsu, S.,Grow, J., Clifasefi, S., Garner, M., Douglass, A.,
Larimer, M., & Marlatt, A. (2009). Mindfulness-Based Relapse Prevention for
Substance Use Disorders: A Pilot Efficacy Trial. Substance Abuse.30, 205-305.
ABSTRACT. The current study is the first randomized-controlled trial evaluating the feasibility an 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.
Chawla, N., Collins, S., Bowen, S., Hsu, S., Grow, J., Douglas, A., & Marlatt, G. A. (2010).
The Mindfulness-Based Relapse Prevention Adherence and Competence Scale: Development,
Interrater Reliability and Validity. Psychotherapy
Research, 20, 388-397.
Abstract: The present
study describes the development of the Mindfulness-Based Relapse Prevention
Adherence and Competence Scale(MBRP-AC),a measure of treatment integrity for Mindfulness-Based
Relapse Prevention (MBRP). MBRP is a newly developed treatment integrating core
aspects of relapse prevention with mindfulness practices. The MBRP-AC was developed
in the context of a randomized controlled trial (RCT) of MBRP efficacy and
consists of two sections: Adherence (adherence to individual components of MBRP
and discussion of key concepts), and Competence (ratings of therapist
style/approach and performance). Audio
recordings from 44 randomly selected group treatment sessions (50%) were rated
by independent raters for therapist adherence and competence in the RCT.
Findings evinced high interrater reliability for all treatment adherence and
competence ratings, and adequate internal consistency for Therapist
Style/Approach and Therapist Performance summary scales. Ratings on the
MBRP-AC suggested that therapists in the recent RCT adhered to protocol,
discussed key concepts in each session, and demonstrated the intended style and
competence in treatment delivery. Finally, overall therapist performance was
positively related to therapeutic alliance, and overall ratings on the Adherence
section were positively related to changes in mindfulness over the course of
Lee, K-H., Bowen,
S., & Bai, A-F. (in press). Psychosocial outcomes of Mindfulness-Based
Relapse Prevention in incarcerated substance abusers in Taiwan: A preliminary
study. Journal of Substance Abuse.
Abstract: Introduction: The current study evaluated effects of an adapted version of Mindfulness-Based Relapse Prevention (MBRP) on several psychosocial indices in a sample of incarcerated adult males with substance use disorders. Method: This study used a 2 (baseline vs post-session) × 2 (MBRP vs. treatment-as-usual (TAU) mixed design. Twenty-four incarcerated individuals with a history of substance abuse were randomly assigned to either MBRP or TAU. At pre- and post-session assessment points, participants completed the Drug Use Identification Disorders Test- Extended(DUDIT-E), the Drug Avoidance Self-Efficacy Scale (DASE) and positive/negative outcome expectancies(Ep/En). The Beck Depression Inventory-II (BDI-II) was completed in each weekly session of MBRP. MANOVA and repeated measures ANOVA examined changes between and within subjects,with the significant level set at 0.05.Results: No between-group differences were found on positive outcome expectancies or self-efficacy.Differences BDI-II scores among MBRP participants showed a downward trend over time. A Group ×Time effect emerged for negative outcome expectancies, with significant differences between groups at post-course assessment.Conclusions: Results from this randomized trial suggest pre- to post-intervention trend-level effects ofMBRP on depression, and significant group differences over time and at post-course on negative outcome expectancies, with the MBRP group reporting increases.
Collins, S. E., Chawla, N., Hsu, S. H., Grow, J., Otto, J. M., & Marlatt, G. A. (2009). Language-based measures of mindfulness: Initial validity and clinical utility. Psychology of Addictive Behaviors, Vol 23, 743-749.
Abstract: This study examined relationships among language use, mindfulness, and substance-use treatment outcomes in the context of an efficacy trial of mindfulness-based
relapse prevention (MBRP) for adults with alcohol and other drug use
(AOD) disorders. An expert panel generated two categories of mindfulness language (ML) describing the mindfulness state and the more encompassing mindfulness practice and MBRP. Findings supported concurrent validity of ML
categories: ML words appeared more frequently in the MBRP manual
compared to the 12-step Big Book. Further, ML categories correlated with
other linguistic variables related to the mindfulness
construct. Finally, predictive validity was supported: greater use of
ML predicted fewer AOD use days during the 4-month follow-up. This study
provided initial support for ML as a valid, clinically useful mindfulness
measure. If future studies replicate these findings, ML could be used
in conjunction with self-report to provide a more complete picture of
the mindfulness journey,” which included words describing challenges of developing a
practice. MBRP participants (n = 48) completed baseline
sociodemographic and AOD measures, and participated in the 8-week MBRP
program. AOD data were collected during the 4-month follow-up. A word
count program assessed the frequency of ML and other linguistic markers
in participants’ responses to open-ended questions about their
postintervention impressions of experience
Witkiewitz, K., Bowen,
S., Villarael, N, & Donovan, D. (in press). The Relation between
Changes in Negative Mood and Heavy Drinking: Moderating Effects of a Craving
Intervention. Journal of Consulting and
Abstract: Negative affect is a
significant predictor of alcohol relapse and the relation between negative
affect and drinking has been shown to be strongly mediated by craving for
alcohol. Thus, targeting craving during treatment could potentially attenuate
the relation between negative affect and drinking. Method: The current study is
a secondary analysis of data from the COMBINE study, a randomized clinical
trial that combined pharmacotherapy with behavioral intervention in the
treatment of alcohol dependence. The goal of the current study was to examine whether
a treatment module that targeted craving would predict changes in negative mood
during the 16-week Combined Behavioral Intervention (CBI; n=776) and the relation between changes in mood, craving, and
changes in heavy drinking during treatment and one year posttreatment. Results:
Changes in negative mood were significantly associated with changes in heavy
drinking during treatment (f=0.78).
Participants (n=432) who received the
craving module had significantly fewer heavy drinking days during treatment (d = 0.31) and receiving the module
moderated the relation between negative mood and heavy drinking during
treatment (f=0.31) and
one year posttreatment (f=0.03).
Moderating effects of the craving module were mediated by changes in craving
during treatment. Within subject analyses indicated significant pre- to
post-module reductions in negative mood. Additionally, post-module craving
significantly mediated the association between negative mood and heavy drinking
during treatment and posttreatment. Conclusions: The craving module of CBI may weaken
the relation between negative affect and heavy drinking by fostering greater
decreases in craving during treatment.
Witkiewitz, K. & Bowen, S. (2010). Depression, Craving and Substance Use Following a
Randomized Trial of Mindfulness-Based Relapse Prevention. Journal of Consulting and Clinical Psychology, 78, 362-374.
Abstract: A strong relation between negative affect and craving has been demonstrated in laboratory and clinical studies, with depressive symptomatology showing particularly strong links to craving and substance abuse relapse. Mindfulness-based relapse prevention (MBRP), shown to be efficacious for reduction of substance use, uses mindfulness-based practices to teach alternative responses to emotional discomfort and lessen the conditioned response of craving in the presence of depressive symptoms. The goal in the current study was to examine the relation between measures of depressive symptoms, craving,and substance use following MBRP. Method: Individuals with substance use disorders (N 168; mean age 40.45 years, SD 10.28; 36.3% female; 46.4% non-White) were recruited after intensive stabilization,then randomly assigned to either 8 weekly sessions of MBRP or a treatment-as-usual control group. Approximately 73% of the sample was retained at the final 4-month follow-up assessment.Results: Results confirmed a moderated-mediation effect, whereby craving mediated the relation between depressive symptoms (Beck Depression Inventory) and substance use (Timeline Follow-Back)among the treatment-as-usual group but not among MBRP participants. MBRP attenuated the relation between postintervention depressive symptoms and craving (Penn Alcohol Craving Scale) 2 months following the intervention (f 2 .21). This moderation effect predicted substance use 4 months following the intervention (f 2 .18). Conclusion: MBRP appears to influence cognitive and behavioral responses to depressive symptoms, partially explaining reductions in postintervention substance use among the MBRP group. Although results are preliminary, the current study provides evidence for the value of incorporating mindfulness practice into substance abuse treatment and identifies a potential mechanism of change following MBRP.
Brewer, J. A., Bowen,
S., Smith, J.T., Marlatt, G. A., & Potenza, M. N. (2010). Applying
Mindfulness-Based Treatments to Co-Occurring Disorders: What Can We Learn from
the Brain? Addiction, 105, 1698-
Abstract: Both depression and substance use disorders represent major global public health concerns and are often co-occurring.Although there are ongoing discoveries regarding the pathophysiology and treatment of each condition, common mechanisms and effective treatments for co-occurring depression and substance abuse remain elusive. Mindfulness training has been shown recently to benefit both depression and substance use disorders, suggesting that this approach may target common behavioral and neurobiological processes. However, it remains unclear whether these pathways constitute specific shared neurobiological mechanisms or more extensive components universal to the broader human experience of psychological distress or suffering.We offer a theoretical, clinical and neurobiological perspective of the overlaps between these disorders, highlight common neural pathways that play a role in depression and substance use disorders and discuss how these commonalities may frame our conceptualization and treatment of co-occurring disorders. Finally, we discuss how advances in our understanding of potential mechanisms of mindfulness training may offer not only unique effects on depression and substance use, but also offer promise for treatment of co-occurring disorders.
Bowen, S. & Marlatt, G. A. (2009). Surfing the Urge: Brief Mindfulness-Based Intervention
for College Student Smokers. Psychology
of Addictive Behaviors, 666-671.
Abstract: The current study investigates effects of a brief mindfulness-based instruction set, based on Marlatt’s urge surfing” technique (Marlatt & Gordon, 1985), on smoking-related urges and behavior. Undergraduate smokers (N 123) who were interested in changing their smoking, but not currently involved in a cessation program, participated in a cue exposure paradigm designed to elicit urges to smoke. They were randomly assigned either to a group receiving brief mindfulness-based instructions or to a no-instruction control group. Results suggest that groups did not differ significantly on measures of urges. However,those in the mindfulness group smoked significantly fewer cigarettes over a 7-day follow-up period as compared to those in the control group. These findings suggest that the mindfulness techniques may not initially reduce urges to smoke but may change the response to urges. The study provides preliminary data for future studies examining both mechanisms and effectiveness of mindfulness-based interventions for cigarette smoking.
Lustyk, K., Chawla, N., Nolan, R., & Marlatt, G. A. (2009). Mindfulness Meditation Research: Issues of participant screening, safety procedures, and researcher training. Advances in Mind-Body Medicine, 24, 20-30.
Abstract: Increasing interest in mindfulness meditation (MM) warrants discussion of research safety. Side effects of meditation with possible adverse reactions are reported in the literature. Yet participant screening procedures, research safety guidelines, and standards for researcher training have not been developed and disseminated in the MM field of study. The goal of this paper is to summarize safety concerns of MM practice and offer scholars some practical tools to use in their research. For example, we offer screener schematics aimed at determining the contraindication status of potential research participants. Moreover, we provide information on numerous MM training options. Ours is the first presentation of this type aimed at helping researchers think through the safety and training issues presented herein. Support for our recommendations comes from consulting 17 primary publications and 5 secondary reports/literature reviews of meditation side effects. Mental health consequences were the most frequently reported side effects, followed by physical health then spiritual health consequences. For each of these categories of potential adverse effects, we offer MM researchers methods to assess the relative risks of each as it pertains to their particular research programs.
Zgierska, A., Rabago, D., Chawla, N., Kushner, K., Kohler, R., Marlatt, A. (2009). Mindfulness Meditation for Substance Use Disorders: A Systematic Review.Journal of Substance Abuse, 30, 266-294.
Abstract: Relapse is common in substance use disorders (SUDs), even among treated individuals. The goal of this article was to systematically review the existing evidence on mindfulness meditation-based interventions (MM) for SUDs. The comprehensive search for and review of literature found over 2000 abstracts and resulted in 25 eligible manuscripts (22 published, 3 unpublished: 8 randomized controlled trials, 7 controlled nonrandomized, 6 noncontrolled prospective, and 2qualitative studies, and 1 case report). When appropriate, methodological quality,absolute risk reduction, number needed to treat, and effect size were assessed.Overall, although preliminary evidence suggests MM efficacy and safety, conclusive data for MM as a treatment of SUDs are lacking. Significant methodological limitations exist in most studies. Further, it is unclear which persons with SUDs might benefit most from MM. Future trials must be of sufficient sample size toanswer a specific clinical question and should target both assessment of effect size and mechanisms of action.
Bowen, S. Witkiewitz, K., Dillworth, T.M., & Marlatt, G. A.
(2007). The role of thought suppression
in the relationship between mindfulness meditation and substance use. Addictive Behaviors, 32, 2324-2328.
Abstract: Previous studies have demonstrated that attempts to suppress thoughts about using substances may actually lead to increases in substance use. Vipassana, a mindfulness meditation practice, emphasizes acceptance, rather than suppression, of unwanted thoughts. A study by Bowen and colleagues examining the effects of a Vipassana course on substance use in an incarcerated population showed significant reductions in substance use among the Vipassana group as compared to a treatment—usual control condition [Bowen S.,Witkiewitz K., Dillworth T.M., Chawla N.,Simpson T.L., Ostafin B.D., et al. (2006). Mindfulness Meditation and Substance Use in an Incarcerated Population.Psychology of Addictive Behaviors.]. The current study further examines the mediating effects of thought suppression in the relationship between participation in the course and subsequent alcohol use. Those who participated in the course reported significant decreases in avoidance of thoughts when compared to controls. The decrease in avoidance partially mediated effects of the course on post-release alcohol use and consequences.
Simpson, T. L., Kaysen, D., Bowen, S., MacPherson, L. M., Chawla, N., Blume, A., Marlatt, G.
A., & Larimer (2007). PTSD symptoms, substance
use, and Vipassana mediation among incarcerated individuals. Journal of Traumatic Stress, 20, 239-249.
Abstract: The present study evaluated whether Posttraumatic Stress Disorder (PTSD) symptom severity was associated with participation and treatment outcomes comparing a Vipassana meditation course to treatment as usual in an incarcerated sample. This study utilizes secondary data. The original study demonstrated that Vipassana meditation is associated with reductions in substance use. The present study found that PTSD symptom severity did not differ significantly between those who did and did not volunteer to take the course. Participation in the Vipassana course was associated with significantly greater reductions in substance use than treatment as usual, regardless of PTSD symptom severity levels.These results suggest that Vipassana meditation is worthy of further study for those with comorbid PTSD and substance use problems.
Bowen, S. Witkiewitz, K., Dillworth, T.M., Chawla, N., Simpson,
T.L., Ostafin, B., Larimer, M.E., Blume, A.W., Parks, G.A. and G. Alan Marlatt,
G.A. (2006). Mindfulness meditation and substance use in an incarcerated population.
Psychology of Addictive Behaviors, 20, 343-347.
Abstract: 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.
Ostafin, B.D., Chawla, N., Bowen, S., Dillworth, T.M., Witkiewitz, K. & Marlatt, G.A.
(2006). Intensive mindfulness training and the reduction of psychological
distress: A preliminary study. Cognitive
and Behavioral Practice, 13, 191-197.
Abstract: There is increasing evidence for the utility of mindfulness training as a clinical intervention. Most of this research has examined secular based mindfulness instruction. The current study examined the effects of a 10-day Buddhist mindfulness meditation course on the psychological symptoms of 53 participants. A repeated-measures analysis of variance indicated reductions in overall psychological distress from the pre-course baseline to a 3-month follow-up. Correlation analyses indicated that the reported reduction in psychological distress was not influenced by social desirability bias and that the effect was not dependent on daily meditation between course completion and follow-up. Issues regarding modality of mindfulness training (secular versus Buddhist) are discussed.
Bowen. S. & Marlatt, G.A. (2005).
Spirituality, mindfulness & substance abuse. Addictive Behaviors, 30, 1335-1341.
Abstract: A growing body of research suggests that mindfulness-based therapies may be effective in treating a variety of disorders including stress, chronic pain, depression and anxiety. However, there are few valid and reliable measures of mindfulness. Furthermore, mindfulness is often thought to be related to spirituality, given its roots in Buddhist tradition, but empirical studies on this relationship are difficult to find. The present study: (1) tested the reliability and validity of a new mindfulness measure, the Freiburg Mindfulness Inventory (FMI), (2) explored the relationship between mindfulness and spirituality, and (3) investigated the relationship between mindfulness and/or spirituality and alcohol and tobacco use in an undergraduate college population (N=196). Results support the reliability of the FMI and suggest that spirituality and mindfulness may be separate constructs. In addition, smoking and frequent binge-drinking were negatively correlated with spirituality scores; as spirituality scores increased the use of alcohol and tobacco decreased. Thus, spirituality may be related to decreased substance use. In contrast, a positive relationship between mindfulness and smoking/frequent binge drinking behavior was uncovered, and warrants further investigation.
(Research funded by National Institute of Drug Abuse, National Institute of Alcohol and Alcoholism, Alcohol and Drug Abuse Institute and Robertwood Johnson)
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