From the Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work (Amaro), Florida International University, Miami, Florida; and Department of Preventive Medicine (Black), Keck School of Medicine, University of Southern California, Los Angeles, California.
Psychosom Med. 2021;83(6):528-538. doi: 10.1097/PSY.0000000000000907.
We tested the efficacy of Moment-by-Moment in Women's Recovery (MMWR), a mindfulness training program adapted for ethnoculturally diverse women with complex social and clinical histories in residential treatment for substance use disorder, on substance use and relapse outcomes.
Participants were randomized to MMWR (n = 100; 60% Hispanic/Latina, 18% non-Hispanic Black) or the attention control condition, Neurobiology of Addiction (n = 100; 56% Hispanic/Latina, 21% non-Hispanic Black). Substance use outcomes (days until first use, days of use, and relapse status: abstained, lapsed, relapsed) were obtained from interviewer-assisted timeline followback for an 8.5-month follow-up period spanning the intervention start through the 6-week intervention period and 7 months after the intervention ended.
An intent-to-treat survival analyses showed that time delay to first marijuana use favored MMWR (hazard ratio = 0.44, 95% confidence interval = 0.20-0.98, p = .049) with a medium-to-large effect size. In negative binomial hurdle models, the MMWR group showed fewer days of marijuana use at 3.5 months (B = -1.71, SE = 0.79, incidence rate ratio = 0.18, p = .030) and a trend at 7 months after the intervention (B = -0.90, standard error = 0.55, incidence rate ratio = 0.41, p = .10). For marijuana, mindfulness practice time during the intervention predicted time delay to first use (B = 0.28, p = .006) and total abstinence days (B = 0.34, p = .002) across the 7 months after MMWR. No other substance use outcomes showed differential response to MMWR relative to controls. Only in MMWR, number of study intervention sessions attended (dose) correlated with a greater length of time to alcohol intoxication (r = .48, p < .001), fewer days of alcohol intoxication (r = -.24, p = .020), and greater improvement in mindfulness skills (r = .61, p < .01).
MMWR added to an ongoing intensive residential treatment program serving vulnerable women is protective against marijuana use but no other substance use outcomes. Mindfulness practice time predicted a delay in time to first marijuana use. MMWR class attendance, an indicator of intervention dose, appears protective of alcohol intoxication at follow-up; thus, extended MMWR exposure might be useful.
我们检验了 Moment-by-Moment in Women's Recovery (MMWR) 的疗效，这是一种针对有复杂社会和临床背景的、人种文化背景多样化的女性的正念训练项目，这些女性正在接受以住宅为基础的物质使用障碍治疗。我们检验了 MMWR 对物质使用和复吸结果的影响。
参与者被随机分配到 MMWR 组（n = 100；60%为西班牙裔/拉丁裔，18%为非西班牙裔黑人）或神经生物学成瘾对照组（n = 100；56%为西班牙裔/拉丁裔，21%为非西班牙裔黑人）。通过访谈者辅助的时间线回溯法，在 8.5 个月的随访期内获取物质使用结果（首次使用的天数、使用天数和复吸状态：未复吸、复吸、复发）。该随访期跨越了干预的开始、6 周的干预期以及干预结束后 7 个月。
意向治疗生存分析表明，首次使用大麻的时间延迟有利于 MMWR（风险比=0.44，95%置信区间=0.20-0.98，p=0.049），具有中到大的效应量。在负二项式障碍模型中，MMWR 组在 3.5 个月时大麻使用天数更少（B=-1.71，SE=0.79，发病率比=0.18，p=0.030），在干预结束后 7 个月时有一个趋势（B=-0.90，标准误差=0.55，发病率比=0.41，p=0.10）。对于大麻，干预期间的正念练习时间预测了首次使用的时间延迟（B=0.28，p=0.006）和干预结束后 7 个月的总禁欲天数（B=0.34，p=0.002）。MMWR 组相对于对照组，没有其他物质使用结果表现出对 MMWR 的不同反应。只有在 MMWR 中，参加研究干预课程的次数（剂量）与酒精中毒所需的时间延长（r=0.48，p<0.001）、酒精中毒天数减少（r=-0.24，p=0.020）和正念技能的改善呈正相关（r=0.61，p<0.01）。
在为弱势女性提供的以住宅为基础的强化治疗项目中加入 MMWR，可以预防大麻的使用，但对其他物质的使用结果没有影响。正念练习时间预测了首次使用大麻的时间延迟。MMWR 课程的出席率，即干预剂量的一个指标，似乎可以预防随访时的酒精中毒；因此，延长 MMWR 的暴露可能是有用的。
