Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2020 Dec 1.
Published in final edited form as: Curr Opin Psychol. 2018 Dec 27;30:11–16. doi: 10.1016/j.copsyc.2018.12.012

Mindfulness-Based Interventions for Addictions among Diverse and Underserved Populations

Claire Adams Spears 1
PMCID: PMC6597324  NIHMSID: NIHMS1517507  PMID: 30682663

Abstract

Mindfulness-based interventions (MBIs) show strong promise for treating addictions, but there is much work to be done to ensure that they are culturally appropriate, accessible, and optimally effective for priority populations who could potentially have the most to gain. This article briefly highlights research on MBIs for addictions among diverse and underserved populations and proposes next steps for increasing their potential to target addiction-related health disparities. Future directions include: 1) Prioritize diversity in clinical trials and conduct appropriately powered moderation analyses; 2) Consider treatment adaptations; 3) Examine underlying mechanisms to optimize MBIs for specific populations; 4) Improve implementation in community-based and other appropriate settings; and 5) Consider use of technology to provide just-in-time support and increase scalability for diverse populations.

Because escaping, avoiding, and reducing negative affect and craving are key drivers of substance use, mindfulness training is a particularly promising approach for addressing addictive behaviors [1]. Mindfulness involves non-judgmental attention to moment-to-moment sensations (including unpleasant emotions, cravings, and withdrawal symptoms), which is thought to foster more flexible, adaptive responses instead of automatically reacting through substance use. Mindfulness training helps people to recognize triggers, accept them for what they are, and more skillfully “ride them out” without trying to push them away by misusing substances. Several mindfulness-based interventions (MBIs) have been developed to target addictive behaviors, including alcohol, tobacco, and illicit substance use [2,3]. These include Mindfulness-Based Relapse Prevention (MBRP [4]), Mindfulness-Oriented Recovery Enhancement (MORE [5]), Mindfulness-Based Addiction Treatment (MBAT [6]), and mindfulness training for smoking cessation [7,8]. A meta-analysis on MBIs for substance misuse concluded that these interventions reduced substance use frequency, craving, and stress with small-to-large effect sizes [2]. Recent articles have reviewed the overall state of the science on MBIs for addictions and made recommendations for future research [e.g., 3,9]. This paper discusses current evidence and future directions with specific focus on ways to understand and optimize these interventions for more diverse and underserved populations.

Overall, certain sub-populations (e.g., individuals with low-socioeconomic status [SES]; racial/ethnic minorities; lesbian, gay, bisexual and transgender [LGBT] men and women; adults with serious mental illness) have not been well represented in mindfulness research [10,11]. A systematic review of randomized controlled trials of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) in the U.S. found that the samples included almost 20% more Caucasians compared to the U.S. population, mean education levels were much higher than the national average, and none of the studies reviewed specifically reported effectiveness among racial/ethnic minority or low-SES populations [10]. Low SES, racial/ethnic minority, and LGBT populations experience tremendous disparities in healthcare access, addiction treatment outcomes, and addiction-related morbidity and mortality [12–14]. High levels of stress (e.g., financial strain; neighborhood disadvantage; discrimination) contribute to addictive behaviors and higher rates of lapse and relapse in disadvantaged populations [13–17]. There is much work to be done to ensure that MBIs for addiction are culturally appropriate, accessible, and optimally effective for priority populations who could potentially have the most to gain. This article briefly highlights some of the work on MBIs for addictions among diverse and underserved populations and proposes next steps for increasing their potential to target addiction-related health disparities.

Rationale and Current Evidence

Rationale

Although most mindfulness research has included predominantly White, heterosexual, cisgender, and relatively affluent populations, there is reason to believe that MBIs might be particularly effective in marginalized populations. First, given that mindfulness is thought to serve as a buffer against health consequences of stress [18], MBIs could be particularly useful for people with more stressful life experiences. For example, research suggests that MBCT is more effective for preventing depressive relapse among individuals with history of childhood trauma [19]. Second, MBIs might target specific intrapersonal and interpersonal stressors that impede progress in addiction treatment for disadvantaged populations (e.g., difficulties coping with discrimination, low self-efficacy, low social support). Third, MBIs foster self-compassion and self-acceptance, which could be particularly valuable in the context of marginalization [20,21]. Fourth, personal mindfulness practice (e.g., mindfully focusing on one’s breath) does not require a high degree of education or material resources, and can be practiced independently in the context of daily life experiences. We found that low-SES African American adults viewed the ability to practice mindfulness on their own as empowering [22].

Current Evidence

MBIs have been used to target stress, depression and quality of life in various marginalized populations, including low-income African American women [23], severely socioeconomically disadvantaged populations [24,25], and gay men living with HIV [26]. Recent studies of MBIs for addiction have also included more diverse populations. For example, MBIs have shown benefits for smoking cessation in low-SES [8,27] and racially/ethnically diverse adults [6,7]. Research also supports the use of MBIs for reducing craving, stress, and relapse to drug and alcohol use among racially/ethnically and socioeconomically diverse samples [28,29], women criminal offenders [29], recently homeless men with co-occurring substance use and psychiatric disorders [30], and low-income women with trauma history [31].

A handful of recent studies have explored differential effects of MBIs for addictions by sociodemographic and other individual characteristics. Researchers found that MBRP was more efficacious than traditional relapse prevention for reducing drug use and preventing drug use relapse among racial/ethnic minority women [20,32]. Another study suggested that MBRP was particularly effective among participants with high-severity substance use disorders and co-occurring depression and anxiety [33]. Overall, MBIs for addictions show strong promise for low-SES and racial/ethnic minority populations, as well as those with psychiatric comorbidities. However, more research is needed to examine and optimize these interventions for diverse and underserved populations, and several future directions are outlined below.

Future Directions

1). Prioritize diversity in clinical trials and conduct appropriately powered moderation analyses.

As the science of MBIs for addictions moves forward, it will be critical to ensure that clinical trials include participants from diverse backgrounds. There has been very limited research examining whether the efficacy of these interventions differs for people of various cultural backgrounds and symptom profiles, with a few notable exceptions [20,32,33]. These analyses have largely been post-hoc, and various subgroups have been combined (e.g., categorizing participants as racial/ethnic minority vs. non-Hispanic White). Clinical trials should not only include diverse samples but also have appropriate statistical power to determine whether individual difference variables moderate treatment effects. Strategies to increase diversity in MBI clinical trials [10] include conducting cultural sensitivity training with research staff; providing transportation, childcare, and food; offering flexible scheduling; providing interventions and assessment materials in multiple languages; and ensuring that eligibility criteria are not overly restrictive.

It will be also be important to understand whether certain populations are more likely to experience adverse effects of MBIs. Although mindfulness meditation is generally associated with improved clinical outcomes, it has been associated with adverse reactions (e.g., psychotic episodes, religious delusions, pain [34]). Treatment adaptations may be needed to minimize adverse effects and/or provide extra support, and it could be that mindfulness training is not appropriate for people with certain clinical profiles.

2). Consider treatment adaptations.

Cultural competence is critical in the delivery of addiction treatments [12,35], and research should consider what (if any) cultural adaptations are needed to improve MBIs for diverse populations [36]. This could include both surface-structure (e.g., using culturally-relevant examples and language) and deep-structure adaptations [35] (e.g., encouraging self-compassion in the context of stigma and the coming-out process for LGBT populations [21]). See Amaro et al. [31] for discussion of MBI adaptations for addressing substance use among low-income, racially/ethnically diverse women with trauma history.

Qualitative research can help to elucidate individuals’ needs and preferences, as well as suggestions for making MBIs more relevant, appealing, and accessible. Based on our qualitative work with low-income, predominantly African American adults seeking mental health services, we provided the following recommendations [22]: a) engage in open discussion about the terms “mindfulness” and “meditation,” including any preconceived ideas, and use more familiar terms like “paying attention;” b) prepare participants for potential unpleasant experiences during meditation and provide extra support in the context of trauma history (e.g., leaving lights on and eyes open, shortening/moving the body scan to later sessions); c) work collaboratively with participants to identify barriers to mindfulness practice, recognizing that informal practice (e.g., pausing for mindful breaths throughout the day) may be more feasible and acceptable than longer formal meditation; d) discuss religion and/or spirituality based on participant preferences (e.g., several participants practiced mindfulness in the context of praying, reading religious texts, or listening to spiritual music); and e) consider ways of promoting empowerment in marginalized populations. MBIs can encourage mindful attention to personal and community strengths/resources rather than focusing excessively on stressors and risk factors. When discussing specific stressors like discrimination, it should be noted that mindful acceptance is not the same thing as resignation. Participants might practice treating themselves kindly in the midst of difficult situations while also mobilizing resources for change.

It will be important to understand how much formal and informal between-session mindfulness practice is feasible and necessary to achieve clinical outcomes for various populations. Some research has linked greater mindfulness practice to better outcomes [37], including lower alcohol and drug use [38] and lower smoking frequency [7]. However, it is also critical to meet people where they are to ensure that mindfulness practice is feasible (e.g., for those who may not have safe, quiet spaces in which to close their eyes for formal meditation).

Given that matching therapists and clients on race/ethnicity and language may improve retention and clinical outcomes [39], MBIs might be more successfully implemented by therapists with similar backgrounds to the target population. The sociodemographic composition of the group may also be important to consider: Greenfield et al. [32] found that racial/ethnic minority participants evidenced better alcohol and drug use outcomes when more than half of their MBRP group were also minorities. So far, treatment adaptations have generally been examined in small feasibility studies and will need to be rigorously tested.

3). Examine underlying mechanisms to optimize MBIs for specific populations.

A better understanding of key mechanisms through which MBIs impact addictive behaviors could inform the development of more efficacious and cost-effective interventions. MBIs could be improved by increasing focus on the most potent mechanisms and/or removing components that do not directly target those mechanisms. Although this work is still in its infancy, researchers have highlighted promising neurobiological and psychosocial mechanisms of MBIs [1,9,40–43]. MBI mechanisms of action may not be the same for everyone and should be studied among diverse populations. We found that dispositional mindfulness predicts lower affective volatility (i.e., greater emotional stability [44]) and weakens the association between stress and alcohol use [45] among African American smokers. Given that high stress/negative affect, neighborhood disadvantage, and low social support all mediate the association between low SES and difficulties quitting smoking [46], mindfulness training might specifically target these mechanisms in low-SES smokers. Similarly, discrimination and social isolation are linked to tobacco use in disadvantaged populations [13]. If MBIs reduce addictive behaviors by enhancing coping with discrimination or bolstering social resources in certain subgroups, interventions could be optimized by increasing focus on these components.

There is also a need for innovative methodology to advance the science of MBI mechanisms. Because several purported mechanisms (e.g., negative affect, craving) fluctuate on a moment-to-moment basis, ecological momentary assessment (EMA [47]) could help to elucidate real-time, real-life mechanisms. Ongoing work using neurobiological methods also holds promise [48], but research is needed with larger and more diverse samples.

4). Improve MBI implementation in community-based and other appropriate settings

It is critical to understand how to reach diverse populations by implementing MBIs in appropriate settings (e.g., community-based health centers, psychiatric facilities, correctional institutions) so that implementation is feasible but does not compromise effects of validated interventions. Potential adaptations to improve implementation include: changing the number, length, and/or frequency of MBI sessions; providing open groups with rolling enrollment (allowing individuals to begin treatment when ready, rather than waiting for the next cohort); and offering ongoing support/meditation groups for relapse prevention. Although the classic MBSR and MBCT protocols include eight weekly 2–2.5-hour sessions and day-long retreat, this may not always be feasible. For example, adapted MBSR protocols for low-income African American women at a federally qualified health center and low-income housing residence included eight weekly 90-minute sessions and no retreat [23,49].

Recent work supports the feasibility and acceptability of providing MBRP on a rolling basis with two 60-minute sessions/week for 4 weeks [50]. Ongoing “booster” sessions or drop-in meditation groups could also be beneficial, given that long-term relapse prevention is paramount. In our work delivering MBAT to low-income African American smokers, a common suggestion was to offer more sessions after the 8-week treatment period [51]. Overall, the above protocol alterations have not been rigorously tested. Future trials should examine which adaptations are most useful for improving treatment acceptability, adherence, and clinical outcomes.

5). Consider use of technology to provide just-in-time support and increase MBI scalability for diverse populations

In-person MBIs require substantial time and resources, which severely limits access for populations with limited healthcare access, inflexible work schedules, and difficulties with transportation/childcare. Preliminary research supports the feasibility of delivering mindfulness-based smoking cessation treatment through internet-based videos with telephone support, with targeted recruitment toward low-SES adults [52]. MBIs for addictions might also be delivered through mobile health technology (mHealth; e.g., text messaging, mobile applications [apps]), given that increased smartphone penetration has been especially pronounced among low-income adults [53]. These interventions could reduce stigma associated with in-person treatment, encourage coping strategies in real-time in users’ natural environments (e.g., in moments of high stress or craving), and standardize treatment in a way that is typically not possible with in-person services. These approaches can be personalized to individual risk factors and preferences, and are highly scalable with relatively low costs compared to in-person services. mHealth approaches could also be used for continuing care after active MBI protocols have ended.

At least two smoking cessation apps with focus on mindfulness and acceptance – “Craving to Quit” [54] and “SmartQuit” [55] – show promise. However, mHealth programs for addictive behaviors have generally not been developed with focus on disadvantaged populations. In developing a mindfulness-based text messaging program for smoking cessation among low-SES African American adults, we conducted a series of qualitative studies and iterative revisions with the goal of developing a program that is consistent with users’ needs and preferences [56]. Text messages reminded participants to practice mindfulness both formally and informally (e.g., “John, try ‘STOP.’ Stop, Take a deep breath, Observe what’s going on right now, Proceed with your day”) and were designed to be personalized and interactive (e.g., “Remember, John, you are quitting for your baby Kayla, your health, and to save $2,373 per year;” participants could also text keywords at any time to receive tips for managing cravings, stress, or lapses). Interestingly, although participants knew that the text messages were automated, they often noted a sense of social support and accountability (e.g., described as a “friend” or “coach” [56]). Our preliminary clinical trial suggested that the text messaging program (“iQuit Mindfully”) was most effective for participants living in poverty (e.g., among participants living below the federal poverty line, smoking cessation rates were higher for those receiving iQuit Mindfully compared to in-person-only treatment, but there were no differences in smoking cessation by treatment condition in the overall sample [57]). This type of 24/7, personalized support could be particularly beneficial for populations who have lower access to treatment and/or need additional services/support when attempting to change their substance use. Data collected via mobile wireless sensors (e.g., physiological indicators of high stress) and geolocation information (e.g., proximity to tobacco outlets or other high-risk locations) could also be integrated with mobile apps to trigger just-in-time intervention.

Future directions for studying technology-delivered MBIs for addiction include: a) conducting larger trials comparing technology-delivered vs. in-person MBIs in diverse samples; b) tailoring these approaches to specific populations (e.g., ensuring that literacy levels are appropriate and platforms are user-friendly; including culturally relevant content); c) exploring ways to foster social support (one aspect of in-person MBI groups that could be lost); d) developing creative ways to increase engagement (given that low user engagement is a pervasive problem with mobile apps [58]); e) examining what the most effective treatment “dose” might be when delivered via technology; and f) exploring how to make effective programs readily accessible to underserved populations.

Conclusions

Preliminary research supports the use of MBIs for addictions among low-SES and racial/ethnic minority populations, as well as adults with psychiatric comorbidities. However, there is much work to be done to expand and optimize the benefits of MBIs for populations who could potentially have the most to gain (e.g., low-SES, racial/ethnic minority, LGBT, serious mental illness). We need to understand how and for whom MBIs for addiction work, how to adapt these interventions for specific populations, and how to increase feasibility, acceptability, effectiveness, and scalability. Some specific future directions include: recruiting diverse populations for clinical trials and examining whether MBI effects differ based on sociodemographic and other individual characteristics; developing and evaluating cultural adaptations; elucidating underlying mechanisms to optimize effectiveness for specific populations; developing feasible ways of implementing MBIs in various settings; and studying technology to deliver just-in-time, personalized support and increase the reach of MBIs for diverse and underserved populations.

Highlights.

  • MBIs for addictions show promise in low-SES and racial/ethnic minority populations.

  • MBI clinical trials should prioritize diversity and conduct moderation analyses.

  • Cultural adaptations of MBIs could increase acceptability and effectiveness.

  • Ways to improve implementation in various treatment settings should be considered.

  • MBIs could be delivered via technology to increase reach among diverse populations.

Acknowledgements:

I thank Dr. Carol Glass and Dr. Christine Vinci for their comments on an earlier version of this manuscript.

Funding: Claire Spears is supported by grant number K23AT008442 from the National Center for Complementary and Integrative Health. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Conflict of Interest: None

References

  • 1.Brewer JA, Elwafi HM, Davis JH. Craving to quit: psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychology of Addictive Behaviors. 2013;27(2):366–379.*This article provides theoretical rationale for mindfulness training in the treatment of addictions, discusses psychological and neural mechanisms, and offers specific examples related to smoking behavior.
  • 2.Li W, Howard MO, Garland EL, McGovern P, Lazar M. Mindfulness treatment for substance misuse: A systematic review and meta-analysis. Journal of Substance Abuse Treatment. 2017;75:62–96.**This systematic review and meta-analysis summarizes findings from randomized controlled trials of MBIs for substance misuse across diverse populations (although without focus on specific underserved sub-populations), with discussion of underlying mechanisms.
  • 3.Garland EL, Howard MO. Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research. Addiction Science & Clinical Practice. 2018;13(1):14.*This article reviews the current literature on MBIs for addictions and proposes future directions for examining efficacy and underlying mechanisms.
  • 4.Bowen S, Chawla N, Marlatt GA. Mindfulness-Based Relapse Prevention for Addictive Behaviors. New York: Guilford; 2011. [Google Scholar]
  • 5.Garland EL. Mindfulness-oriented recovery enhancement for addiction, stress, and pain. Washington, DC: NASW Press; 2013. [Google Scholar]
  • 6.Vidrine JI, Spears CA, Heppner WL, et al. Efficacy of mindfulness-based addiction treatment (MBAT) for smoking cessation and lapse recovery: A randomized clinical trial. Journal of Consulting and Clinical Psychology. 2016;84(9):824–838. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Brewer JA, Mallik S, Babuscio TA, et al. Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug and Alcohol Dependence. 2011;119:72–80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Davis JM, Manley AR, Goldberg SB, Smith SS, Jorenby DE. Randomized trial comparing mindfulness training for smokers to a matched control. Journal of Substance Abuse Treatment. 2014;47(3):213–221. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Wilson AD, Roos CR, Robinson CS, et al. Mindfulness-based interventions for addictive behaviors: Implementation issues on the road ahead. Psychology of Addictive Behaviors. 2017;31(8):888–896.*This article reviews research on the efficacy of and mechanisms underlying MBIs for addictive behaviors and provides important future directions for improving implementation.
  • 10.Waldron EM, Hong S, Moskowitz JT, Burnett-Zeigler I. A Systematic Review of the Demographic Characteristics of Participants in US-Based Randomized Controlled Trials of Mindfulness-Based Interventions. Mindfulness. 2018;9:1671–1692.**This systematic review highlights the underrepresentation of racial/ethnic minority and low-SES populations in mindfulness research in the U.S., and provides suggestions for increasing diversity in MBI clinical trials.
  • 11.Fuchs C, Lee JK, Roemer L, Orsillo SM. Using mindfulness- and acceptance-based treatments with clients from nondominant cultural and/or marginalized backgrounds: Clinical considerations, meta-analysis findings, and introduction to the special series. Cognitive and Behavioral Practice. 2013;20(1):1–12.*This article discusses the relevance of mindfulness and acceptance-based treatments for clients from non-dominant cultural and/or marginalized backgrounds, presents a meta-analysis of MBIs among these populations, and offers important considerations for ensuring cultural competence.
  • 12.Guerrero EG, Marsh JC, Khachikian T, Amaro H, Vega WA. Disparities in Latino substance use, service use, and treatment: Implications for culturally and evidence-based interventions under health care reform. Drug and Alcohol Dependence. 2013;133(3):805–813. [DOI] [PubMed] [Google Scholar]
  • 13.U.S. National Cancer Institute. A sociological approach to addressing tobacco-related health disparities National Cancer Institute Tobacco Control Monograph 22. NIH Publication No. 17-CA-8035A. U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2017. [Google Scholar]
  • 14.Vaeth PAC, Wang-Schweig M, Caetano R. Drinking, Alcohol Use Disorder, and Treatment Access and Utilization Among US Racial/Ethnic Groups. Alcoholism-Clinical and Experimental Research. 2017;41(1):6–19. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological bulletin. 2003;129(5):674–697. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Myers HF. Ethnicity- and socio-economic status-related stresses in context: An integrative review and conceptual model. Journal of Behavioral Medicine. 2009;32(1):9–19. [DOI] [PubMed] [Google Scholar]
  • 17.Slater ME, Godette D, Huang BJ, Ruan WJ, Kerridge BT. Sexual Orientation-Based Discrimination, Excessive Alcohol Use, and Substance Use Disorders Among Sexual Minority Adults. Lgbt Health. 2017;4(5):337–344. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Creswell JD, Lindsay EK. How Does Mindfulness Training Affect Health? A Mindfulness Stress Buffering Account. Current Directions in Psychological Science. 2014;23(6):401–407. [Google Scholar]
  • 19.Williams JM, Crane C, Barnhofer T, et al. Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: a randomized dismantling trial. Journal of Consulting and Clinical Psychology. 2014;82(2):275–286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Witkiewitz K, Greenfield BL, Bowen S. Mindfulness-based relapse prevention with racial and ethnic minority women. Addictive Behaviors. 2013;38(12):2821–2824. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Iacono G An affirmative mindfulness approach for lesbian, gay, bisexual, transgender, and queer youth mental health. Clinical Social Work Journal. 2018.*This conceptual paper discusses the relevance of MBIs for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, provides suggestions for implementing MBIs with this population, and describes a clinical case example.
  • 22.Spears CA, Houchins SC, Bamatter WP, Barrueco S, Hoover DS, Perskaudas R. Perceptions of Mindfulness in a Low-income, Primarily African American Treatment-Seeking Sample. Mindfulness. 2017;8(6):1532–1543.*This qualitative study explored perceptions of mindfulness, experiences with mindfulness practice, and recommendations for implementing MBIs in a low-income, predominantly African American treatment-seeking sample.
  • 23.Burnett-Zeigler IE, Satyshur MD, Hong S, Yang A, Moskowitz JT, Wisner KL. Mindfulness based stress reduction adapted for depressed disadvantaged women in an urban Federally Qualified Health Center. Complementary therapies in clinical practice. 2016;25:59–67. [DOI] [PubMed] [Google Scholar]
  • 24.Hick SF, Furlotte C. An Exploratory Study of Radical Mindfulness Training with Severely Economically Disadvantaged People: Findings of a Canadian Study. Aust Soc Work. 2010;63(3):281–298. [Google Scholar]
  • 25.Maddock A, Hevey D, Eidenmueller K. Mindfulness Training as a Clinical Intervention with Homeless Adults: a Pilot Study. Int J Ment Health Ad. 2017;15(3):529–544. [Google Scholar]
  • 26.Gayner B, Esplen MJ, DeRoche P, et al. A randomized controlled trial of mindfulness-based stress reduction to manage affective symptoms and improve quality of life in gay men living with HIV. Journal of Behavioral Medicine. 2012;35(3):272–285. [DOI] [PubMed] [Google Scholar]
  • 27.Davis JM, Goldberg SB, Anderson MC, Manley AR, Smith SS, Baker TB. Randomized trial on mindfulness training for smokers targeted to a disadvantaged population. Substance Use and Misuse. 2014;49(5):571–585. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Bowen S, Witkiewitz K, Clifasefi SL, 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;71(5):547–556. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Witkiewitz K, Warner K, Sully B, et al. Randomized trial comparing mindfulness-based relapse prevention with relapse prevention for women offenders at a residential addiction treatment center. Substance use & misuse. 2014;49(5):536–546. [DOI] [PubMed] [Google Scholar]
  • 30.Garland EL, Roberts-Lewis A, Tronnier CD, Graves R, Kelley K. Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial. Behaviour Research and Therapy. 2016;77:7–16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.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. Substance use & misuse. 2014;49(5):547–559. [DOI] [PubMed] [Google Scholar]
  • 32.Greenfield BL, Roos C, Hagler KJ, Stein E, Bowen S, Witkiewitz KA. Race/ethnicity and racial group composition moderate the effectiveness of mindfulness-based relapse prevention for substance use disorder. Addictive Behaviors. 2018;81:96–103.**This is one of the few studies examining whether sociodemographic characteristics moderate treatment effects of MBIs for addictions.
  • 33.Roos CR, Bowen S, Witkiewitz K. Baseline Patterns of Substance Use Disorder Severity and Depression and Anxiety Symptoms Moderate the Efficacy of Mindfulness-Based Relapse Prevention. Journal of Consulting and Clinical Psychology. 2017;85(11):1041–1051. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Lustyk MK, Chawla N, Nolan RS, Marlatt GA. Mindfulness meditation research: issues of participant screening, safety procedures, and researcher training. Advances in Mind-Body Medicine. 2009;24(1):20–30. [PubMed] [Google Scholar]
  • 35.Resnicow K, S R, Braithwaite RL, Ahluwalia JS, Butler J. Cultural sensitivity in substance use prevention. Journal of Community Psychology. 2000;28:271–290. [Google Scholar]
  • 36.Amaro H Implementing mindfulness-based relapse prevention in diverse populations: challenges and future directions. Substance use & misuse. 2014;49(5):612–616.*This brief article provides suggestions for furthering the study of MBIs for addictions in diverse populations, including considering cultural adaptations to increase ecological validity.
  • 37.Parsons CE, Crane C, Parsons LJ, Fjorback LO, Kuyken W. Home practice in Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction: A systematic review and meta-analysis of participants’ mindfulness practice and its association with outcomes. Behaviour Research and Therapy. 2017;95:29–41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Grow JC, Collins SE, Harrop EN, Marlatt GA. Enactment of home practice following mindfulness-based relapse prevention and its association with substance-use outcomes. Addictive Behaviors. 2015;40:16–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Sue S, Fujino DC, Hu LT, Takeuchi DT, Zane NW. Community mental health services for ethnic minority groups: a test of the cultural responsiveness hypothesis. Journal of Consulting and Clinical Psychology. 1991;59(4):533–540. [DOI] [PubMed] [Google Scholar]
  • 40.Witkiewitz K, Lustyk MK, Bowen S. Retraining the addicted brain: a review of hypothesized neurobiological mechanisms of mindfulness-based relapse prevention. Psychology of Addictive Behaviors. 2013;27(2):351–365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Spears CA, Hedeker D, Li L, et al. Mechanisms Underlying Mindfulness-Based Addiction Treatment Versus Cognitive Behavioral Therapy and Usual Care for Smoking Cessation. Journal of Consulting and Clinical Psychology. 2017;85(11):1029–1040. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Garland EL. Restructuring reward processing with Mindfulness-Oriented Recovery Enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain. Annals of the New York Academy of Sciences. 2016;1373(1):25–37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Kober H, Brewer JA, Height KL, Sinha R. Neural stress reactivity relates to smoking outcomes and differentiates between mindfulness and cognitive-behavioral treatments. Neuroimage. 2017;151:4–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Adams CE, Chen M, Guo L, et al. Mindfulness predicts lower affective volatility among African Americans during smoking cessation. Psychology of Addictive Behaviors. 2014;28(2):580–585. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Adams CE, Cano MA, Heppner WL, et al. Testing a Moderated Mediation Model of Mindfulness, Psychosocial Stress, and Alcohol Use among African American Smokers. Mindfulness. 2015;6(2):315–325. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Businelle MS, Kendzor DE, Reitzel LR, et al. Mechanisms linking socioeconomic status to smoking cessation: a structural equation modeling approach. Health Psychology. 2010;29(3):262–273. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Annu Rev Clin Psycho. 2008;4:1–32. [DOI] [PubMed] [Google Scholar]
  • 48.Creswell JD. Mindfulness Interventions. Annual Review of Psychology. 2017;68:491–516. [DOI] [PubMed] [Google Scholar]
  • 49.Szanton SL, Wenzel J, Connolly AB, Piferi RL. Examining mindfulness-based stress reduction: Perceptions from minority older adults residing in a low-income housing facility. BMC Complementary and Alternative Medicine. 2011;11:44. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Roos CR, Kirouac M, Stein E, W DA, Bowen S, Witkiewitz K. An Open Trial of Rolling Admission Mindfulness-Based Relapse Prevention (Rolling MBRP): Feasibility, Acceptability, Dose-Response Relations, and Mechanisms. Mindfulness. 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Spears CA, Dannenfelser MA, Bell SA, Carter BP, Scarlett CA, Wetter DW. Mindfulness-Based Smoking Cessation among Predominantly Low-Income, African American Smokers. Annals of Behavioral Medicine. 2018;52(S1):S521. [Google Scholar]
  • 52.Davis JM, Manley AR, Goldberg SB, Stankevitz KA, Smith SS. Mindfulness training for smokers via web-based video instruction with phone support: a prospective observational study. BMC Complementary and Alternative Medicine. 2015;15:95. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Pew Research Center. Record shares of Americans now own smartphones, have home broadband. 2017; http://www.pewresearch.org/fact-tank/2017/01/12/evolution-of-technology/Archived by WebCite® at http://www.webcitation.org/73lXLweZn.
  • 54.Garrison KA, Pal P, O’Malley SS, et al. Craving to Quit: A Randomized Controlled Trial of Smartphone app-based Mindfulness Training for Smoking Cessation. Nicotine & Tobacco Research. 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55.Bricker JB, Copeland W, Mull KE, et al. Single-arm trial of the second version of an acceptance & commitment therapy smartphone application for smoking cessation. Drug and Alcohol Dependence. 2017;170:37–42. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56.Spears CA, Bell SA, Scarlett CA, et al. Text messaging to enhance mindfulness-based smoking cessation treatment: Program development through qualitative research. Jmir Mhealth Uhealth. In press. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57.Spears CA, Abroms L, Glass CR, et al. Mindfulness-based smoking cessation enhanced with mobile technology (iQuit Mindfully): Pilot randomized controlled trial. Under review. [DOI] [PMC free article] [PubMed]
  • 58.Krebs P, Duncan DT. Health App Use Among US Mobile Phone Owners: A National Survey. Jmir Mhealth Uhealth. 2015;3(4):e101. [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES