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Systematic Review
To determine the effects of MBIs for SUDs in terms of substance use outcomes, craving and adverse events compared to standard care, further psychotherapeutic, psychosocial or pharmacological interventions, or instructions, waiting list and no treatment.
Forty RCTs met our inclusion criteria, with 35 RCTs involving 2825 participants eligible for meta‐analysis. All studies were at high risk of performance bias and most were at high risk of detection bias.
Mindfulness‐based interventions (MBIs) versus no treatment
Twenty‐four RCTs included a comparison between MBI and no treatment. The evidence was uncertain about the effects of MBIs relative to no treatment on all primary outcomes: continuous abstinence rate (post: risk ratio (RR) = 0.96, 95% CI 0.44 to 2.14, 1 RCT, 112 participants; follow‐up: RR = 1.04, 95% CI 0.54 to 2.01, 1 RCT, 112 participants); percentage of days with substance use (post‐treatment: standardized mean difference (SMD) = 0.05, 95% CI ‐0.37 to 0.47, 4 RCTs, 248 participants; follow‐up: SMD = 0.21, 95% CI ‐0.12 to 0.54, 3 RCTs, 167 participants); and consumed amount (post‐treatment: SMD = 0.10, 95% CI ‐0.31 to 0.52, 3 RCTs, 221 participants; follow‐up: SMD = 0.33, 95% CI 0.00 to 0.66, 2 RCTs, 142 participants). Evidence was uncertain for craving intensity and serious adverse events. Analysis of treatment acceptability indicated MBIs result in little to no increase in study attrition relative to no treatment (RR = 1.04, 95% CI 0.77 to 1.40, 21 RCTs, 1087 participants). Certainty of evidence for all other outcomes was very low due to imprecision, risk of bias, and/or inconsistency. Data were unavailable to evaluate adverse events.
Mindfulness‐based interventions (MBIs) versus other treatments (standard of care, cognitive behavioral therapy, psychoeducation, support group, physical exercise, medication)
Nineteen RCTs included a comparison between MBI and another treatment. The evidence was very uncertain about the effects of MBIs relative to other treatments on continuous abstinence rate at post‐treatment (RR = 0.80, 95% CI 0.45 to 1.44, 1 RCT, 286 participants) and follow‐up (RR = 0.57, 95% CI 0.28 to 1.16, 1 RCT, 286 participants), and on consumed amount at post‐treatment (SMD = ‐0.42, 95% CI ‐1.23 to 0.39, 1 RCT, 25 participants) due to imprecision and risk of bias. The evidence suggests that MBIs reduce percentage of days with substance use slightly relative to other treatments at post‐treatment (SMD = ‐0.21, 95% CI ‐0.45 to 0.03, 5 RCTs, 523 participants) and follow‐up (SMD = ‐0.39, 95% CI ‐0.96 to 0.17, 3 RCTs, 409 participants). The evidence was very uncertain about the effects of MBIs relative to other treatments on craving intensity due to imprecision and inconsistency. Analysis of treatment acceptability indicated MBIs result in little to no increase in attrition relative to other treatments (RR = 1.06, 95% CI 0.89 to 1.26, 14 RCTs, 1531 participants). Data were unavailable to evaluate adverse events.
In comparison with no treatment, the evidence is uncertain regarding the impact of MBIs on SUD‐related outcomes. MBIs result in little to no higher attrition than no treatment. In comparison with other treatments, MBIs may slightly reduce days with substance use at post‐treatment and follow‐up (4 to 10 months). The evidence is uncertain regarding the impact of MBIs relative to other treatments on abstinence, consumed substance amount, or craving. MBIs result in little to no higher attrition than other treatments. Few studies reported adverse events.