Journal of Social Work Practice in the Addictions, 12:264281, 2012

Copyright Taylor & Francis Group, LLC

ISSN: 1533-256X print/1533-2578 online
DOI: 10.1080/1533256X.2012.702632

Evaluation of Meditation in the Treatment

of Chemical Dependency
LESLIE J. TEMME, PHD, LCSW
Assistant Professor, Western Carolina University Department of Social
Work, Cullowhee, North Carolina, USA

JUDY FENSTER, PHD, LCSW, and GEOFFREY L. REAM, PHD

Associate Professors, Adelphi University School of Social Work,
Garden City, New York, USA

This research investigated the effect of meditation on warning

signs of relapse among adults in residential treatment for chemical
dependency. Results were that meditation increased participants
mindfulness, decreased negative mood, and reduced warning
signs of relapse. The effect of the intervention on risk of relapse
was mediated by mindfulness, the effect of which was, in turn,
partially mediated by decrease in negative mood states. The data
provide evidence for the effectiveness of meditation to reduce risk
for relapse in this population and also add to our knowledge of
the relationship between negative mood states and risk for relapse
among those in treatment for chemical dependency.
KEYWORDS chemical dependency, meditation, mindfulness,
mood states, relapse, substance abuse treatment
Chemical dependency is recognized as a chronic, relapsing disorder (Gerwe,
2000; Hser, Longshore, & Anglin, 2007; McKay & Hiller-Sturmhofel, 2011),
and relapse prevention is a primary focus of chemical dependency treatment (Carroll, 1996; Thakker & Ward, 2010). Treatment is generally found
Received November 18, 2011; revised April 4, 2012; accepted May 11, 2012.
The authors would like to acknowledge the Fahs-Beck Fund for Research and
Experimentation, Dr. Richard Miller of the Integrative Restoration Institute, Adrienne Jamiel,
and the staff at Phoenix House for all of their support.
Address correspondence to Leslie J. Temme, Assistant Professor, Western Carolina
University Department of Social Work, G02 McKee, Cullowhee, NC 28723, USA. E-mail:
ltemme@email.wcu.edu
264

Meditation in Chemical Dependency Treatment

265

to be successful in decreasing use; for example, a 1-year follow-up of the

national Drug Abuse Treatment Outcome Study (Hubbard, Craddock, Flynn,
Anderson, & Etheridge, 1997) found significant decreases in cocaine, heroin,
and marijuana use within the treatment modalities of long-term residential
(LTR), outpatient drug-free (ODF), short-term inpatient (STI), and outpatient
methadone treatments (OMT), as well as decreases in heavy alcohol use
in all modalities except OMT. However, these findings demonstrating the
success of treatment must be taken together with the unavoidable empirical
reality that most treatment participants relapse. A comprehensive review of
both inpatient and outpatient alcohol treatment outcome studies found that
only one third of patients maintained abstinence from alcohol 1 year following treatment (W. R. Miller, Walters, & Bennett, 2000), and McLellan, Lewis,
OBrien, and Kleber (2000) estimated rates of relapse to be over 60% for
individuals who seek treatment for chemical dependency. Researchers concur that effective relapse prevention continues to be an elusive endeavor
(Jones, Knutson, & Haines, 2003; Kiefer et al., 2004; Levy, 2008; Stewart,
2003; Thakker & Ward, 2010).
In an effort to address relapse issues and improve client outcomes,
some chemical dependency treatment programs have begun to introduce
alternative practices such as yoga and meditation to supplement standard
treatment (Cook, Becvar, & Pontious, 2000; Finger & Arnold, 2002; Khalsa,
Khalsa, Khalsa, & Khalsa, 2008; Shannahoff-Khalsa, 2000; Wesa & Culliton,
2004; Witkiewitz & Marlatt, 2004). Meditation, in particular, improves general psychological well-being (Brown & Ryan, 2003; Roemer & Orsillo, 2002;
Teasdale, Moore, Hayhurst, Pope, & Williams, 2002), and over half of substance abuse treatment providers use it as a component of treatment (Priester
et al., 2009).
Currently, most relapse prevention interventions are designed within a
cognitive behavioral framework. Cognitive behavioral techniques are based
on the premise that thought is both the initiator and the determinant of
behavior (Beck, Freeman, Pretzer, Davis, & Fleming, 1990). However, cognitive theorists now posit that unconscious thoughts and resultant behavior
become habituated and, therefore, the process in the brain is reflexive
(Heinz, Veilleux, & Kassel, 2009; McCusker, 2001); that is, the brain interprets
a situation or feeling, and the response is immediate and automatic. In meditation, the mind is trained to sustain constant attention on changing internal
and external stimuli, creating the habit of paying attention versus reacting
automatically (Baer, 2003; R. Miller, 2007). Evidence suggests that the brain
activity that creates this automatic pilot is interrupted by the practice of meditation (Allen, Chambers, & Knight, 2006; Cahn & Polich, 2006; Newberg &
Iversen, 2003; Walsh & Shapiro, 2006), resulting in self-regulated behavior (Brown & Ryan, 2004). This ability to self-regulate behavior is a result
of sustained attention cultivated through the meditative practice. Sustained

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L. J. Temme et al.

attention creates a process by which the individual views thoughts as objects

of observation, circumventing the need to react to every thought and feeling that is brought to ones attention (Bishop et al., 2004; Shapiro, Carlson,
Astin, & Freedman, 2006). Additionally, through the combination of sustained attention and increased awareness, the reflexive process in the brain
is slowed down. This reduction in reactivity provides the individual the
opportunity to challenge habitual reactions to thoughts and feelings (Allen
et al., 2006; Roemer & Orsillo, 2002; Roemer et al., 2009) and to allow for
exposure to and acceptance of these experiences (Brown & Ryan, 2004;
Kabat-Zinn, 2003; R. Miller, 2007; Teasdale, Segal, & Williams, 2003).
The most frequently investigated meditation techniques are transcendental meditation (Yogi, 1963) and mindfulness-based practices, including
mindfulness-based stress reduction (Kabat-Zinn, 1982), mindfulness-based
cognitive therapy (Teasdale et al., 2000), and mindfulness-based relapse
prevention (Bowen et al., 2009). Integrative restoration (iRest) is a more
recently introduced form of meditation that cultivates self-monitoring, selfcontrol, and self-acceptance (R. Miller, 2007). Through the practice of what
R. Miller calls rotation of attention, there is a relaxation response, wherein
there is an awareness of and disidentification from thoughts and feelings.
This allows individuals to interrupt automatic responses and instead prepare
for situations or moods that will ultimately present themselves. The development of such awareness is posited to help individuals pause, observe
what they are thinking or feeling, and avoid reacting in a habitual manner. Mindfulness, the learned capacity to be aware of and accept ones own
emotional states without necessarily acting on them or letting them escalate,
has been advanced as a common factor across different meditation orientations, and is measured as the outcome variable in many meditation-based
techniques (Roemer & Orsillo, 2002).
Mindfulness has direct relevance to risk of relapse, which is currently
conceptualized as a cyclical interaction of processes resulting from internal
and external factors including social pressures, cravings or cues, and
negative mood (Hufford, Witkiewitz, Shields, Koyda, & Caruso, 2003;
Warren, Hawkins, & Sprott, 2003; Witkiewitz & Marlatt, 2004; Zywiak
et al., 2006). Negative mood states, including depression, loneliness, anger,
and frustration (Connors & Longabaugh, 1996; Kavanagh, Andrade, &
May, 2004; Leukefeld, Tims, & Platt, 2001; Witkiewitz & Marlatt, 2004),
are the most common of all antecedents to relapse (Fernandez-Montalvo,
Lopez-Goni, Illescas, Landa, & Lorea, 2007; Strowig, 2000), and also increase
relapse severity (Poling, Kosten, & Sofuoglu, 2007; Strowig, 2000; Tate,
Brown, Unrod, & Ramo, 2004). Social pressure (Longabaugh, Rubin, Stout,
Zywiak, & Lowman, 1996) and cravings (Drummond, Litten, Lowman, &
Hunt, 2000) have been connected to mood states as antecedents to relapse.
External and internal cues are seen as producing an automatic reaction

Meditation in Chemical Dependency Treatment

267

connected to relapse through positive or negative mood states (McCusker,

2001). Mindfulness training ostensibly reduces risk of relapse through
increasing recognition and regulation of negative mood states before they
produce relapse.
The evidence base for the effect of mindfulness on risk of relapse
includes some promising findings. A randomized controlled trial of transcendental meditation, biofeedback, and electronic neurotherapy for severe
alcoholism found significant effects on nondrinking days for meditation
and biofeedback (Taub, Steiner, Weingarten, & Walton, 1994). Another
randomized controlled trial, this one including individuals recently discharged from intensive or nonintensive substance abuse outpatient treatment
(Bowen et al., 2009), found lower rates of substance use, decreased craving, and increased acceptance and acting with awareness for participants
in a mindfulness-based relapse prevention program. This study, however,
did not differentiate between participants who had been in intensive versus
nonintensive treatment. Furthermore, there was some disparity between the
treatment group and the control group, as the treatment group was 2 hr long
and consisted of a 30-min meditation practice as well as 1.5 hr of discussion provided by masters-level clinicians, whereas the control groups were
1.5 hr in duration and were conducted by licensed chemical dependency
counselors with varying levels of experience in the delivery of outpatient
aftercare services.
There remain some gaps in the evidence base, however, and some
studies report null results. An earlier review of studies of meditation among
substance-abusing populations (Kavanagh et al., 2004) found no controlled
trials among exclusively chemically dependent populations. Results from
noncontrolled studies have been inconsistent (B. Carlson & Larkin, 2009) or
lacking in conclusive data (Zgierska et al., 2009). In two studies of the effect
of meditation on postrelease substance use for incarcerated individuals,
the meditation group demonstrated decreases in quantity and frequency of
postrelease substance use (Bowen et al., 2006; Witkiewitz, Marlatt, & Walker,
2005). However, it is difficult to conclusively attribute the positive outcome
to the intervention in either study: In one (Witkiewitz, Marlatt, & Walker,
2005), the treatment-as-usual group evidenced similar outcomes when compared to the meditation group. In the other (Bowen et al., 2006), inmates
had been receiving meditation instruction prior to the investigation. Neither
study, moreover, measured adherence to meditation, nor tested levels of
mindfulness. A quasi-experimental study of mindfulness-based stress reduction in a therapeutic setting for substance abusers reported nonsignificant
results for the outcome of substance use (Marcus, Fine, & Kouzekanani,
2001).
This study, therefore, employs both experimental (random assignment)
and quasi-experimental (self-select) designs to examine whether meditation
lowers warning signs related to the risk of relapse among individuals in

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L. J. Temme et al.
Mindfulness

Decreased
Negative
Mood

Meditation Training

Decreased
Risk for
Relapse

FIGURE 1 Conceptual model for meditation trainings effect on risk of relapse.

residential substance abuse treatment. Our hypothesis was that participation

in a meditation intervention would reduce the warning signs of relapse,
and that at least part of this effect would be indirect, through reduction
of negative mood states. Figure 1 illustrates the hypothesized relationships
among meditation, mindfulness, negative mood, and risk for relapse. This
shows how the meditation training was expected to increase mindfulness
and, through increasing mindfulness, decrease negative mood. As negative mood decreased, the risk for relapse was also expected to decrease.
Finally, Figure 1 includes an arrow representing the direct (unmediated)
effect of mindfulness on risk of relapse, indicating that mindfulness might
have had effects on risk of relapse that were not explained by negative
mood. We expected results in the self-select trials not to be significantly
different from results in the random assignment trial.

METHOD
This study was conducted in a residential treatment facility. A residential
setting provides an environment that limits peer and other social pressure
to use substances, as well as limiting environmental cues that might elicit
urges or cravings. Therefore, the setting allowed for the collection of data
regarding mood states while partially controlling for social pressure, urges,
and cravings.
Following approval from the internal review boards of the authors
institution and the treatment program, participants were recruited from an
inpatient residential therapeutic community in Brooklyn, New York, that
treats adults voluntarily seeking treatment for chemical dependency. All
participants met the criteria for chemical dependency as specified in the
Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision
[DSMIVTR]; American Psychiatric Association, 2000).
Study participants received either meditation training or treatment
as usual (TAU). Treatment at this facility consisted of substance abuse

Meditation in Chemical Dependency Treatment

269

education groups, peer support groups, cognitive behavioral relapse prevention groups, individual sessions, and special topic seminars. Participants
in the TAU group received a special seminar topic group for 1 hr three
times a week, whereas those in the meditation group received the meditation intervention for 1 hr three times a week. Those in the meditation
group were offered 10 sessions of iRest meditation, provided on-site at the
treatment facility and led by a certified iRest instructor.
Although 148 participants enrolled in the study, only those completing
at least 6 weeks of TAU were included in analyses. This resulted in a loss
of 26 people from the control group, bringing the control group total to
50. Among those in the meditation group, 19 individuals left treatment prior
to completing the meditation group, bringing the meditation group total
to 53.
To keep meditation class sizes small and to include those newer to
treatment, the study was conducted in three rounds, over a total period
of 15 weeks. Participants in the first round were randomized to either
the meditation or the TAU group. The number of individuals who initially
signed up to participate in the study totaled 60. Random assignment of this
first round was carried out by taking participants names in the order in
which they signed up and assigning every other participant to the meditation group. To facilitate comparison between randomized controlled and
uncontrolled trial designs, and (because it would have been unethical to
withhold potentially helpful treatment) to ensure that those who wanted
to could experience the meditation intervention, clients in the second and
third rounds were offered a choice to attend the meditation group or receive
TAU. In the first round, 26 individuals completed the meditation group and
26 completed TAU. For the second round, 20 individuals completed the
meditation group and 16 completed TAU. In the third round, 7 completed
the meditation group and 8 completed TAU. Only those who completed
eight or more meditation sessions were included in the valid sample. This
excluded another 10 participants from the meditation group, bringing the
total for the meditation group to 43 and for the final sample to 93.

Measurement
Mindfulness, the primary expected outcome of meditation, was measured by
the Five-Facet M Questionnaire, which includes five elements of mindfulness
known to be highly correlated with awareness and acceptance: observing,
describing, acting with awareness, accepting without judgment, and nonreactivity to inner experience (Baer, Smith, Hopkins, Krietemeyer, & Toney,
2006). It contains 39 items rated on a 5-point Likert-type scale ranging from
1 (never or very rarely) to 5 (very often or almost always). In our data,
Cronbachs = .89 at pretest and .74 at posttest.

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L. J. Temme et al.

The warning signs of relapse were measured by the 27-item Assessment

of Warning Signs of Relapse scale, developed by W. R. Miller and Harris
(2000) to identify the attitudes and beliefs identified as warning signs of
relapse by Gorski and Miller (1996). We adapted the original 7-point Likert
scale to 5 points, ranging from 1 (never) to 5 (very often or always), to
maintain consistency of format with other measures in the questionnaire and
modified the text of items to be inclusive of use of drugs other than alcohol;
for example, I think about drinking became I think about drinking or
using drugs. In our data, = .88 at pretest and .74 at posttest.
Participants mood states were captured using the 95-item Profile
of Mood States (POMS) instrument, developed by McNair, Lorr, and
Droppleman (1971/1981). The POMS has demonstrated validity and reliability in assessing moods associated with cocaine, nicotine, and alcohol
withdrawal (Wilkins et al., 2005) and of mood related to mindfulness-based
stress reduction in a study of mood among cancer patients (L. E. Carlson,
Ursuliak, & Goodey, 2001; Speca, Carlson, & Goodey, 2000). In our data,
= .95 at pretest and .75 at posttest.

RESULTS
Description of Sample
A total of 93 participants completed the study, with 43 in the meditation
group and 50 in the control group. The mean age of participants was
39 years old. A majority (81%) were male. Thirty-three percent identified
as Catholic, 30% were non-Catholic Christians, 7% identified as Muslims,
and 30% responded other or none. The largest group (47%) self-identified
as African American, followed by Hispanic/Latino (34%) and White (10%).
Additionally, 9% either identified as other or chose not to answer this item.
Primary drug of choice was reported as follows: 37% cocaine, 20% marijuana,
18% alcohol, and 15% heroin, with the remaining 10% of participants identifying other opiates, prescription drugs, or PCP as the primary substance used
prior to entering treatment. These frequency distributions are representative
of chemically dependent adults seeking treatment in Brooklyn, New York
(Lambert-Wacey, 2009).
Regarding number of treatment episodes, 43% of the study participants
identified the current admission as their first residential treatment stay, and
57% reported two or more treatment episodes. When compared to average
treatment stays within the Brooklyn, New York, area, the study population
reported a 15% greater number of residents who had two or more treatment episodes (Lambert-Wacey, 2009). At posttest, 4% had been in treatment
30 days or less, 33% had been in treatment between 30 and 90 days, and
63% had been in treatment longer than 90 days.

Meditation in Chemical Dependency Treatment

271

PretestPosttest Differences on Study Variables

70
60
50
40

Warning Signs of Relapse

80

Figures 2 through 4, including error bars indicating 95% confidence intervals (CIs) of the means, describe, separately by experimental condition
and trial, pretest and posttest scores on (respectively) warning signs of
relapse, mindfulness, and negative mood states. To determine whether the
mean differences apparent in these graphs were actually significant after
controls, we ran regression analyses predicting each dependent variable
from treatment condition, trial, its pretest score, and demographic controls.
To discern whether effects on any of these variables differed between the
randomized and self-select trials, we allowed treatment condition and trial
to interact. Table 1 describes the results. According to its first row, for
each of warning signs of relapse, mindfulness, and negative mood states,
change in the expected direction was significantly greater among participants in the randomized controlled trials meditation group than in the
randomized controlled trials control group. The next four rows address
whether changes observed in the control group (second and third rows)
or differences between the meditation and control group (fourth and fifth
rows) differed by trial. All of these coefficients are nonsignificant, indicating
that changes observed in the self-select trials were comparable to changes
observed in the randomized controlled trial.

Meditation
Control
1st Trial: Random Assign

Meditation
Control
2nd Trial: Self-Select

Meditation
Control
3rd Trial: Self-Select

Pretest Relapse Risk

Posttest Relapse Risk

95% CI of the Mean

95% CI of the Mean

FIGURE 2 Mean pretest and posttest scores for warning signs of relapse, separately by
treatment condition and trial.

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120

130

Mindfulness
140

150

160

L. J. Temme et al.

Meditation
Control
1st Trial: Random Assign

Meditation
Control
2nd Trial: Self-Select

Meditation
Control
3rd Trial: Self-Select

Pretest Mindfulness

Posttest Mindfulness

95% CI of the Mean

95% CI of the Mean

FIGURE 3 Mean pretest and posttest scores for mindfulness, separately by treatment
condition and trial.

Mediation Analysis
To distinguish the mechanism of effect of the meditation training intervention through increase in mindfulness and reduction in negative mood states,
we ran path analyses in Mplus 6.0. Figure 5 describes relationships among
key study variables in the final model, for which fit statistics were satisfactory: Comparative Fit Index (CFI) > .95, Standardized Root Mean Square
Residual (SRMR) < .05. Change in mindfulness, negative mood states, and
warning signs of relapse were operationalized by posttest scores controlling for pretest scores. All path analyses controlled for age, gender, race,
religion, and trial (i.e., first, second, or third). The overall effect of the meditation intervention on change in warning signs of relapse, consistent with
the regression models, was significant, = .17, p = .039. When change in
mindfulness was added, its effect was significant, = .49, p < .001, and
the direct effect of the intervention itself was reduced to = .01, p > .05,
indicating that the interventions effect on reducing warning signs of relapse
was through increasing mindfulness (Baron & Kenny, 1986). Adding change
in negative mood state as an additional mediator produced the coefficients
described in Figure 4, reducing the direct effect of change in mindfulness
from = .49, p < .001, to = .21, p = .036. This indicates that at least

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20

40

Negative Mood States

60
80
100

120

Meditation in Chemical Dependency Treatment

Meditation
Control
1st Trial: Random Assign

Meditation
Control
2nd Trial: Self-Select

Meditation
Control
3rd Trial: Self-Select

Pretest Negative Mood

Posttest Negative Mood

95% CI of the Mean

95% CI of the Mean

FIGURE 4 Mean pretest and posttest scores for negative mood states, separately by treatment
condition and trial.

part of the effect of change in mindfulness on change in warning signs of

relapse is through its association with negative mood states.

DISCUSSION
According to our results, iRest meditation training increased mindfulness,
decreased negative mood states, and decreased warning signs of relapse
in adult residential chemical dependency treatment. The effect of the intervention when participants self-selected into it was comparable to (i.e., not
significantly different from) its effect under random assignment. Our results
affirmed that the mechanism of the interventions effect on reducing warning
signs of relapse was through increasing mindfulness, and also found that at
least part of the effect of increased mindfulness on warning signs of relapse
was indirect, through change in negative mood states.
Our results, demonstrating a link between increased mindfulness and
decrease in warning signs of relapse, are congruent with previous studies showing meditation to be a promising intervention in the treatment of
substance use (Bowen et al., 2006; Bowen et al., 2009; Taub et al., 1994;
Witkiewitz et al., 2005). Our findings support the utilization of meditation

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L. J. Temme et al.

TABLE 1 Regression Models of Meditation Interventions Effects on Warning Signs of Relapse,

Mindfulness, and Negative Mood States
Warning Signs of
Relapse
B
Meditation group
(reference =
control)
Trial (reference =
1st trial)
2nd trial
3rd trial
Interaction terms
2nd trial
meditation
3rd trial
meditation
Pretest score
Age
Female gender
(reference =
male)
Race (reference =
Black/African
American)
Other/missing
White
Latino
Religion
(reference = other
Christian)
Other/none
Muslim
Catholic
Constant
R2
F(14, 78)

Mindfulness

Negative Mood States

95% CI

95% CI

9.8

[17.7, 2.0]

10.9

[0.8, 21.1]

22.5

[42.0, 3.1]

7.9+
0.4

[17.2, 1.5]
[10.3, 11.1]

3.8
6.4

[15.7, 8.1]
[7.4, 20.3]

6.0
5.7

[29.0, 17.1]
[32.7, 21.3]

8.5

[3.4, 20.5]

10.5

[4.6, 25.6]

7.2

[22.0, 36.3]

9.3

[6.9, 25.4]

12.5

[33.3, 8.3]

9.4

[31.1, 50.0]

0.6
0.1
1.1

[0.4, 0.7]
[0.1, 0.4]
[8.2, 5.9]

0.4
0.1
5.2

[0.2, 0.6]
[0.8, 0.6]
[12.4, 22.7]

0.7 [0.5, 0.9]

0.03
[0.4, 0.3]
2.5
[11.6, 6.5]

95% CI

3.5
1.2
2.8

[15.0, 7.9]
[12.5, 10.0]
[4.1, 9.7]

6.8
8.6
6.8

[21.5, 7.9] 20.3

[23.1, 6.0] 14.4
[15.7, 2.1]
1.0

[8.0, 48.7]
[42.2, 13.3]
[16.0, 18.0]

3.1
8.9
6.4
24.9

[10.4, 4.2]
[20.4, 2.6]
[14.6, 1.8]
[4.6, 45.1]
0.48
5.15

3.3
15.3
3.7
42.7

[6.2, 12.7] 18.0+

[0.4, 30.2] 16.0
[7.0, 14.4] 12.8
[4.9, 80.6]
26.7+
0.48
5.18

[0.1, 36.0]
[44.6, 12.7]
[7.5, 33.0]
[20.3, 73.7]
0.34
2.95

Notes. Coefficients are unstandardized.

+
p < .10. p < .05. p < .01. p < .001.

in generaland iRest meditation in particularin reducing the warning

signs associated with risk of relapse in the treatment of chemical dependency. Future research could potentially increase our knowledge of longer
term substance use outcomes among individuals exposed to meditation
during or after treatment. Our finding that increased mindfulness was associated with improved mood concurs with previous studies (Arch & Craske,
2006; Ivanovski & Malhi, 2007; Nyklicek & Kuijpers, 2008; Sephton et al.,
2007), as do our findings about the effects of negative mood on risk of
relapse (Fernandez-Montalvo et al., 2007; Hodgins, el-Guebaly, Armstrong, &

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Meditation in Chemical Dependency Treatment

R2 = .604***

R2 = .450***
.60***

Change in
negative
mood state

.3

3*

**

Change in
mindfulness

Received
meditation
intervention

.49

**

R2 = .661***
.21

.09

.03

Change in
warning signs
of relapse

FIGURE 5 Path model illustrating mechanism of meditation interventions effect through

change in mindfulness and change in negative mood state. Change is operationalized by
posttest score controlling for pretest score. Coefficients are standardized. All coefficients control for trial (1, 2, or 3), age, gender, race, and religion. Model fit statistics: CFI (Comparative Fit
Index) = .963, SRMR (Standardized Root Mean Square Residual) = .018. p < .05. p < .01.

p < .001.

Dufour, 1999). Taken together, the evidence supports the use of meditation
to address negative mood states common to chemically dependent clients.
The fact that, in this study, the effect of increase in mindfulness on warning signs of relapse was only partially mediated by negative mood indicates
that there could be other aspects of mindfulness that resulted in the decrease
of warning signs of relapse. The mechanisms of mindfulnesssustained
attention, increased awareness, and improved acceptanceare believed to
change individuals relationship to their thoughts (not the thoughts themselves), and create a reduction in reactivity that might improve individuals
ability to self-regulate behavior (Arch & Craske, 2006; Brown & Ryan,
2004; Teasdale et al., 2002). Although there is not yet any empirical evidence of this, it could be that these mechanisms of mindfulness resulted in
participants being able to disengage from potentially disturbing thoughts,
providing them with a means to self-regulate the habitual responses that
contribute to risks associated with relapse. The findings of this study would
support meditation as an effective addition to traditional relapse prevention
strategies and point to the need for further study of methods that enhance
the efficacy of cognitive behavioral approaches.

Limitations
This study had three notable limitations. The first relates to measurement
instruments utilized. On the POMS instrument, a few participants appeared
to have trouble identifying or differentiating some of the more subtle feelings on the scale, such as bushed, weary, or bewildered, or had a limited
understanding of some items on the Mindfulness scale. For example, one
item states, When I take a shower or a bath, I stay alert to sensations of
water on my body. When one participant with limited literacy was read this

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L. J. Temme et al.

item aloud, he responded, Of course I pay attention. I have to be sure the

water doesnt get too hot! To improve response accuracy in future studies,
investigators might consider revising scale items and educating clients about
terms and concepts regarding mindfulness and mood, while identifying and
aiding those with poor literacy. A second limitation could stem from the
manner in which information was presented to participants during recruitment and on the consent form. Brown and Ryan (2004) caution that if
participants know that enhanced mindfulness is the goal of a prescribed
meditation intervention, outcomes could be influenced by effects of social
desirability and demand characteristics. Because the study consent form and
recruitment presentation listed possible benefits of meditation, it is possible
that participants in this study had preformed positive expectations regarding outcomes. Finally, although the results of this study are consistent with
the association between mood and substance use for women (Lau-Barraco,
Skewes, & Stasiewicz, 2009; Levy, 2008), this study is limited in that only
18% of the participants were women. Therefore, future research focusing on
women in treatment could potentially contribute to improved services for
chemically dependent women.

Implications for Practice

Social workers continue to provide most first-line health, mental health,
and psychological referral and direct practice services in the United States
(Gant, Benn, Gioia, & Seabury, 2009). Data from this study suggest that
clients might benefit from social workers and other clinicians increasing
their focus on negative mood as a risk factor in chemical dependency treatment. Furthermore, because an association between mood and substance
use in females has been established (Lau-Barraco et al., 2009; Levy, 2008),
meditation might provide specific benefits in the treatment of chemically
dependent women, especially those in programs that treat mood disorders
and depression.
This study contributes to a growing body of literature that substantiates
the efficacy of complementary alternative methods (CAM) within clinical settings. Alternative methods are currently being used in a variety of programs
(Cook et al., 2000; Finger & Arnold, 2002; Khalsa et al., 2008; ShannahoffKhalsa, 2000; Wesa & Culliton, 2004; Witkiewitz & Marlatt, 2004). Meditation
as a clinical intervention is not costly and is easily implemented; consequently, it is an alternative method that is increasingly being tested in
substance abuse treatment settings. Social work philosophy and practice
endorse holistic, integrative approaches to clinical assessment and intervention (Henderson, 2000). The results of this study would support social work
practitioners in the use of meditation as an effective and efficacious CAM to
enhance contemporary treatment approaches.

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277

CONCLUSION
Chemical dependency remains one of the most devastating and costly social
issues confronting society today. In the past two decades, the efficacy
of chemical dependency treatment has been called into question, as outcomes have been found to be inconsistent and improvements marginal.
Conversely, meditation as a clinical intervention has produced increasingly
positive outcomes in both medical and psychiatric settings, for clients suffering from anxiety, depression, chronic pain, and cancer. The results of this
study support meditation as a viable clinical intervention that could enhance
contemporary treatment approaches.
Mindfulness has been credited with creating an awareness of choice
(Hirst, 2003). The results of this study would indicate that meditation could
provide clients with a considerable advantage in regard to risk for relapse.
This study also reaffirms the important connection of negative mood and
risk for relapse within the chemically dependent population. Furthermore,
there is evidence to encourage further investigation of mindfulness, and to
advance the integration of meditation as a legitimate treatment approach
within clinical settings.

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