A randomised controlled trial of mindfulness-based stress reduction programme for substance abuse patients in deaddiction centre

INTRODUCTION

The history of substance use is extensive, and daily trends in substance use are evolving. It can be challenging to recognise the substance at an earlier level until it starts to exhibit bodily and mental alterations because it is changing the dimension of usage. As a result, it has an adverse influence on public health as a result, and a large number of studies support this.^[1] The use of any psychoactive substance or drug, including prescription medications and illicit drugs, is referred to as ‘substance usage’ when it is not medically necessary. In addition to endangering people’s health, using psychoactive substances also threatens the social and economic fabric of their families, communities and nations. Rapid scenario analyses can be useful for analysing patterns in drug use. In India, marijuana (40%), alcohol (30%) and opioids (15%) were the three most frequently used substances, as per a Research Study Analysis conducted by the United Nations Office on Drugs and Crime in 2002 involving 4648 individuals with substance use disorder.^[2] Based on a Rapid Situation and Response Assessment involving 5800 male individuals with substance use disorder, 76% of opioid users presently inject heroin, 76% inject buprenorphine, 70% chase and 64% use propoxyphene. The majority of individuals with substance use disorder also drink alcohol concurrently (80%).^[3] Despite their job, age or gender, the majority of persons who consume these substances impose a financial strain on the nation due to the costs associated with treating their effects and helping them rehabilitate. Drug use is becoming more prevalent as a result of shifting cultural ideals, escalating economic hardship and deteriorating social ties. Today, drug addiction and drug trafficking are a global scourge that affects every region of the globe. Millions of drug addicts live miserable lives on the edge of death all over the world. India is considerably affected by the trend of drug abuse, and the number of drug users there is increasing daily. Addiction can be effectively controlled. People can recover control of their lives and battle the damaging consequences that addiction has on their brains and behaviour through treatment. Chronic diseases must be treated by correcting engrained behaviours. The deaddiction centre plays a key role in the treatment of people who have addiction or substance dependence. Because addiction is a chronic disorder, relapse or a return to drug use after an attempt to stop can be a part of the process for some individuals. However, current treatments are designed to help prevent recurrence. Relapse rates for drug usage are comparable to those for other chronic illnesses. If individuals stop following their medical treatment plan, people are more prone to relapse.

If one quits following their medical treatment plan, they are more likely to experience a relapse. When patients quit taking drugs for the 1^st time, they may experience a variety of physical and psychological symptoms, such as agitation or insomnia, as well as sadness, anxiety and other mental health problems. Additional elements, including a prolonged stay in a rehab facility, being away from family, a protracted period of unemployment, a reduction in income, a lack of self-esteem and uncertainty about the future all raise the stress levels of people receiving treatment for addiction. According to Cleck and Blendy, prolonged exposure to diverse psychological stresses might increase neuropsychiatric illnesses such as drug addiction. Addiction is a chronic brain condition in which people are unable to control their need for substances despite adverse health and social repercussions. Addicts’ brains are changed, and they respond to stress considerably differently from non-addicts’ brains. The impacts of stress and drug usage are frequent throughout the addiction cycle. This higher than normal stress level affects the prognosis and creates an unpleasant scenario that could lead to relapse and a poor therapeutic response. In the fields of clinical science, social-cognitive-affective neuroscience, and basic emotion research, the idea of mindfulness has garnered interest. MBSR includes a variety of mindfulness exercises, such as hatha yoga and both formal and casual meditation. The formal practice includes attention that is breath-centred and body-scanning-based, changing focus among sensory cues and open observation of immediate experience, strolling meditation and mindful eating. Brief pauses during casual practice involve voluntarily changing focus to the present time. These mindfulness exercises are intended to improve one’s capacity for seeing the immediate content of experience, particularly the fleeting character of thoughts, emotions, memories, mental images and bodily sensations.

MATERIALS AND METHODS

RESULTS

The mean and standard error of the PSS is presented in Table 1. Specifically, the means for the control pre-test, experimental pre-test, control post-test and experimental post-test are 36.9, 36.0, 33.4 and 18.9, respectively. The two-way RM ANOVA indicated significant differences among the groups (control and experimental), among the tests (pre-test and post-test), and in the interaction between group and test (all with P < 0.001). The control pre-test and post-test did not show significance (P = 0.265). The experimental pre-test and post-test showed a decrease in PSS scores and were statistically significant (P < 0.001). This shows that the intervention is beneficial in decreasing the PSS score of the participants [Figure 1].

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Figure 1:

Effectiveness of mindfulness-based stress reduction programme on perceived stress scale in control (Con) and experimental (Exp) groups.

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DISCUSSION

The objective of the study was to assess the effectiveness of MBSR reduced perceived stress. Even though MBSR is recognised as a successful therapy for stress and emotional symptoms, its effectiveness in the treatment of substance abuse patients must be investigated because stress has a significant impact on prognosis. According to research findings, MBSR is an efficient approach for treating a wide range of psychological disorders. The research investigated the impact of engaging in a mindfulness meditation-centred stress reduction programme on mood disruption and stress indicators among cancer outpatients. Individuals in the intervention group demonstrated significantly reduced overall mood disruption and subscales related to depression, anxiety, anger and confusion, along with increased vitality compared to participants in the control group.^[13,14] This finding of the studies carried out in a therapeutic community demonstrates that there were no abrupt decreases in anxiety and rumination after mindfulness-based cognitive therapy and that the average path of change in worry and rumination was likewise quite linear. The findings suggest a dose-response relationship; the more MBSR sessions participants attended and the more days they participated in a structured mindfulness exercise, the greater these findings imply that an MBSR programme may affect people’s physiological reactions to stress.^[15]

The study by Carlson et al. suggests that the use of MBSR could improve male drug users’ health-related quality of life (HRQOL). This result agreed with earlier research findings about the positive effects of MBSR on HRQOL. It was found that MBSR significantly improved overall quality of life, symptoms of stress and sleep quality in research on outpatients with breast and prostate cancer.^[16] Studies suggest through their impact on stress, MBSR or other mindfulness programmes may be helpful in reducing alcohol problems on college campuses.^[17-20] Individuals with a history of trauma were given MBSR practice in a community-based drug rehabilitation environment. The demographic comprised highly marginalised and economically disadvantaged African American and Latina women with a history of trauma. Through an iterative feedback process, the structured methods of MBSR were tailored to meet the specific needs of this population. The community’s low literacy levels were also taken into consideration. Adaptations focused on addressing the role of stress in preventing relapse and targeted common effects of addiction and trauma, such as shortened attention span, heightened sensitivity in certain body areas triggering painful memories and reduced ability to focus. With appropriate modifications, MBSR has the potential to serve as a relapse prevention tool during the early stages of recovery. Client feedback indicated a high level of acceptance and satisfaction with the program.^[18]

To improve the patient’s mental state, MBSR employs the following mechanisms: To begin, mindfulness promotes enhanced awareness of what is happening in each moment, with an accepting attitude, rather than being involved in habitual thoughts, emotions and behavioural patterns. Increased awareness then leads to new methods of responding and coping with oneself and the environment around us. Mindfulness cultivates a sense of self that transcends ideas, feelings and physiological sensations such as pain. Clients create an ‘observer-self ’ through mindfulness activities. They can now notice their thoughts and emotions in a non-judgmental and nonreactive way that they earlier prevented. Previously ignored thoughts and feelings may now be viewed objectively and without judgment. Clients learn to be aware of their thoughts without acting on them, being dominated by them or believing them.^[19] The strength of this study is the usage of MBSR to relieve stress on a less well-studied problem. Our data show that following an effective administration of the MBSR programme, there is a considerable reduction in the level of stress among substance misuse patients receiving treatment in a de-addiction centre. As a result, persons undergoing long-term treatment in addiction treatment facilities will be able to use this treatment. MBSR will alter the patient’s lifestyle, which will be aggravated by their condition. Future research should assess the efficacy of MBSR and other standard and newer cognitive behavioural therapies in patients receiving treatment in addiction treatment clinics.

CONCLUSION

The study’s findings, which reveal that persons in the experimental group who received an MBSR programme had less stress than those in the control group, provide strong evidence for MBSR’s effectiveness in stress reduction. The observed reduction in participants’ stress levels demonstrates the efficacy of MBSR procedures in improving coping strategies and emotional regulation, both of which are critical components of the recovery process. Furthermore, including mindfulness techniques in addiction treatment programmes not only relieves stress but also promotes general well-being and resilience, both of which are necessary for long-term sobriety. These findings highlight the importance of using mindfulness-based techniques as a supplemental therapeutic tool in the comprehensive care of drug misuse patients, providing hope for better treatment outcomes and stress reduction.