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Women's Treatment and Early Recovery (MBRP-W)

This study is currently recruiting participants.
See Contacts and Locations
Verified November 2016 by Hortensia Amaro, University of Southern California
Sponsor:
Collaborator:
National Institute on Drug Abuse (NIDA)
Information provided by (Responsible Party):
Hortensia Amaro, University of Southern California
ClinicalTrials.gov Identifier:
NCT02977988
First received: November 28, 2016
Last updated: November 29, 2016
Last verified: November 2016
  Purpose
Approximately 25 million Americans struggle with alcohol or drug problems annually. Abuse of alcohol and drugs is costly to our nation, exacting more than $428 billion in costs related to crime, lost work productivity and health care. While effective treatments exist, over half of those who enter treatment for substance use disorders drop out early in treatment and return to alcohol or drug abuse. Psychological stress is a causal factor in the pathogenesis of substance use disorder (SUD) and relapse risk. Low-income women report high levels of stress in SUD residential treatment stemming from significant economic and family stressors in addition to challenges of adjusting to residential treatment demands. Unmanaged stress, especially in early stages of residential treatment, is a major concern because it can increase dropout. Dropout from residential treatment places women at risk of substance use relapse. A gap in knowledge persists regarding the use of mindfulness-based interventions with racially/ethnically diverse low-income women with SUDs, especially regarding the efficacy of adapted (Mindfulness-based interventions) MBIs for preventing residential dropout and decreasing relapse. We have fully adapted, developed, and pilot tested a novel MBI, Moment-by-Moment in Women's Recovery: Mindfulness Based Relapse Prevention for Women (MBRP-W), that supports the needs of women in residential treatment. This MBI integrates relapse prevention, addresses literacy level, and is relevant to issues surrounding treatment- and relapse-related stressors of disadvantaged women. The current project has three specific aims: (1) to test the efficacy of MBRP-W on residential treatment retention and substance use relapse in racially/ethnically diverse low-income women; (2) to determine the mechanisms of change underlying the MBRP-W program; and (3) to explore neural changes associated with program effects. A rationale for MBRP-W is the need for self-initiated stress management skills in women with SUDs during the early stressful periods of residential treatment that increase risk of dropout and relapse.

Condition Intervention
Substance-related Disorders Behavioral: Mindfulness Meditation Behavioral: Brain and Recovery (B&R)

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Neural Mechanisms in Women's Treatment and Early Recovery

Resource links provided by NLM:


Further study details as provided by Hortensia Amaro, University of Southern California:

Primary Outcome Measures:
  • Days in residential treatment [ Time Frame: 11 month interval ]
    Days in residential treatment confirmed by residential clinic archival records

  • Use of and relapse to alcohol and illicit drugs [ Time Frame: 11 month interval ]
    Use of and relapse to alcohol and illicit drug obtained from the interviewer-assisted timeline followback calendar and confirmed by urine drug screen and alcohol breathalyzer test


Secondary Outcome Measures:
  • Neural correlates [ Time Frame: 10 week interval ]
    Brain tissue morphology and neural network correlates of mindfulness training obtained from magnetic resonance imaging (MRI) and functional magnetic resonance imaging (fMRI) in subsample of n=15 in each treatment group at pre- and immediate post-intervention.

  • Psychological mechanisms of action underlying intervention [ Time Frame: 11 month interval ]
    Self-report of mindfulness qualities, perceived stress, psychological distress, distress tolerance, self-regulation, craving, and negative affect


Estimated Enrollment: 165
Study Start Date: March 2016
Estimated Study Completion Date: May 2019
Estimated Primary Completion Date: April 2019 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Mindfulness Meditation
Mindfulness-Based Relapse Prevention-Women (MBRP-W)
Behavioral: Mindfulness Meditation
MBRP-W is delivered in 12 bi-weekly 80-minute group sessions. Facilitators with previous experience in MBSR and trained in MBRP-W will deliver each group. Each session has a central theme and is divided into five segments consisting of: (a) a welcome meditation or other mindfulness practice, (b) a review of session objectives, (c) a brief didactic psycho-educational presentation and discussion based on the session's theme, (d) experiential and formal meditation or other practices, and (e) readings and assignments for the next class. Participants are expected to learn skill building techniques to reducing stress using mindfulness-based principles to complement their recovery treatment program.
Other Name: Mindfulness-Based Relapse Prevention-Women (MBRP-W)
Active Comparator: Active Comparator
Brain and Recovery (B&R)
Behavioral: Brain and Recovery (B&R)
B&R is delivered in 12 bi-weekly 80-minute group sessions delivered by two trained interventionists. The B&R group will receive didactic education on the neurobiology of addiction. B&R contains no information on behavior change, stress reduction, or mindfulness-based or relapse-related content. The intervention was developed over three years with a population similar to those in the study and with input from patients and experts on neurobiology of addiction. Topics include: (1) brain structures and functions related to addiction, (2) effects of various types of substances on the brain, and (3) rewarding effects and how these lead to addiction. Participants are expected to gain knowledge pertaining to the effects of drugs on the brain.

Detailed Description:
  • This randomized clinical trial will deliver two interventions as add-ons to residential substance use disorder (SUD) treatment: (1) Moment-by-Moment in women's Recovery: Mindfulness-Based Approach to Relapse Prevention (MBRP-W) and (2) Brain and Recovery (B&R) which serves as an active psychoeducational attention control group.
  • Participants (N=165) who meet study eligibility criteria based on intake assessment will be recruited and complete baseline assessments during weeks 3-6 after entry into a residential treatment program. Participants will be randomly assigned to interventions using Urn randomization. All participants (MBRP-W and B&R) will receive SUD treatment as normally provided by the treatment program. Fifteen participants from each intervention group (N=30) will be selected to participate in a brain imaging (MRI and fMRI) substudy.
  • Participants will be adult females who have been admitted to a residential treatment center in an urban area of California and who are diagnosed with a SUD based on clinical intake Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) diagnostic assessment.
  • MBRP-W is delivered in 12 bi-weekly 80-minute group sessions with SUD clinical populations. Facilitators will have previous experience in MBSR facilitation and will be trained in MBRP-W. Each session has a central theme and is divided into five segments consisting of (a) a welcome meditation or other mindfulness practice, (b) a review of session objectives, (c) a brief didactic psycho-educational presentation and discussion based on the session's theme, (d) experiential and formal meditation or other practices, and (e) readings and practice assignments for the next class.
  • B&R is delivered in 12 bi-weekly 80-minute group sessions with SUD clinical populations. Facilitators will be trained in B&R. The B&R group will receive didactic education on the neurobiology of addiction. B&R contains no information on behavior change, relapse prevention, stress reduction, or mindfulness-based or relapse-related content. The intervention was developed over three years with a population similar to that of the current study (i.e., racially/ethnically diverse and low-income women in SUD treatment) with input and review from focus group participants, care providers in SUD treatment, and three experts on the neurobiology of addiction. Topics include: (1) brain structure and function related to addiction, (2) effects of various types of substance use on the brain, and (3) rewarding effects of substance use and how these rewarding effects can lead to addiction.
  • There are three data collection points, 1) baseline, 2) immediate post-intervention, and 3) 8-months post-intervention completion. Data will be collected in-person by research interviewers via computer-assisted interviews, which includes administration of an alcohol Breathalyzer test to assess alcohol use and collection of a urine sample to assess drug use. Interviews will be conducted at the treatment program (for those who remain in residential treatment) or at convenient locations for participants no longer in treatment. Baseline interview will occur prior to randomization, post-intervention interview will occur within 1-2 weeks of the last group session, and the follow-up interview will occur at an 8-months post-intervention completion window. Brain imaging for a subsample of participants will be completed at baseline and immediate post-intervention.
  • Number of intervention program class sessions attended will be collected for all enrolled participants.
  • Participant Satisfaction Surveys measuring acceptability, credibility, and perceived utility of the study arms will be administered to both groups at two class sessions.
  • Applied Mindfulness Practice Scale (AMPS) measuring the participant's application of mindfulness skills to address life challenges, will be administered to the MBRP-W participants at four class sessions as well as at follow-up. Mindfulness practice effort will also be assessed at these same four class sessions.
  • An in-treatment clinical record review of services will be collected weekly for the duration of residential treatment.
  Eligibility

Ages Eligible for Study:   18 Years to 65 Years   (Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria for parent study:

  • Female
  • Adult in California (18 years or older)
  • Diagnosed with a substance use disorder (SUD)
  • Speaks fluent English
  • Client at study site, substance use disorder residential facility at time of recruitment

Exclusion criteria for parent study:

  • Inability to comprehend informed consent
  • Unwilling to sign informed consent
  • Cognitive impairment, psychotic disorder or severe chronic mental health condition based on clinical intake DSM-V assessment
  • Older than 65 years of age
  • Reported suicidality in last 30 days
  • Current prisoner
  • Pregnant in the 3rd trimester
  • Pregnant (MRI subsample only)
  • Not willing to be audio recorded
  • Not willing to have data stored for research purposes

Additional exclusion criteria for brain imaging sub-study:

  • Older than 50 years of age
  • Not in good general health
  • Left handed (with a mean item score >1 on the handedness scale)
  • Currently pregnant
  • Current medical devices (cardiac pacemaker, implanted cardiac defibrillator, carotid artery vascular clamp, neurostimulator, cochlear implant, metal fragments (including shrapnel) in the head, eyes, or skin, vascular stent, ocular implant, penile implant, vascular filter for clots (including Greenfield, Umbrella, or Birds Nest filters)
  • Other non-removable devices (IUD, dental braces or retainer, piercings that cannot be removed prior to resting, permanent eye-liner)
  • Body Mass Index (BMI) greater than 36
  • History of head trauma resulting in loss of consciousness for more than 5 minutes
  • Documented or subjectively reported claustrophobia
  • Having hair extensions or a wig connected by wire
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT02977988

Contacts
Contact: Hortensia Amaro, PhD 2138215567 hamaro@usc.edu
Contact: David S Black, PhD, MPH 3234428223 davidbla@usc.edu

Locations
United States, California
Prototypes' Pomona Women's Center Recruiting
Pomona, California, United States, 91767
Contact: April Wilson, MSW, CATC IV    213-542-3845    awilson@prototypes.org   
Contact: Garett Staley, LCSW, MPA,    (909) 624-1233    gstaley@prototypes.org   
Sponsors and Collaborators
University of Southern California
National Institute on Drug Abuse (NIDA)
Investigators
Principal Investigator: Hortensia Amaro University of Southern California School of Social Work
  More Information

Additional Information:
Publications:

Responsible Party: Hortensia Amaro, Associate Vice Provost of Community Research Initiative, Dean's Professor of Social Work and Preventive Medicine, University of Southern California
ClinicalTrials.gov Identifier: NCT02977988     History of Changes
Other Study ID Numbers: UP-14-00391-AM001
1R01DA038648-01A1 ( U.S. NIH Grant/Contract )
Study First Received: November 28, 2016
Last Updated: November 29, 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by Hortensia Amaro, University of Southern California:
Mindfulness
Women
Relapse prevention
Clinical trial
Substance use disorder
Ethnically diverse
Underserved
Health disparities
Stress
Addiction
Latina/Hispanic
African American
Treatment retention
Residential treatment
Brain Imaging

Additional relevant MeSH terms:
Substance-Related Disorders
Chemically-Induced Disorders
Mental Disorders

ClinicalTrials.gov processed this record on September 21, 2017