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What is Mindfulness-Based Relapse Prevention (MBRP)?

By The Science of Mindfulness

Mindfulness-Based Relapse Prevention (MBRP)

Mindfulness-Based Relapse Prevention, also known as MBRP, is a group aftercare program for people who have completed an initial treatment for a substance use disorder. It was developed at the University of Washington by Sarah Bowen, Neha Chawla, and the late G. Alan Marlatt, together with colleagues, by combining mindfulness practice with the cognitive-behavioral relapse prevention model1, 2. The central idea is that relapse often follows automatic reactions to cravings, difficult emotions, and familiar triggers. By practicing awareness of these moments, participants learn to pause, notice what is happening in the body and mind, and choose a response instead of acting on habit.

Course Format: MBRP is taught in an 8-week group format3, with sessions typically around two hours long. Participants practice formal meditations such as the body scan, sitting meditation, and mindful movement, and apply them to recovery-specific situations. Signature exercises include “urge surfing,” in which a craving is observed as it rises, peaks, and passes without being acted on, and a brief breathing space known as SOBER (Stop, Observe, Breathe, Expand, Respond) that can be used in the moment of a trigger2. Home practice and group discussion of high-risk situations are part of every session.

Instructor Requirements: There is no single accrediting body. MBRP facilitators are typically clinicians with a background in substance use treatment who have their own mindfulness practice and have completed MBRP-specific facilitator training. Training is offered through university-based centers, including the Mindfulness-Based Professional Training Institute at UC San Diego.

Course Outcomes: The first randomized trial of MBRP enrolled 168 adults with substance use disorders who had recently completed intensive treatment. Compared with treatment as usual, those who received MBRP had significantly lower rates of substance use over the four months after the program, and showed greater decreases in craving and greater increases in acceptance and acting with awareness3. A larger trial of 286 people compared MBRP with a cognitive-behavioral relapse prevention program and with treatment as usual (12-step programming and psychoeducation). At three months there were no significant differences between groups. At six months, both MBRP and relapse prevention participants had a significantly lower risk of relapse to drug use and heavy drinking than those receiving treatment as usual, and at twelve months MBRP was more effective than relapse prevention at reducing drug use and heavy drinking4.

A systematic review and meta-analysis of 42 studies of mindfulness treatments for substance misuse (not limited to MBRP) found small-to-large effects on the frequency and severity of substance use, craving, and stress, and higher rates of abstinence from cigarette smoking compared with alternative treatments5. The authors note that more research is needed on how these programs work and on how well they perform in diverse treatment settings.

Clinical Populations: MBRP has been studied mainly in adults with alcohol and other substance use disorders who have completed an initial phase of treatment. It is designed as aftercare to support recovery, not as a replacement for medical treatment or detoxification.

Learn More: The MBRP overview from UC San Diego’s Mindfulness-Based Professional Training Institute describes the program and facilitator training. Readers looking for a related program for chronic pain and opioid misuse can see Mindfulness-Oriented Recovery Enhancement (MORE).

This page is for general education and is not medical advice. Please speak with a qualified health professional about treatment options.

References

  1. Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-Based Relapse Prevention for Alcohol and Substance Use Disorders. Journal of Cognitive Psychotherapy, 19(3), 211-228. https://doi.org/10.1891/jcop.2005.19.3.211
  2. Bowen, S., Chawla, N., & Marlatt, G. A. (2011). Mindfulness-based relapse prevention for addictive behaviors: A clinician’s guide. Guilford Press.
  3. Bowen, S., Chawla, N., Collins, S. E., Witkiewitz, K., Hsu, S., Grow, J., Clifasefi, S., Garner, M., Douglass, A., Larimer, M. E., & Marlatt, A. (2009). Mindfulness-Based Relapse Prevention for Substance Use Disorders: A Pilot Efficacy Trial. Substance Abuse, 30(4), 295-305. https://doi.org/10.1080/08897070903250084
  4. Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., Carroll, H. A., Harrop, E., Collins, S. E., Lustyk, M. K., & Larimer, M. E. (2014). Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders. JAMA Psychiatry, 71(5), 547. https://doi.org/10.1001/jamapsychiatry.2013.4546
  5. Li, W., Howard, M. O., Garland, E. L., McGovern, P., & Lazar, M. (2017). Mindfulness treatment for substance misuse: A systematic review and meta-analysis. Journal of Substance Abuse Treatment, 75, 62-96. https://doi.org/10.1016/j.jsat.2017.01.008

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