Addiction treatment attracts wellness claims the way few fields do, and most of them have nothing behind them. Mindfulness is unusual in that it has been tested properly.
The trial
Bowen and colleagues (2014) randomised people who had completed initial treatment for a substance use disorder to one of three conditions:
- Mindfulness-Based Relapse Prevention (MBRP)
- Standard relapse prevention — the established cognitive-behavioural approach
- Treatment as usual — in this setting, twelve-step based aftercare
Published in JAMA Psychiatry, with participants followed for twelve months.
Both structured approaches — mindfulness-based and standard — outperformed treatment as usual. The comparison between the two structured approaches was more interesting than a simple win for either, and the advantages showed up at different points in the follow-up rather than uniformly.
The honest summary: mindfulness-based relapse prevention is a real, evidence-supported option, roughly comparable to the established cognitive-behavioural approach, and better than aftercare as usually delivered.
That is a more modest claim than most mindfulness marketing makes, and a considerably stronger one than most things offered alongside treatment can support at all.
Why it plausibly works
The mechanism is not mysterious, and it connects to the stress research directly.
Sinha’s work found that stress-induced craving predicted how soon someone relapsed — and that stress and environmental cues produce the same state: rising distress plus a compulsive pull toward the substance.
Note what that describes. Not a decision. A state — one that arrives, intensifies and, if nothing is done, resolves into action.
What MBRP trains is the capacity to notice that state as it arrives and to tolerate it without acting. The technique most associated with it, “urge surfing”, treats a craving as a wave: it rises, peaks and subsides, usually within a period that can be endured if you know it will end.
That is a direct intervention on the exact mechanism the stress research identifies, which is more than can be said for most complementary offerings.
What it does not do
It is not a substitute for medication where medication is indicated. For opioid use disorder in particular, the evidence for buprenorphine and methadone is in a different category entirely.
It is not the same as a meditation app. The trial tested a structured eight-session programme delivered by trained clinicians, with specific content aimed at relapse. Twenty minutes a day of guided breathing is a reasonable thing to do and it is not what was studied.
It does not suit everyone. Some people find sitting with internal experience actively unpleasant, particularly early on and particularly with significant trauma history. That is a real clinical consideration, not resistance.
What “urge surfing” actually involves
Worth describing concretely, because the name puts people off and the practice is unremarkable.
When a craving arrives, the instinct is to fight it or to distract from it. Both treat it as an emergency requiring immediate action, which is approximately how it feels.
The alternative is to turn attention toward it and describe it: where it is felt in the body, whether it is tightening or loosening, what the thoughts attached to it are saying. Not arguing with those thoughts — noting them.
The observation that makes this work is that cravings are time-limited. They rise, peak and fall, typically over a period measured in minutes rather than hours. Someone who has never watched one all the way through does not know that, and reasonably assumes it will simply keep escalating until they act.
Having watched several arrive and leave without acting, the relationship changes. Not because the craving is weaker — because it has stopped being an emergency and become a thing that happens and passes.
That is the whole technique. It sounds too simple to matter, and it is the part with a randomised trial behind it.
Where it fits practically
The useful position is that MBRP is one credible tool with evidence behind it, most valuable when someone has finished treatment and needs something portable for the moments when a craving arrives.
Portable is the operative word. It requires no appointment, no facility and no other person, which makes it available at four o’clock on a Tuesday when the therapist is not.
That is precisely why it works well alongside in-person support rather than instead of it. Practising a technique in a session is not the same as using it in the situation that provokes it — and having someone alongside during the first real tests is how a technique becomes a habit rather than a thing someone was once taught.
That transition, from knowing to using, is most of what support after treatment actually consists of.
The short version
Mindfulness-based relapse prevention has a randomised trial in a major journal, performed comparably to the established cognitive-behavioural approach, and beat aftercare as usually delivered.
It is a genuine option. It is not a replacement for medication, it is not an app, and it is not for everyone. In a field where most adjuncts have no evidence at all, that combination makes it worth knowing about.
References
- Bowen S, Witkiewitz K, Clifasefi SL, et al. (2014). Relative Efficacy of Mindfulness-Based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders: A Randomized Clinical Trial. JAMA Psychiatry. 10.1001/jamapsychiatry.2013.4546
- Sinha R (2008). Chronic Stress, Drug Use, and Vulnerability to Addiction. Annals of the New York Academy of Sciences. 10.1196/annals.1441.030
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