Substance Use & Misuse, 49:595–600, 2014 C 2014 Informa Healthcare USA, Inc. Copyright ISSN: 1082-6084 print / 1532-2491 online DOI: 10.3109/10826084.2014.850310
ORIGINAL ARTICLE
Differences in Trait Mindfulness Across Mental Health Symptoms Among Adults in Substance Use Treatment Ryan C. Shorey1 , Hope Brasfield1 , Scott Anderson2 and Gregory L. Stuart1 Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle on 09/29/14 For personal use only.
1
University of Tennessee—Knoxville, Knoxville, Tennessee; 2 Cornerstone of Recovery, Louisville, Tennessee Keywords mindfulness, substance use, depression, posttraumatic stress disorder, treatment, relapse
Mindfulness is a growing area of investigation among individuals manifesting substance use disorders, as mindfulness meditation may help to prevent relapse to substance use. The current study examined levels of trait mindfulness in substance users seeking treatment from May 2012 to August 2012 in a Tennessee residential center and whether patients with probable (i.e., diagnoses based on a self-report screening instrument) comorbid depression or PTSD reported lower mindfulness than patients without a probable comorbid diagnosis. Data were collected from a convenience sample of archival patient records (N = 125) and four instruments. The majority of patients were male (n = 84) and non-Hispanic Caucasian (92%); the mean age of the sample was 37.36 (SD = 12.47). Results showed that lower trait mindfulness was associated with increased levels of substance use, depression, and PTSD. Patients with a probable depression or PTSD diagnosis reported lower mindfulness than patients without these disorders. Patients with probable comorbid depression and PTSD reported the lowest levels of mindfulness. These findings suggest that altering levels of mindfulness may be important for individuals manifesting dual-diagnoses in substance user treatment. The study’s limitations are noted.
INTRODUCTION
Individuals who seek treatment for substance use disorders (SUD) manifest high rates of relapse. Understanding factors that may reduce the risk of relapse and improve treatment outcomes is of critical importance. Recently, there has been increased attention on the role of mindfulness deficits in contributing to substance use and how mindfulness-based interventions can be implemented in substance use treatment1 (e.g., Eisenlohr-Moul, Walsh, Charnigo, Lynam, & Baer, 2012; Marcus & Zgierska, 2009). Indeed, it is believed that mindfulness-based interventions may help to reduce risk for relapse (Bowen et al., 2009). Mindfulness has been defined as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p. 4). In essence, mindfulness is being attentive to whatever is occurring in the present moment (e.g., emotions, thoughts) without needing to judge or change anything about the experience. Previous research with mindfulness and substance use has demonstrated that individuals who seek treatment for substance use report lower levels of trait mindfulness
1 Treatment can be briefly and usefully defined as a unique, planned, goal-directed, temporally structured, multidimensional change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help-based (AA,NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which aren’t also used with nonsubstance users. Whether or not a treatment technique is indicated or contraindicated, its selection underpinnings (theory-based, empirically-based, “principle of faith-based, tradition-based, etc.) continue to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) and wellbeing treatment-driven models, there are now new sets of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Conflict-resolution models may stimulate an additional option for intervention. Each ideological model has its own criteria for success as well as failure as well as iatrogenic-related harms. Treatment is implemented in a range of environments; ambulatory as well as within institutions which can include controlled environments Treatment includes a spectrum of clinician–caregiver–patient relationships representing various forms of decision-making traditions/models; (1). the hierarchical model in which the clinician–treatment agent makes the decision(s) and the recipient is compliant and relatively passive, (2) shared decision-making which facilitates the collaboration between clinician and patient(s) in which both are active, and (3) the “informed model” in which the patient makes the decision(s). Editor’s note. This work was supported, in part, by grants F31AA020131 and K24AA019707 from the National Institute on Alcohol Abuse and Alcoholism awarded to the first and last authors, respectively. Address correspondence to Ryan C. Shorey, M.A., Department of Psychology, University of Tennessee, 1404 Circle Dr., Austin Peay Building, 311, Knoxville, TN 37996, USA; E-mail: [email protected]
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R. C. SHOREY ET AL.
relative to nonsubstance users (e.g., Dakwar, Mariani, & Levin, 2011); that trait mindfulness is associated with increased cigarette use, which is mediated by increased depressive affect and perceived stress (Black, Sussman, Johnson, & Milam, 2012); and that Mindfulness-Based Relapse Prevention (MBRP; Bowen et al., 2009), which combines aspects of Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1990), Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2012) and relapse prevention, reduces substance use to a greater degree relative to standard 12-step outpatient treatment. A factor that may complicate our understanding of the relation between mindfulness and substance use is the high comorbidity between substance use and depression and posttraumatic stress disorder (PTSD). Approximately 25–50% of individuals diagnosed with a SUD2 meet criteria for major depressive disorder and 10–25% meet criteria for PTSD (Falck, Wang, Siegal, & Carlson, 2004; Kessler et al., 1997). Individuals with depression or PTSD are also at heightened risk for relapse to substance use after SUD treatment (e.g., Kodl et al., 2008). Thus, it is possible that individuals who seek substance use treatment and who also have comorbid depression and/or PTSD may evidence reduced trait mindfulness above and beyond individuals with substance use diagnoses only. This would be consistent with the suppositions of Brewer, Bowen, Smith, Marlatt, and Potenza (2010) who detail how mindfulness-based interventions may target underlying mechanisms for substance use and comorbid disorders. The current study examined the relation between trait mindfulness, depression, and PTSD among residential substance use treatment patients. We hypothesized that (1) lower trait mindfulness would be associated with increased substance use, depression, and PTSD; (2) individuals with probable comorbid depression or PTSD would report lower trait mindfulness relative to individuals without probable comorbid depression or PTSD; and (3) individuals with probable comorbid depression and PTSD would evidence the lowest levels of trait mindfulness.
2
The reader is reminded that psychiatric diagnoses are the outcome of a checklisted consensual perception and judgment and are not empirically informed. A diagnostic process, in simplistic terms, permits the collection of necessary and relevant data/information in order to facilitate decision making. From a medical-treatment perspective, an useful diagnosis “offers,” minimally, three critical, necessary types of information: etiology, process, and prognosis. . .which are not always known. The relatively recent substance-use-disorder-related nosology, which relates as well to “dual diagnosis,” is inadvertently misleading in that any substance use and user, of whatever type(s) can be “tagged”/diagnosed in each area of his/her life: medically, psychiatrically, socially, gender identification, educationally, spiritually, morally, IQ, SES, ethnically, racially, legal-status, etc., depending upon the criteria used (whatever their underpinnings and validity) and the needs of the categorizers. Neither “substance use disorder” (in its variations) nor dual diagnosis, also in its variations offer, in a predictable sense, etiological, process, and prognostic information which can be or which are used for effective treatment planning, implementation, and evaluation of the range of heterogeneous drug users. Editor’s note.
METHOD Participants and Procedures
Archival treatment records were coded from 125 patients housed at a 28–30 day residential substance use treatment facility in the state of Tennessee from May 2012 to August 2012. Patient records were chosen by convenience by sequential entry into the treatment facility during the date range specified. This reflects all new admissions to the residential treatment program during that time period. To be admitted to the treatment facility, patients must have a primary substance use disorder diagnosis and be 18 years of age or older. Table 1 presents demographic information for the sample. All procedures for the current study were approved by the Institutional Review Board of the University of Tennessee. Measures
Mindful Attention Awareness Scale (MAAS) The 14-item version of the MAAS was employed (Brown, West, Loverich, & Biegel, 2011). The 14-item version of the MAAS has demonstrated good reliability (Cronbach’s α = .88) and validity (Brown et al., 2011). A mean score was obtained by summing all items on a 6-point scale and dividing by the total number of items. Higher scores on the MAAS indicate higher levels of trait mindfulness. Patients were asked to rate items about their “every day experience.” A single question was also included that asked patients to indicate whether they had any previous training in mindfulness or meditation during their lifetime using a yes/no format. Psychiatric Diagnostic Screening Questionnaire (PDSQ) The PDSQ (Zimmerman, 2002; Zimmerman & Mattia, 2001) was used to assess depression and PTSD in the two weeks prior to treatment. The PDSQ has established cutoff scores to indicate probable diagnoses (scores of 9 and 5 for depression and PTSD, respectively; Zimmerman & Mattia, 2001). The sensitivity and specificity of the cutoff scores are .90 and .67 (depression) and .92 and .62 (PTSD) (Zimmerman & Mattia, 2001). The depression subscale consists of 22 items and the PTSD subscale consists of 13 items, with all items rated on a true/false format. The internal consistency, test–retest reliability, and validity of the PDSQ are established (Zimmerman, 2002). Alcohol Dependence Scale (ADS) The ADS (Skinner & Allen, 1982) is a 25-item self-report measure that examines alcohol use in the past 12 months. The ADS measures the severity of alcohol dependence, with items covering symptoms that include withdrawal, impaired control over alcohol use, awareness of compulsion to drink alcohol, and alcohol seeking behavior. Higher scores on the ADS correspond to more severe alcohol dependence. The ADS has demonstrated good psychometric properties (e.g., α = .92; Skinner & Allen, 1982).
DIFFERENCES IN TRAIT MINDFULNESS ACROSS MENTAL HEALTH SYMPTOMS AMONG ADULTS IN SUBSTANCE USE TREATMENT
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Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle on 09/29/14 For personal use only.
TABLE 1. Demographic characteristics of study sample and diagnostic groups
Gender Male Female Race Non-Hispanic Caucasian African American Hispanic Other (e.g., Multiracial; Native American) Employment status Employed Unemployed Relationship status Married Never married Divorced Other (e.g., widowed) Age (mean, SD) Education (years completed; mean, SD) Diagnosis Alcohol dependence Opioid dependence Polysubstance dependence Cannabis dependence Sedative/hypnotic/anxiolytic Dependence Cocaine dependence Amphetamine dependence Alcohol abuse Prior mindfulness/meditation Experience Experience
Total sample (n = 125)
Probable PTSD (n = 44)
Probable depression (n = 59)
PTSD + depression (n = 27)
n = 84 n = 41
n = 24 n = 20
n = 35 n = 24
n = 14 n = 13
92% 4% 1.6% 2.4%
86.4% 4.5% 4.5% 4.6%
97.7% 2.3% – –
95.2% 4.8% – –
32.8% 67.2%
38.6% 61.4%
32.2% 67.8%
37% 63%
41% 36.8% 12.8% 9.4% 37.36 (12.47) 13.71 (2.39)
54.3% 14.3% 20% 11.5% 37.86 (11.77) 14.06 (2.37)
54.5% 13.6% 15.9% 16% 36.84 (12.25) 13.94 (2.64)
59.1% 13.6% 13.6% 13.7% 39.22 (11.76) 13.96 (2.55)
50% 26.2% 13.9% 3.3% 1.6%
50% 22.7% 20.5% 2.3% 2.3%
44.1% 35.6% 13.6% 1.7% 3.4%
48.1% 18.5% 22.2% 3.7% 3.7%
1.6% 1.6% 1.6% 19.2%
2.3% – – 31.8%
1.7% – – 30.5%
3.7% – – 40.7%
Drug Use Disorders Identification Test (DUDIT) The DUDIT (Stuart, Moore, Kahler, & Ramsey, 2003; Stuart, Moore, Ramsey, & Kahler, 2004) is a 14-item selfreport measure that assesses the frequency of drug use and symptoms that may indicate tolerance/dependence in the
year prior to treatment entry. The DUDIT examines seven different types of drugs (cannabis, cocaine, hallucinogens, stimulants, sedatives/hypnotics/anxiolytics, opiates, and other substances). The DUDIT has demonstrated good reliability (α = .90) and validity (Stuart et al., 2004).
TABLE 2. Correlations among mindfulness, mental health, substance use, and demographic variables among residential substance use treatment seekers (N = 125)
1. MAAS 2. Depression 3. PTSD 4. ADS 5. DUDIT 6. Age 7. Gender 8. Employment 9. Marital status M SD
1.
2.
3.
4.
5.
6.
7.
8.
9.
–
−.56∗∗∗ –
−.25∗∗ .34∗∗∗ –
−.24∗∗ .33∗∗∗ .25∗∗ –
−.23∗ .38∗∗∗ .13 −.28∗∗ –
.17 −.14 .01 .06 −.59∗∗∗ –
−.23∗∗ .19∗ .32∗∗∗ .00 .18∗ −.05 –
−.01 −.14 .03 .08 −.25∗∗ .16 −.19∗ –
8.42 5.21
4.61 5.95
10.88 10.14
14.88 14.36
37.36 12.47
1.32 .47
.10 −.08 .02 .13 −.31∗∗∗ .45∗∗∗ −.13 −.09 – .40 .49
4.09 1.03
.32 .47
Note. MAAS = Mindful Attention Awareness Scale; PTSD = Posttraumatic stress disorder; ADS = Alcohol Dependence Scale; DUDIT = Drug Use Disorders Identification Test; Gender (0 = male, 1 = female); Employment (0 = unemployed, 1 = employed); Marital Status (0 = single, 1 = in relationship). ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001.
598
R. C. SHOREY ET AL.
TABLE 3. Differences in trait mindfulness between probable diagnostic groups
Depression MAAS
PTSD MAAS
Probable diagnosis group M (SD)
Nondiagnostic group M (SD)
F
p
d
n = 59 (47.2%) 3.62 (.97)
n = 66 (52.8%) 4.51 (.89)
20.04
ORIGINAL ARTICLE
Differences in Trait Mindfulness Across Mental Health Symptoms Among Adults in Substance Use Treatment Ryan C. Shorey1 , Hope Brasfield1 , Scott Anderson2 and Gregory L. Stuart1 Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle on 09/29/14 For personal use only.
1
University of Tennessee—Knoxville, Knoxville, Tennessee; 2 Cornerstone of Recovery, Louisville, Tennessee Keywords mindfulness, substance use, depression, posttraumatic stress disorder, treatment, relapse
Mindfulness is a growing area of investigation among individuals manifesting substance use disorders, as mindfulness meditation may help to prevent relapse to substance use. The current study examined levels of trait mindfulness in substance users seeking treatment from May 2012 to August 2012 in a Tennessee residential center and whether patients with probable (i.e., diagnoses based on a self-report screening instrument) comorbid depression or PTSD reported lower mindfulness than patients without a probable comorbid diagnosis. Data were collected from a convenience sample of archival patient records (N = 125) and four instruments. The majority of patients were male (n = 84) and non-Hispanic Caucasian (92%); the mean age of the sample was 37.36 (SD = 12.47). Results showed that lower trait mindfulness was associated with increased levels of substance use, depression, and PTSD. Patients with a probable depression or PTSD diagnosis reported lower mindfulness than patients without these disorders. Patients with probable comorbid depression and PTSD reported the lowest levels of mindfulness. These findings suggest that altering levels of mindfulness may be important for individuals manifesting dual-diagnoses in substance user treatment. The study’s limitations are noted.
INTRODUCTION
Individuals who seek treatment for substance use disorders (SUD) manifest high rates of relapse. Understanding factors that may reduce the risk of relapse and improve treatment outcomes is of critical importance. Recently, there has been increased attention on the role of mindfulness deficits in contributing to substance use and how mindfulness-based interventions can be implemented in substance use treatment1 (e.g., Eisenlohr-Moul, Walsh, Charnigo, Lynam, & Baer, 2012; Marcus & Zgierska, 2009). Indeed, it is believed that mindfulness-based interventions may help to reduce risk for relapse (Bowen et al., 2009). Mindfulness has been defined as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p. 4). In essence, mindfulness is being attentive to whatever is occurring in the present moment (e.g., emotions, thoughts) without needing to judge or change anything about the experience. Previous research with mindfulness and substance use has demonstrated that individuals who seek treatment for substance use report lower levels of trait mindfulness
1 Treatment can be briefly and usefully defined as a unique, planned, goal-directed, temporally structured, multidimensional change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help-based (AA,NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which aren’t also used with nonsubstance users. Whether or not a treatment technique is indicated or contraindicated, its selection underpinnings (theory-based, empirically-based, “principle of faith-based, tradition-based, etc.) continue to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) and wellbeing treatment-driven models, there are now new sets of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Conflict-resolution models may stimulate an additional option for intervention. Each ideological model has its own criteria for success as well as failure as well as iatrogenic-related harms. Treatment is implemented in a range of environments; ambulatory as well as within institutions which can include controlled environments Treatment includes a spectrum of clinician–caregiver–patient relationships representing various forms of decision-making traditions/models; (1). the hierarchical model in which the clinician–treatment agent makes the decision(s) and the recipient is compliant and relatively passive, (2) shared decision-making which facilitates the collaboration between clinician and patient(s) in which both are active, and (3) the “informed model” in which the patient makes the decision(s). Editor’s note. This work was supported, in part, by grants F31AA020131 and K24AA019707 from the National Institute on Alcohol Abuse and Alcoholism awarded to the first and last authors, respectively. Address correspondence to Ryan C. Shorey, M.A., Department of Psychology, University of Tennessee, 1404 Circle Dr., Austin Peay Building, 311, Knoxville, TN 37996, USA; E-mail: [email protected]
595
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle on 09/29/14 For personal use only.
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R. C. SHOREY ET AL.
relative to nonsubstance users (e.g., Dakwar, Mariani, & Levin, 2011); that trait mindfulness is associated with increased cigarette use, which is mediated by increased depressive affect and perceived stress (Black, Sussman, Johnson, & Milam, 2012); and that Mindfulness-Based Relapse Prevention (MBRP; Bowen et al., 2009), which combines aspects of Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1990), Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2012) and relapse prevention, reduces substance use to a greater degree relative to standard 12-step outpatient treatment. A factor that may complicate our understanding of the relation between mindfulness and substance use is the high comorbidity between substance use and depression and posttraumatic stress disorder (PTSD). Approximately 25–50% of individuals diagnosed with a SUD2 meet criteria for major depressive disorder and 10–25% meet criteria for PTSD (Falck, Wang, Siegal, & Carlson, 2004; Kessler et al., 1997). Individuals with depression or PTSD are also at heightened risk for relapse to substance use after SUD treatment (e.g., Kodl et al., 2008). Thus, it is possible that individuals who seek substance use treatment and who also have comorbid depression and/or PTSD may evidence reduced trait mindfulness above and beyond individuals with substance use diagnoses only. This would be consistent with the suppositions of Brewer, Bowen, Smith, Marlatt, and Potenza (2010) who detail how mindfulness-based interventions may target underlying mechanisms for substance use and comorbid disorders. The current study examined the relation between trait mindfulness, depression, and PTSD among residential substance use treatment patients. We hypothesized that (1) lower trait mindfulness would be associated with increased substance use, depression, and PTSD; (2) individuals with probable comorbid depression or PTSD would report lower trait mindfulness relative to individuals without probable comorbid depression or PTSD; and (3) individuals with probable comorbid depression and PTSD would evidence the lowest levels of trait mindfulness.
2
The reader is reminded that psychiatric diagnoses are the outcome of a checklisted consensual perception and judgment and are not empirically informed. A diagnostic process, in simplistic terms, permits the collection of necessary and relevant data/information in order to facilitate decision making. From a medical-treatment perspective, an useful diagnosis “offers,” minimally, three critical, necessary types of information: etiology, process, and prognosis. . .which are not always known. The relatively recent substance-use-disorder-related nosology, which relates as well to “dual diagnosis,” is inadvertently misleading in that any substance use and user, of whatever type(s) can be “tagged”/diagnosed in each area of his/her life: medically, psychiatrically, socially, gender identification, educationally, spiritually, morally, IQ, SES, ethnically, racially, legal-status, etc., depending upon the criteria used (whatever their underpinnings and validity) and the needs of the categorizers. Neither “substance use disorder” (in its variations) nor dual diagnosis, also in its variations offer, in a predictable sense, etiological, process, and prognostic information which can be or which are used for effective treatment planning, implementation, and evaluation of the range of heterogeneous drug users. Editor’s note.
METHOD Participants and Procedures
Archival treatment records were coded from 125 patients housed at a 28–30 day residential substance use treatment facility in the state of Tennessee from May 2012 to August 2012. Patient records were chosen by convenience by sequential entry into the treatment facility during the date range specified. This reflects all new admissions to the residential treatment program during that time period. To be admitted to the treatment facility, patients must have a primary substance use disorder diagnosis and be 18 years of age or older. Table 1 presents demographic information for the sample. All procedures for the current study were approved by the Institutional Review Board of the University of Tennessee. Measures
Mindful Attention Awareness Scale (MAAS) The 14-item version of the MAAS was employed (Brown, West, Loverich, & Biegel, 2011). The 14-item version of the MAAS has demonstrated good reliability (Cronbach’s α = .88) and validity (Brown et al., 2011). A mean score was obtained by summing all items on a 6-point scale and dividing by the total number of items. Higher scores on the MAAS indicate higher levels of trait mindfulness. Patients were asked to rate items about their “every day experience.” A single question was also included that asked patients to indicate whether they had any previous training in mindfulness or meditation during their lifetime using a yes/no format. Psychiatric Diagnostic Screening Questionnaire (PDSQ) The PDSQ (Zimmerman, 2002; Zimmerman & Mattia, 2001) was used to assess depression and PTSD in the two weeks prior to treatment. The PDSQ has established cutoff scores to indicate probable diagnoses (scores of 9 and 5 for depression and PTSD, respectively; Zimmerman & Mattia, 2001). The sensitivity and specificity of the cutoff scores are .90 and .67 (depression) and .92 and .62 (PTSD) (Zimmerman & Mattia, 2001). The depression subscale consists of 22 items and the PTSD subscale consists of 13 items, with all items rated on a true/false format. The internal consistency, test–retest reliability, and validity of the PDSQ are established (Zimmerman, 2002). Alcohol Dependence Scale (ADS) The ADS (Skinner & Allen, 1982) is a 25-item self-report measure that examines alcohol use in the past 12 months. The ADS measures the severity of alcohol dependence, with items covering symptoms that include withdrawal, impaired control over alcohol use, awareness of compulsion to drink alcohol, and alcohol seeking behavior. Higher scores on the ADS correspond to more severe alcohol dependence. The ADS has demonstrated good psychometric properties (e.g., α = .92; Skinner & Allen, 1982).
DIFFERENCES IN TRAIT MINDFULNESS ACROSS MENTAL HEALTH SYMPTOMS AMONG ADULTS IN SUBSTANCE USE TREATMENT
597
Subst Use Misuse Downloaded from informahealthcare.com by University of Newcastle on 09/29/14 For personal use only.
TABLE 1. Demographic characteristics of study sample and diagnostic groups
Gender Male Female Race Non-Hispanic Caucasian African American Hispanic Other (e.g., Multiracial; Native American) Employment status Employed Unemployed Relationship status Married Never married Divorced Other (e.g., widowed) Age (mean, SD) Education (years completed; mean, SD) Diagnosis Alcohol dependence Opioid dependence Polysubstance dependence Cannabis dependence Sedative/hypnotic/anxiolytic Dependence Cocaine dependence Amphetamine dependence Alcohol abuse Prior mindfulness/meditation Experience Experience
Total sample (n = 125)
Probable PTSD (n = 44)
Probable depression (n = 59)
PTSD + depression (n = 27)
n = 84 n = 41
n = 24 n = 20
n = 35 n = 24
n = 14 n = 13
92% 4% 1.6% 2.4%
86.4% 4.5% 4.5% 4.6%
97.7% 2.3% – –
95.2% 4.8% – –
32.8% 67.2%
38.6% 61.4%
32.2% 67.8%
37% 63%
41% 36.8% 12.8% 9.4% 37.36 (12.47) 13.71 (2.39)
54.3% 14.3% 20% 11.5% 37.86 (11.77) 14.06 (2.37)
54.5% 13.6% 15.9% 16% 36.84 (12.25) 13.94 (2.64)
59.1% 13.6% 13.6% 13.7% 39.22 (11.76) 13.96 (2.55)
50% 26.2% 13.9% 3.3% 1.6%
50% 22.7% 20.5% 2.3% 2.3%
44.1% 35.6% 13.6% 1.7% 3.4%
48.1% 18.5% 22.2% 3.7% 3.7%
1.6% 1.6% 1.6% 19.2%
2.3% – – 31.8%
1.7% – – 30.5%
3.7% – – 40.7%
Drug Use Disorders Identification Test (DUDIT) The DUDIT (Stuart, Moore, Kahler, & Ramsey, 2003; Stuart, Moore, Ramsey, & Kahler, 2004) is a 14-item selfreport measure that assesses the frequency of drug use and symptoms that may indicate tolerance/dependence in the
year prior to treatment entry. The DUDIT examines seven different types of drugs (cannabis, cocaine, hallucinogens, stimulants, sedatives/hypnotics/anxiolytics, opiates, and other substances). The DUDIT has demonstrated good reliability (α = .90) and validity (Stuart et al., 2004).
TABLE 2. Correlations among mindfulness, mental health, substance use, and demographic variables among residential substance use treatment seekers (N = 125)
1. MAAS 2. Depression 3. PTSD 4. ADS 5. DUDIT 6. Age 7. Gender 8. Employment 9. Marital status M SD
1.
2.
3.
4.
5.
6.
7.
8.
9.
–
−.56∗∗∗ –
−.25∗∗ .34∗∗∗ –
−.24∗∗ .33∗∗∗ .25∗∗ –
−.23∗ .38∗∗∗ .13 −.28∗∗ –
.17 −.14 .01 .06 −.59∗∗∗ –
−.23∗∗ .19∗ .32∗∗∗ .00 .18∗ −.05 –
−.01 −.14 .03 .08 −.25∗∗ .16 −.19∗ –
8.42 5.21
4.61 5.95
10.88 10.14
14.88 14.36
37.36 12.47
1.32 .47
.10 −.08 .02 .13 −.31∗∗∗ .45∗∗∗ −.13 −.09 – .40 .49
4.09 1.03
.32 .47
Note. MAAS = Mindful Attention Awareness Scale; PTSD = Posttraumatic stress disorder; ADS = Alcohol Dependence Scale; DUDIT = Drug Use Disorders Identification Test; Gender (0 = male, 1 = female); Employment (0 = unemployed, 1 = employed); Marital Status (0 = single, 1 = in relationship). ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001.
598
R. C. SHOREY ET AL.
TABLE 3. Differences in trait mindfulness between probable diagnostic groups
Depression MAAS
PTSD MAAS
Probable diagnosis group M (SD)
Nondiagnostic group M (SD)
F
p
d
n = 59 (47.2%) 3.62 (.97)
n = 66 (52.8%) 4.51 (.89)
20.04
