Mindfulness-Based Relapse Prevention
Core Mechanism
Mindfulness practice builds awareness of triggers, craving, and habitual reaction patterns; decentering from substance-related thoughts and urge surfing break the automaticity of relapse cycles
Ontology
Relapse is driven by automatic cognitive-affective-behavioral chains — craving triggers habitual responding before conscious choice can intervene; mindfulness inserts a gap between stimulus and response
Therapeutic Voice
"The craving is a wave. You don't have to ride it to shore. Just watch it rise, crest, and fall."
View of the Person
An addicted being whose relapse is driven by automatic reactivity to craving — mindfulness reveals the impermanent nature of urges and creates space for conscious choice
Evidence
Not in major guidelines as standalone; VA/DoD references mindfulness approaches
3+ RCTs (Bowen et al., 2009; 2014; Witkiewitz et al., 2014)
Included in mindfulness-for-addiction meta-analyses; Grant et al. (2017)
Integrates Marlatt's cognitive-behavioral relapse prevention with MBSR-style mindfulness training. Specifically targets the automaticity of addictive behavior. Growing evidence base. 2014 JAMA Psychiatry RCT showed comparable outcomes to gold-standard relapse prevention at 12-month follow-up.
Conditions
Epistemology
Blind Spots
Requires sustained meditation practice many clients find difficult; abstinence-oriented (less suited for harm reduction); 8-week group format may miss individual complexity; assumes post-acute stabilization
Contraindications
Active psychosis, acute intoxication, clients who have not achieved initial sobriety/reduction, severe dissociation where mindfulness triggers depersonalization, situations requiring immediate medical detoxification
Training
Licensed clinician with addiction treatment experience. Personal mindfulness practice required. MBRP facilitator training through UW team (Bowen, Chawla, Marlatt).
UW MBRP team — facilitator training. Personal practice prerequisite similar to MBSR/MBCT teacher training.
5 days intensive + personal practice commitment + supervised group facilitation
$1.5K–3K for training; retreat/practice costs additional
Philosophical Roots
Buddhist psychology (impermanence of craving, mindfulness as investigation); Marlatt (cognitive-behavioral relapse prevention model); Kabat-Zinn (MBSR); Teasdale (decentering, metacognitive awareness); Segal (cognitive reactivity)
Related Modalities
Test Yourself
What is urge surfing?
Show answer
A technique where the person observes craving as a wave — rising, cresting, and falling — without acting on it. Builds tolerance for discomfort and demonstrates the impermanent nature of urges.