1. Mindfulness and Relapse Prevention among New Mothers during Recovery for Opioid Misuse Roxanne D. Erolin Chair: Diane Abatemarco, PhD, MSW Preceptor: Meghan Gannon, PhD, MSPH
Background
Results
Discussion and Limitations
The opioid epidemic is a growing public health issue in the US where 91 Americans die of opioid overdose every day. This epidemic affects various populations including pregnant women and new mothers. The number of pregnant women dependent on opioids at time of delivery increased by 5 fold between Newborns exposed to opioids in utero can suffer negative health outcomes, such as neonatal abstinence syndrome. Current treatments for opioid use disorder includes using agonist agents, such as methadone or buprenorphine, and a comprehensive therapeutic regimen.
Stress is a known factor of relapse and there are new modalities being tested to address stress among those undergoing treatment for opioid use disorder. One such method is Mindfulness Based Interventions (MBI). MBI’s involve meditation to gain self-awareness of one’s thoughts and emotions. There are a few studies that show MBI’s are effective in decreasing risk of relapse. However, there are limited studies evaluating MBI’s among new mothers with opioid use disorder.
This study examined the relationship between a Mindfulness Based Intervention called Mindfulness-Based Parenting (MBP) and risk of relapse. MBP was designed by MATER as part of a larger grant funded project through the Children’s Bureau called Practicing Safety Mindfulness for Mothers in Drug Treatment (PSMDT).
This study aims to determine the following:
Evaluate the dose-response relationship between MBP sessions and risk of relapse.
Determine the influence of psychosocial and demographic factors on risk of relapse among postpartum women
In the “Any Use” model, our analysis showed that attending more sessions were associated with an increased risk of relapse. At the same time, repeating the course was associated with a decreased risk of “Any Use” significantly. While those who repeated the course were in effect taking more MBP sessions, the results suggest that completing and graduating the Mindfulness course twice is more beneficial than attending an equal number of sessions inconsistently.
Our analysis found a few psychosocial factors that is associated with the risk of relapse. In the “Any Use” and “Opioid Use” models, we found that lower total PSI scores was associated with a decreased risk of relapse. The data highlighted ACEs as an important factor associated with risk of relapse. It also showed that longer treatment duration was associated with relapse, but it is important to note that recovery is not linear.
This study provides additional evidence that MBP is associated with reducing the risk of relapse and can encourage more participants to repeat the full course. It also showed that the interaction of the various psychosocial and demographic factors can influence the risk of relapse and thus highlighting the complexity of the issue. This study offers insight into further research on relapse prevention among this population.
The average number of sessions attended by the MBP group was (SD=6.31) and 34.8% of participants repeated the course.
Those in the MBP group had statistically significant improvements between pre and post for PSS (t=4.372, df = 64, p-value<0.001) and Mindfulness scores (t=-4.434, df=64, p-value<0.001), no significant difference in total PSI scores.
No significant difference between pre and post PSS, PSI, and Mindfulness scores among Controls.
Bivariate Analysis
Education was significantly associated with relapse on “Any use” (χ²=8.819, p- value=0.032) and “Other Substance Use” (χ²=8.178, p-value=0.042)
Those with higher ACE scores were times more likely to relapse on “Any Use” than those with lower scores (p-value=0.018).
Method
Limitations:
UDS records differ between participants. Those who stayed at My Sister’s Place, a residential treatment facility, were tested more frequently than those who were treated at Family Center, an outpatient treatment center.
Due to differences in UDS frequency, it is possible that substance use between collections were missed.
UDS records do not differentiate positive results of substances used for medical purposes, which can lead to over reporting.
Those treated by My Sister’s Place received intensive care in a controlled environment. Thus, it may reduce the opportunity for relapse, if a participant desired to.
Design: Retrospective cohort study with data abstraction and secondary data analysis
Sample: Participants of the PSMDT study (N=78: MBP group = 66, Control = 12)
MBP:
12-session weekly curriculum including 3 mother/child dyad sessions
Participants could complete intervention twice and make up missed classes
Dates and number of sessions attended were obtained for each participant
Relapse:
Captured using participants’ urine drug screen (UDS) results abstracted from their medical record
Collected UDSs from time period of first MBP session to 6 months post final MBP session/cohort participation
Evaluated 4 outcomes: “Opioid Use”, “Other Substance Use”, “Opioid plus Other Substance Use”, and “Any Use”
PSMDT Database:
Demographic variables: Age, Education, Parity, Race, Marital Status, and Adverse Childhood Events (ACE), and Length of Treatment
Psychosocial Assessments: Pre and Post MBP/cohort measures for Perceived Stress Scale (PSS), Parental Stress Index (PSI), and Five Facet Mindfulness (Mindfulness Score)
Data Analysis:
Univariate analysis for all demographic, psychosocial, and relapse variables
Bivariate analysis of the 4 relapse outcomes with number of sessions attended, demographic, and psychosocial variables using Chi-square analysis and binary logistic regression
Built 4 multivariate logistic regression models to predict risk of relapse with number of sessions attended and repeating the course while controlling for demographic and psychosocial measures.
Bivariate and multivariate analysis evaluated risk of relapse within 6 months post- MBP/cohort participation
Core Competencies
Fluency of Content Knowledge
Critical Thinking
Research Methodology and Information Literacy
Technical Proficiency
Communication
Contribution to the Discipline/Profession
Multivariate Models
“Any Use”:
Higher number of MBP sessions attended was associated with an increased risk of relapse by 22.7%
Repeating the course was associated with a decreased risk of relapse by 97.3%
Higher ACE scores were associated with an increased risk of relapse by 80.4%
Lower post-MBP PSI scores were associated with a decreased the risk of relapse by 6.7%
“Opioid Use”
Participants who were in treatment longer were times more likely to relapse on opioids than those who recently started treatment at MATER
Lower post-MBP PSI scores was associated with a decreased risk of relapse by 8.4%
“Other Substances”
Higher ACE scores was associated with an increase in risk of relapse by 52.7%
Those with less than high school education were times more likely to relapse than those who completed high school/GED
Acknowledgements
I would like to thank my Chair, Dr. Diane Abatemarco, and my Preceptor, Dr. Meghan Gannon, for your guidance and the opportunity to take on this project. Thank you to Kim, Michelle, Rhonda, and Chevonne from MATER for all your help in finding the UDS data. Thank you to the faculty and staff at MATER for the honor and privilege of working with you all. A huge thanks to family, friends, and Carlos for moral support. Lastly, thank you to the faculty and staff at the Jefferson College of Population Health at Thomas Jefferson University for an amazing program.