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					     The Effects of Vipassana Meditation
         on Alcohol & Drug Relapse
          and Criminal Recidivism
                                                UW/ABRC




              G. Alan Marlatt, Ph.D.
          Addictive Behaviors Research Center
               Department of Psychology
               University of Washington




     VM: 206.685.1200 E-mail: abrc@u.washington.edu
http://depts.washington.edu/abrc/marlatt_presentations.htm
         Project Choices Team
                                            UW/ABRC
PRINCIPAL INVESTIGATOR         G. Alan Marlatt, PhD

CO-PRINICIPAL INVESTIGATORS    Mary Larimer, PhD
                               Arthur Blume, PhD
                               Tracy Simpson, PhD

RESEARCH COORDINATORS          George A. Parks, PhD
                               Jessica M. Cronce

RESEARCH STUDY ASSISTANTS      James K. Buder
                               Tiara Dillworth

GRADUATE RESEARCH ASSISTANTS   Laura MacPherson
                               Katie Witkiewitz
                               Sarah Bowen
            Introduction
                                UW/ABRC


From 1970 to 1997, the number of
substance-involved offenders has
increased from 21,266 prisoners in the
Federal Bureau of Prisons with 16%
being drug offenders to 98,483
incarcerated individuals of which over
60% are drug offenders.
            Introduction
                                  UW/ABRC



There is evidence that other spiritual
interventions besides AA,
particularly meditation-based
interventions, are associated with
reduced alcohol and substance use.
            Introduction
                                 UW/ABRC



Two types of spiritually-based
meditation techniques, Transcendental
Meditation (TM), and to a lesser extent
Vipassana meditation, have been
evaluated as treatments for substance
abuse, with encouraging results
(Alexander et al., 1994; Marlatt, 1994;
Marlatt & Kristeller, 1998).
             Introduction
                                   UW/ABRC


Marlatt et al. (1984) found that the
meditation (CSM), progressive
relaxation, and bibliotherapy all lead to
significant reductions in alcohol
consumption during the training
period compared to the no-treatment
control subjects.
            Introduction
                                UW/ABRC


Vipassana meditation, the intervention
addressed in this study, is rooted in
traditional Buddhist teachings and has
been made available to practitioners
around the world by the revered
Buddhist teacher, S. N. Goenka (Hart,
1987).
             Introduction
                                  UW/ABRC


Preliminary results from research with
inmate populations in India indicate
that Vipassana meditation helps in
reducing recidivism, reducing
psychopathological symptoms, and
increasing more positive behaviors
such as cooperation with prison
authorities (Chandiramani et al., 1995;
Kumar, 1995; and Vora, 1995).
             Introduction
                                   UW/ABRC

 Vipassana has also been
  implemented in correctional
  facilities within the United States.

 The first Vipassana course in a
  North American correctional facility
  was conducted at the North
  Rehabilitation Facility (NRF) in
  Seattle, Washington in 1997.
               Introduction
                                      UW/ABRC


 Prior to closing in the fall of 2002, NRF
  was a minimum-security jail facility with
  an adult male and female inmate
  population of approximately 300.

 Between January 2001 and November
  2002, nine ten-day courses were held at
  NRF and included in the study.
               Research Aims
                                            UW/ABRC

 Document the effectiveness of a specific spiritual
  practice, Vipassana Meditation, for reducing
  alcohol and drug relapse, alcohol-related negative
  consequences, and criminal recidivism in a
  correctional population.
 Evaluate several domains of spirituality as
  mediators and moderators of the effectiveness of
  Vipassana meditation on alcohol and drug
  relapse, criminal recidivism, mental health, and
  spiritual outcomes in this population.
 Evaluate participant characteristics as predictors
  of willingness to participate in Vipassana
  meditation.
                      Participants
                                                 UW/ABRC
 n=305, 244 men and 61 women recruited from NRF
 61% Caucasian, 11% Native American, 7% Latino/Latina,
  13% African-American, 2% Asian, 6% other
 Average age 37.8 years old
 56% employed at least part-time prior to incarceration
 79% GED or high school diploma
 58% Christian, 17% no formal religion, 25% other
 26% attended religious services more than 1x month, 34%
  less than 1x month, 40% never
  Most common charges/convictions
       (in order of frequency):
                                            UW/ABRC

1. Driving Under the Influence of Intoxicants
2. Theft
3. Violation of the Uniform Controlled Substance Act
   (VUCSA)
4. Driving with License Suspended (typically
   suspended due to previous DUI)
5. Assault/Domestic Violence
6. Possession of Stolen Property
7. Harassment
8. Prostitution
9. Criminal Trespass
10. Hit and Run
                      Procedure
                                                 UW/ABRC
 Participants self-selected to participate in the 10-day
  Vipassana meditation course
 Inmates could participate in the Vipassana course and
  not participate in the research study
 Participants in both the Vipassana and control
  conditions completed baseline measures
  approximately 1 week prior to the first day of the
  Vipassana course
 All participants completed a post-course assessment
  approximately 2-3 days after the last day of the
  Vipassana course while still incarcerated
                       Procedure
                                                  UW/ABRC
 Participants who completed both baseline and post-
  course were eligible for longitudinal follow-up (59
  Vipassana; 107 control)
 Follow-up assessments are administered onsite at the
  University of Washington 3- and 6-months post-release
 Thus far, 49 Vipassana participants & 65 participants in
  the control group have completed the 3-month follow-up
  questionnaire, and 6-month follow-up is underway
 Case-matching of Vipassana and control participants will
  occur after data collection is complete, prior to final data
  analysis
    Pre-Course (Baseline) Assessment
        Participant Characteristics
                                 UW/ABRC


   Age
   Ethnicity
   Education
   Work status
   Religious background and practices
   Criminal history
   PTSD
 Pre-Course (Baseline) Assessment
  Spiritual and Religious Domains
                                   UW/ABRC


 LOT-Optimism
 RBBQ-Religious Beliefs and Behaviors
  Questionnaire
 RCAS-Religious Coping Scale
 Meaning Scale
 DES-Daily Spiritual Experiences Scale
      Pre-Course (Baseline) Assessment
        Alcohol Use (90 days pre-NRF)
                                   UW/ABRC


   DDQ-R Daily Drinking Questionnaire
   Alcohol Q/F Index
   AUDIT-Screening
   ADS - Dependency
   DRIE – Locus of Control
   ICS – Impaired Control
   SIP-2R - Consequences
    Pre-Course (Baseline) Assessment
       Drug Use (90 days pre-NRF)
                                    UW/ABRC


 DDTQ – Daily Drug-taking Questionnaire
 ASI – Quantity/frequency of AOD
 DAST – Drug Dependency
    Pre-Course (Baseline) Assessment
      Thinking, Motivation, Distress
                                        UW/ABRC

 Marlowe-Crown – Social Desirability
 SRQ – Self-Regulation Questionnaire
 WBSI – White Bear Suppression Inventory
 RCQ – Readiness to Change Questionnaire
 BSI – Psychopathology Screening
  Pre-Course (Baseline) Assessment
    Recidivism and AOD Relapse
                                 UW/ABRC


 TLFB (90) – Timeline Followback
 Criminal History/ Recidivism
       Post-Course and Follow-up
             Assessments
                                    UW/ABRC

Post-Course Assessment:
 All measures except participant
  characteristics and alcohol/drug items

3- & 6-month Follow Up Assessments:
 All measures except participant
  characteristics
 Addition of TLFB for AOD Relapse and
  Recidivism
               Preliminary Analyses
                                                UW/ABRC

 These analyses only include a subset of the sample
  that has completed both baseline and 3-month follow-
  up. Additional research participants will be assessed
  at 3- and 6-months before final results are available.

 The comparisons reported represent group mean
  differences from Time 1 (90 days prior to incarceration,
  retrospective) to Time 2 (3-months post-release) and
  were calculated before case matching could take place.
  Final results will include only Vipassana course
  completers and their case-matched controls.
            Preliminary Analyses
                                               UW/ABRC

 Preliminary analyses of variance were conducted
  to explore the repeated measures effect of the
  meditation intervention on a variety of the
  psychosocial and alcohol/drug use dependent
  variables.
 Recognizing that running multiple significance
  tests may inflate Type I error rates, future reports
  of the complete data set will use a Bonferroni
  corrected alpha level.
 However, given the small sample size and
  exploratory nature of these analyses, results that
  were significant at p = .05 are reported.
Changes from Pre-Course to 3-month Follow-up:
            Main Effects for Time
                                      UW/ABRC

Measure/Domain                 F          p

Religious Coping Activities   5.55       .02

Meaning Scale                 5.15       .03

Peak weekly alcohol use       30.95      .0005

Peak weekly heroin use        8.89       .004
Changes from Pre-Course to 3-month Follow-up:
         Group x Time Interaction Effects
                                           UW/ABRC
Measure/Domain                      F          p
Locus of control (DRIE)            4.44       .04
Impaired Control Scale             8.17       .006
Thought suppression (WBSI)         4.57       .04
Optimism (LOT)                     13.53      .001
Depression (BSI)                   4.54       .04
Hostility (BSI)                    4.24       .04
Alcohol consequences (SIP total)   3.95       .05
Drug addiction (DAST)              6.28       .02
Peak weekly tobacco use            5.46       .02
Peak weekly powder cocaine use     9.80       .003
Peak weekly crack cocaine use      4.82       .03
Peak weekly marijuana use          4.21       .04
Changes from Pre-Course to 3-month Follow-up:
  Alcohol Related Negative Consequences
                                                           UW/ABRC

                SIP Total Score   SIP Total Score
           22

           20

           18

           16

           14

                                        Treatment Group
           12

           10                               T AU control

           8                                Vip assana
          Baseline                 3-mont hs
Changes from Pre-Course to 3-month Follow-up:
                     Locus of Control
                                                               UW/ABRC

          .28
                               DRIE Total Score
          .26


          .24


          .22


          .20


          .18


          .16                      Treatment Group


          .14                             Control (TAU)

          .12                             Meditation (TAU+V)
          Baseline             3-months
Changes from Pre-Course to 3-month Follow-up:
          Drug Abuse/Dependence
                                                           UW/ABRC
          16
                         DAST Total Score
          15


          14


          13


          12


          11


          10
                               Treatment Group

           9                          Control (TAU)

           8                          Meditation (TAU+V)
         Baseline          3-months
Changes from Pre-Course to 3-month Follow-up:
       Psychopathology (Depression)
                                                            UW/ABRC
        7.0        BSI Depression Scale Score
        6.5


        6.0


        5.5


        5.0


        4.5


        4.0
                                Treatment group

        3.5                            Control (TAU)

        3.0                            Meditation (TAU+V)
        Baseline            3-months
             Discussion
                                  UW/ABRC



To be mindful is to be aware of the full
range of experiences that exist, to
bring one’s complete attention to the
present experience on a moment-to-
moment basis. This is consistent with
the Buddhist view of transcendence as
'enlightened awareness of the true
being' (Goldstein & Kornfield, 1987).
             Discussion
                                  UW/ABRC



Meditation or “Right Mindfulness” is
presented a critical element in the
Eight-Fold Path leading to the ultimate
spiritual goal of enlightenment.
             Discussion
                                  UW/ABRC



Alcohol and drug addiction are
described in the Buddhist literature as
problems related to ego-attachment,
with an emphasis on “craving” as the
major process underlying the dynamic
of the addictive process.
             Discussion
                                 UW/ABRC



Groves and Farmer (1994) write:
“From its beginning two and a half
thousand years ago, the central
concerns in Buddhism have been
craving and attachment. …Buddhist
teachings then constitute a rich source
of etiological models and possible
therapies for addictions.”
              Discussion
                                 UW/ABRC


Groves and Farmer (1994) describe
Vipassana meditation as a means of
overcoming addiction problems: “In
the context of addictions, mindfulness
might mean becoming aware of
triggers of craving, and choosing to do
something else which might ameliorate
or prevent craving, so weakening this
habitual response…”
              Discussion
                                   UW/ABRC



The process of meditation can thus
lead to both the alleviation of addiction
and the development of spiritual
growth toward eventual enlightenment.
Thank You!

				
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