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The Effects of Vipassana Meditation The Effects of Vipassana Meditation on Alcohol & Drug Relapseon Alcohol & Drug Relapse

and Criminal Recidivismand Criminal Recidivism

G. Alan Marlatt, Ph.D.Addictive Behaviors Research Center

Department of PsychologyUniversity of Washington

VM: 206.685.1200 E-mail: abrc@u.washington.eduhttp://depts.washington.edu/abrc/marlatt_presentations.htm

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Project Choices TeamProject Choices Team

PRINCIPAL INVESTIGATOR G. Alan Marlatt, PhD

CO-PRINICIPAL INVESTIGATORSMary Larimer, PhD Arthur Blume, PhD Tracy Simpson, PhD

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

RESEARCH STUDY ASSISTANTSJames K. BuderTiara Dillworth

GRADUATE RESEARCH ASSISTANTS Laura MacPherson Katie Witkiewitz Sarah Bowen

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IntroductionIntroduction

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.

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IntroductionIntroduction

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

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IntroductionIntroduction

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).

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IntroductionIntroduction

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.

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IntroductionIntroduction

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).

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IntroductionIntroduction

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).

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IntroductionIntroduction

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.

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IntroductionIntroduction

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.

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Research AimsResearch Aims

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.

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ParticipantsParticipants

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

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Most common charges/convictionsMost common charges/convictions(in order of frequency):(in order of frequency):

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

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ProcedureProcedure

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

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ProcedureProcedure

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

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Pre-Course (Baseline) AssessmentParticipant Characteristics

Age Ethnicity Education Work status Religious background and practices Criminal history PTSD

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LOT-Optimism RBBQ-Religious Beliefs and Behaviors

Questionnaire RCAS-Religious Coping Scale Meaning Scale DES-Daily Spiritual Experiences Scale

Pre-Course (Baseline) AssessmentSpiritual and Religious Domains

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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) AssessmentAlcohol Use (90 days pre-NRF)

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DDTQ – Daily Drug-taking Questionnaire

ASI – Quantity/frequency of AOD

DAST – Drug Dependency

Pre-Course (Baseline) AssessmentDrug Use (90 days pre-NRF)

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Marlowe-Crown – Social Desirability

SRQ – Self-Regulation Questionnaire

WBSI – White Bear Suppression Inventory

RCQ – Readiness to Change Questionnaire

BSI – Psychopathology Screening

Pre-Course (Baseline) AssessmentThinking, Motivation, Distress

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TLFB (90) – Timeline Followback

Criminal History/ Recidivism

Pre-Course (Baseline) AssessmentRecidivism and AOD Relapse

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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

Post-Course and Follow-up Assessments

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Preliminary AnalysesPreliminary Analyses

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.

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Preliminary AnalysesPreliminary Analyses

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.

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Changes from Pre-Course to 3-month Follow-up:Changes from Pre-Course to 3-month Follow-up:

Main Effects for Time Main Effects for Time

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

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Changes from Pre-Course to 3-month Follow-up:Changes from Pre-Course to 3-month Follow-up:

Group x Time Interaction Effects Group x Time Interaction Effects

Measure/Domain F pLocus of control (DRIE) 4.44 .04Impaired Control Scale 8.17 .006Thought suppression (WBSI) 4.57 .04Optimism (LOT) 13.53 .001Depression (BSI) 4.54 .04Hostility (BSI) 4.24 .04Alcohol consequences (SIP total) 3.95 .05Drug addiction (DAST) 6.28 .02Peak weekly tobacco use 5.46 .02Peak weekly powder cocaine use 9.80 .003Peak weekly crack cocaine use 4.82 .03Peak weekly marijuana use 4.21 .04

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Changes from Pre-Course to 3-month Follow-up:Changes from Pre-Course to 3-month Follow-up: Alcohol Related Negative ConsequencesAlcohol Related Negative Consequences

SIP Total Score

3-monthsBaseline

Est

imat

ed M

argi

nal

Mea

ns22

20

18

16

14

12

10

8

Treatment Group

TAU control

Vipassana

SIP Total Score

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Changes from Pre-Course to 3-month Follow-up:Changes from Pre-Course to 3-month Follow-up: Locus of ControlLocus of Control

3-monthsBaseline

Est

ima

ted

Ma

rgin

al M

ea

ns

.28

.26

.24

.22

.20

.18

.16

.14

.12

Treatment Group

Control (TAU)

Meditation (TAU+V)

DRIE Total Score

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Changes from Pre-Course to 3-month Follow-up:Changes from Pre-Course to 3-month Follow-up: Drug Abuse/DependenceDrug Abuse/Dependence

3-monthsBaseline

Est

ima

ted

Ma

rgin

al M

ea

ns

16

15

14

13

12

11

10

9

8

Treatment Group

Control (TAU)

Meditation (TAU+V)

DAST Total Score

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Changes from Pre-Course to 3-month Follow-up:Changes from Pre-Course to 3-month Follow-up: Psychopathology (Depression)Psychopathology (Depression)

3-monthsBaseline

Est

ima

ted

Ma

rgin

al M

ea

ns

7.0

6.5

6.0

5.5

5.0

4.5

4.0

3.5

3.0

Treatment group

Control (TAU)

Meditation (TAU+V)

BSI Depression Scale Score

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DiscussionDiscussion

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).

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DiscussionDiscussion

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

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DiscussionDiscussion

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.

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DiscussionDiscussion

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.”

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DiscussionDiscussion

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…”

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DiscussionDiscussion

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

Thank You!