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Purpose: Self-efficacy has been shown as an important predictor of outcomes following substance use disorder (SUD) treatment, evidencing it as a potential mechanism of behavior change. This secondary analysis examined the mediating effects of self-efficacy within Mindfulness-Based Relapse Prevention (MBRP) and standard Relapse Prevention (RP) for individuals with SUD in an aftercare setting. We hypothesized that post-treatment self-efficacy would mediate the association between treatment condition and 12-month substance use outcomes.

Methods: Participants were 286 individuals recruited following in/outpatient treatment and were randomized to either MBRP, RP, or treatment as usual (TAU). Participants completed the Drug Taking Confidence Questionnaire (DTQC-8) to assess self-efficacy and Timeline Follow-Back (TLFB) to assess quantity and frequency of substance use at baseline, post-treatment, 6-, and 12-month follow-up. Latent growth curve modeling examined changes in self-efficacy across time. Mediation analyses examined if self-efficacy measured at post-treatment, and change in self-efficacy over time, mediated the association between treatment and outcomes.

Results: Participants who received MBRP had the greatest post-treatment self-efficacy scores (M(SD)= 4.21(1.17)), followed by RP (M(SD)= 3.80(1.34)) and TAU (M(SD)= 3.70(1.19)). Greater self-efficacy at post-treatment predicted a higher probability of no drug (b(SE)= 0.80(0.21); p<0.001) or alcohol (b(SE)= 0.53(0.24); p=0.03) use at 12-months, and fewer heavy drinking days (b(SE)= -0.93(0.26); p<0.001). Increases in self-efficacy over time predicted a higher probability of no drug (b(SE)= 2.23(1.04); p= 0.03) or alcohol (b(SE)= 1.80(0.84); p=0.03) use at 12-months, and fewer drug use days (b(SE)= -0.95(0.45); p=0.04). Post-treatment self-efficacy significantly mediated the association between treatment condition and probability of no drug use (b(SE)= 0.08(0.03); p<0.05) and fewer heavy drinking days (b(SE)= -0.08(0.02); p<0.05) at 12-months.

Conclusion: Across all conditions self-efficacy mediated the association between treatment and both the probability of drug use occurring and frequency of heavy drinking days, with those who received MBRP having highest self-efficacy at all time points.

Non-Expert Summary: It’s important for treatment providers to understand the mechanisms that lead to behavior change within individuals seeking treatment for substance use disorders. This study lends support to self-efficacy (the belief in one’s ability to accomplish one’s goals) as an important mechanism for improved treatment outcomes. Results indicate that individuals who received Mindfulness-Based Relapse Prevention, compared to Cognitive-Behavioral Relapse Prevention, had higher levels of post-treatment self-efficacy, which was associated with reduced substance use twelve months later.


Poster presented at the Brain & Behavioral Health Research Day 2022



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