Mindfulness Mechanisms in Alcohol Use: Comparing Top-Down and Bottom-Up Processes.

Objective: This study compared two mechanisms by which mindfulness may reduce hazardous drinking: effortful control and craving, "top-down" and "bottom-up" processes, respectively. These relationships were compared in a secondary analysis of a randomized controlled trial of mindfulness-based relapse prevention (MBRP) versus relapse prevention (RP) treatments to explore if they differed based on more explicit versus subtle mindfulness training. Method: A total of 182 individuals (48.4% female; 21-60 years old) who reported drinking >14/21 drinks/week (for females/males, respectively) in the past 3 months but who wished to quit/reduce their drinking were recruited from Denver and Boulder, CO, United States. Participants were randomly assigned to either 8 weeks of MBRP or RP treatment and completed assessments at baseline, halfway through treatment, and at the end of treatment. The Five-Factor Mindfulness Questionnaire-Short Form, Alcohol Urge Questionnaire, and Effortful Control Scale completed halfway through treatment assessed the predictor, dispositional mindfulness, and mediators, craving and effortful control, respectively. The Alcohol Use Disorder Identification Task was completed after treatment and measured hazardous drinking. Cross-group path analyses were conducted including both mediators/treatments in the same model. Results: Comparing models with and without equality constraints across treatments, no paths significantly differed based on a chi-square test of difference, χ²(5) = 5.11, p = .40, and only the indirect effect of craving was significant (B = -1.01, p = .01). Conclusions: Findings suggest mindfulness may be associated with hazardous drinking reductions through craving but not effortful control and this indirect relationship works similarly across treatments engendering mindfulness explicitly and implicitly. Public Health Significance Statement This study indicated that effortful attentional control is not a significant mediator of the association between dispositional mindfulness and harmful alcohol use. In contrast, craving did mediate this relationship. The indirect relationship between mindfulness and harmful alcohol use via craving did not differ between mindfulness-based relapse prevention versus relapse prevention treatment, suggesting that reductions in craving may be affected by even slight increases in mindfulness and indicate the benefit of implementing mindfulness in alcohol treatment. [ABSTRACT FROM AUTHOR]