Additive Effectiveness of Mindfulness Meditation to a School-Based Brief Cognitive-Behavioral Alcohol Intervention for Adolescents

Objective: This randomized controlled trial is the 1st study to evaluate the additive efficacy of mindfulness meditation to brief school-based universal cognitive behavior therapy (CBT + MM) for adolescent alcohol consumption. Previous studies have lacked strong controls for nonspecific effects, and treatment mechanisms remain unclear. The present study compared a CBT + MM condition to an active control CBT intervention with progressive muscle relaxation (CBT + PMR) for nonspecific effects and an assessment-only control (AoC). Method: Cluster sampling was used to recruit Australian adolescents (N = 404; 62% female) ages 13-17 years (M = 14.99, SD = .66) of mostly Australian−New Zealand or European descent. School classes were randomized to 3 intervention conditions (CBT + PMR = 8 classes, CBT + MM = 7 classes, AoC = 7 classes), and adolescents completed preintervention, postintervention, and 3- and 6-month follow-up assessments, including measures of alcohol consumption, mindfulness, impulsivity, and the alcohol-related cognitions of alcohol expectancies and drinking refusal self-efficacy. Results: Multilevel modeling analyses revealed that both intervention conditions reduced the growth of alcohol consumption compared to the AoC (b = −.18, p = .014), although CBT + MM was no more effective than was CBT + PMR (b = −.06, p = .484). Negative alcohol expectancies increased for adolescents in the intervention conditions compared to the AoC (b = 1.09, p = .012), as did positive alcohol expectancies (b = 1.30, p = .008). There was no effect of interventions on mindfulness, drinking refusal self-efficacy, or impulsivity. Conclusions: There was no evidence of mindfulness-specific effects beyond existing effects of CBT within a brief universal school-based CBT intervention. Hypothesized mechanisms of change were largely unsupported. What is the public health significance of this article? This study supports targeting cognitive risk factors for adolescent alcohol use through cognitive-behavioral therapy to reduce the growth of alcohol consumption in adolescents. The addition of mindfulness meditation to existing cognitive−behavioral therapy did not improve alcohol use outcomes when compared to an active control.