Where, & who for?
MEAR has been developed in SMART Howard House detoxification unit in Oxford, UK, a ten-bedded residential unit for people detoxing from alcohol and/or opioids, and often other substances too. Howard House is funded by Oxford City Council, and admits people for approximately twelve weeks, while they undergo medical reduction/ detoxification at a pace that makes it as comfortable as possible for them, alongside a therapeutic groupwork programme which includes mindfulness, and one-to-one support from a keyworker, with optional counselling sessions. Residents are referred by the community addiction services, meaning there is a wide range of people, from those who have been homeless for some time, to those who have careers and families.
Many treatment services offering mindfulness programmes for addiction are designed for those later in their recovery journeys, often requiring a certain level of stability before they start, and there has been scepticism about doing it this early, especially during a medical withdrawal from substances. There are people at different stages of their detox in any one session, there are new admissions and discharges most weeks, and people are not always motivated to attend the sessions: they agree to take part when they come in for detox, but it can often be the last thing they feel like doing as their detox progresses. They may have trauma histories which can make it very difficult for them to sit with their experience, and they can find they have emerging undiagnosed mental health, physical, neurological or cognitive problems, which may have been masked by substance use for many years. For these reasons the standard mindfulness programmes can be overwhelming for people, meaning adaptations needed to be made.
A rolling version of Mindfulness-Based Relapse Prevention (MBRP) was developed and researched by Devin Ashwood, and adaptations to MBSR for lower-income women pre-recovery have been explored: these projects helped inform this programme, and have paved the way in advancing rolling programmes for a diverse group, and for those earlier in the recovery journey, but it is still a very young area of development and research.
Motivational elements have been woven into this course, and it has been designed to be as safe and sensitive to trauma or emerging mental health problems as possible, whilst still enabling those who take part to learn valuable lessons. Research was carried out into these two elements – acceptability and effectiveness – which was presented at the Society for the Study of Addiction annual conference in 2020. Another piece of research into an adapted online version of the programme is also being carried out in Belgium.