Stigma and Recovery From Alcohol Use Disorder: A Mixed-Methods Analysis of Mindfulness Processes - Project Summary/Abstract The stigma associated with alcohol use disorder (AUD) adversely impacts treatment engagement, retention, and outcomes, with heightened effects among individuals from disadvantaged communities who experience disproportionate harms from AUD. Mindfulness-based interventions have shown promise in supporting AUD recovery for these populations. Leading theories seeking to explain the efficacy of mindfulness-based interventions, such as the mindfulness-to-meaning theory, suggest that mindfulness-based interventions may foster resilience to stigma, a significant barrier to AUD recovery. However, no studies to date have directly examined this pathway. This mixed-methods study aims to elucidate stigma, mindfulness processes, social factors impacting health, and recovery among a sample of disadvantaged adults with AUD. Aim 1 will utilize moderated mediation latent growth curve models to examine reductions in internalized stigma as a mechanism underlying the efficacy of mindfulness-based relapse prevention (MBRP) compared to referral to online mutual support. Secondary analysis will be conducted on data from an ongoing randomized trial (NIAAA R01AA031159; n=430). Aim 2 will collect twice-daily ecological momentary assessment (EMA) data over 6 weeks from a subsample of disadvantaged adults randomized to MBRP (n=20). Group iterative multiple model estimation will be used to identify idiographic (i.e. individual-specific) and nomothetic (i.e., shared group) associations between internalized stigma, stigma-related stress, mindfulness processes, and AUD recovery outcomes, specifically heavy drinking and alcohol-related consequences. Aim 3 will employ reflexive thematic analysis of participants' responses to free-response questionnaires, assessed twice, immediately before and immediately after the 6- week EMA period, to contextualize quantitative findings and explore experiences of stigma, its interaction with disadvantage, and innate protective factors that could be leveraged by mindfulness-based interventions. The proposed study innovatively integrates secondary analysis, EMA, idiographic modeling, and qualitative approaches to provide nuanced insights into recovery pathways among individuals with varied AUD treatment goals (i.e., abstinence and moderation). By elucidating stigma and mindfulness processes via both idiographic and nomothetic analytic techniques, their interplay with socioeconomic disadvantage, and factors supporting wellbeing, this study will make an important contribution to addressing stigma and enhancing recovery for disadvantaged communities disproportionately affected by AUD and AUD-related stigma. Results will advance understanding of the impacts of stigma on AUD recovery and how mindfulness-based interventions support recovery among these populations, informing the optimization of contextually sensitive, strengths-based AUD interventions.
