Methamphetamine (MA) is a psychotropic substance controlled under Chinese regulations, and the 2023 World Drug Report indicates that about 36 million people use amphetamine-type drugs, representing 0.7% of the global population (1). Unlike other types of substance abuse, over 45% of those who have used MA are female. However, women account for only 27% of those who receive drug treatment. Accumulating evidence suggests that female stimulant drug users may be more vulnerable to the development of problematic drug use patterns as compared to men, but many previous studies focused on young male MA adults (2). In addition, women seem to be more inclined to MA and less likely to use other alternative medications when unable to obtain MA. Young adulthood is a transitional phase from adolescence to full-fledged adulthood. The prevalence of alcohol and drug use peaks during young adulthood, potentially impeding critical developmental tasks and setting the stage for chronic substance misuse and associated social, educational, and health-related outcomes (3), so they warrant particular attention. Therefore, in this study, we choose MA-dependent young female adults so we can better understand the therapeutic effect of MBRP on MA users.

Regarding MA use disorder (MUD), craving is one of the core characteristics and a key factor in maintaining addictive behavior (4). Psychological craving (drug craving) can be defined as an intense, conscious desire for drugs (5). Several studies have shown that increased psychological craving significantly predicts substance use relapse (6), so reducing psychological craving may be an effective way to reduce the incidence of relapse among MA-dependent female youths. In China, drug abuse is illegal, and people who find it difficult to abstain from drug use or relapse during community detoxification face 2 years of compulsory isolation. In general, drug addicts can achieve complete physical detoxification through mandatory detoxification in drug rehabilitation centers, but it is difficult to get rid of the “mental addiction”, and more than 90% of drug addicts relapse after leaving a rehabilitation center (7). For this reason, many methods have been introduced to reduce psychological craving, such as art therapy, transcranial direct stimulation (tDCS), and motivational interviewing (MI), all of which have a certain degree of clinical efficacy. However, due to the need for long-term professional treatment or expensive equipment, these methods have some problems in the large-scale promotion of treatment (8). The elaborated intrusion (EI) theory of desire emphasizes the role of cognitive processes in experiencing and sustaining craving episodes. It holds that the initial source of desire is a learned association between a particular internal or external cue and a particular behavior. These, along with associated physiological responses, can lead to intrusive thoughts. When these thoughts arise and trigger a strong emotional response or sense of deficit, they can lead to cognitive elaboration (9). That is, to seek out or manipulate relevant information from memory to construct a vivid sensory image of the object of desire and related, resulting in a strong craving. Therefore, according to this theoretical model, anything that prevents or interrupts this fine process helps to prevent or limit the duration of craving episodes. In recent years, mindfulness has been introduced into the field of addiction treatment (10). Mindfulness-based relapse prevention (MBRP) combines meditation with traditional relapse prevention (RP) for the treatment of multiple substance addictions, such as alcohol and nicotine. MBRP improves awareness and acceptance of personal experiences through mindfulness meditation practices that allow a person to experience that his or her current physical and emotional state is transitory. At the same time, MBRP encourages practitioners to focus on the present moment, and to attend to thoughts and feelings with acceptance, openness, and non-judgmental attitudes, thus reducing “automatic” reactions and allowing addicts to break free from deep-seated beliefs and behaviors associated with drugs and drug use behavior (11), thus interrupting the cognitive fine-grained process of the desire invasion theory, and giving the addict the opportunity to break away from the deep-rooted beliefs (brief) and behavioral habits associated with the drug. Several studies have demonstrated MBRP training can improve trait mindfulness (or disposition mindfulness). Trait mindfulness is a naturally occurring mental quality that varies in different individuals. It refers to a present-oriented, nonjudgmental awareness of cognitions, emotion, perception, and habitual behavior in daily life, this dispositionality may strengthened through participation in MBRP training and other types of interventions (12). After undergoing MBRP training, substance addicts experience significant reductions in their cravings and relapse rates (13, 14). However, few studies on MBRP have been conducted on MA-dependent young female Chinese adults in compulsory drug treatment facilities, and objective measures of whether trait mindfulness improve treatment are lacking.

The study aimed to investigate whether mindfulness-based relapse prevention (MBRP) can help MA-dependent female youths reduce their psychological cravings and increase their trait mindfulness, which was objectively measured using a “mental feedback monitoring balance” instrument during the training process. The intervention will help MA-dependent female youths learn to be aware of their feelings and better regulate their behaviors, thus decreasing cravings and reducing the incidence of relapse.

This study explored the feasibility of MBRP training to reduce psychological craving in MA-dependent female youths. After 4 weeks, the addicts gradually increased their trait mindfulness and became aware of the reasons for their addiction and what methods were effective when craving reappeared. This study is the first to implement MBRP in young, MA-dependent Chinese women, utilizing biological markers to measure mindfulness.

The main effects of time on observing, non-judging, and non-reacting are significant, which indicates that the mindfulness ability of young female MA-dependent adults increased over time. This finding is consistent with a previous study by Brewer et al., which also reported significant increases in FFMQ scores over time for treatment completers in the mindfulness training group based on MBRP (19). The two dimensions of describing, “actaware” did not show significant changes, probably due to the fact that MA-dependent female youths generally received a limited education and have been in a state of emotional repression for a long period (20, 21). Having a higher level of education is associated with a better ability to express and describe emotions (22). On the other hand, drug addicts tend to struggle with emotional expression and have an imbalance in emotional regulation, which can have a negative impact on their ability to describe their feelings. Additionally, studies have shown that unemployed individuals tend to score lower on the action awareness scale compared to those who are employed. Interestingly, a significant number of drug addicts in this study were found to be unemployed (23). Thus, a longer period may be needed for improvement in these aspects. It is also important to note that the interaction between time and group had a significant impact on both mindfulness ability and psychological cravings. These findings indicated that MBRP training had shown significant improvement in the trait mindfulness of young female MA-dependent adults, while also reducing their cravings over time than the control group. MBRP training encourages the participants to focus on the present moment and pay attention to the associated thoughts and feelings with acceptance, openness, and a non-judgmental attitude, and to pay more attention to their body, emotions, and thoughts in high-risk situations, thus attenuating the “automated” response between emotion and drug use and reducing psychological cravings and the likelihood of relapse, in line with the results of previous studies (24, 25).

Concentration and relaxation, as indexed by the mental feedback monitoring balance instrument, can serve as a measure of mindfulness. Past studies have mostly used self-report scales to assess individual trait mindfulness changes, such as the FFMQ and MMAS. To improve the objectivity of the present study, the mental feedback monitoring balance instrument can be a more detailed assessment of mindfulness levels and clarify the relationship between mindfulness and changes in craving more clearly and enhance ecological validity. Brain–computer interface technology has been widely used in the field of mindfulness in recent years, and measurement of biological parameters using wearable devices can help the public better understand the effects of mindfulness practice on the body. The acquisition process only requires contacting the support arm for EEG acquisition with the prefrontal Fpl of the brain and clamping a reference electrode to the earlobe to acquire EEG signals, making it simple to measure a wide variety of brainwave data (29). To confirm the effectiveness of the MBRP training, we utilized the mental feedback monitoring balance instrument to compare body scanning exercise data between sessions 1 and 8, as well as the breath meditation exercise data between sessions 3 and 8. The findings indicate that after prolonged MBRP training, whether in the form of body scanning or breath meditation exercises, the MBRP group experienced a notable boost in concentration. Although relaxation also increased during the body scanning exercise, the change was not statistically significant. This could be since most participants reported lying down to be a more relaxing position during the body scan exercise in session 1 compared to the sitting or standing position in the SOBER exercise, creating a potential ceiling effect. Our research provides valuable insights into the effectiveness of mindfulness-based relapse prevention (MBRP) training for young female adults who are dependent on methamphetamine. However, it is important to acknowledge the limitations of our study. Our research utilized a 4-week training program (26, 27), and there is ongoing debate regarding the optimal frequency of mindfulness training (28). A further study should be conducted with a larger sample size to explore the impact of a more intense schedule. It is worth noting that consistent and ongoing mindfulness practice is essential for achieving optimal results. While mindfulness prevention training can lead to positive changes during compulsory drug treatment, individuals may face new challenges and stressors upon returning to society. Therefore, it is crucial to investigate the long-term effects of mindfulness training on addiction recovery and to explore how individuals maintain and enhance their mindfulness practice post-treatment. Additionally, it is important to assess whether mindfulness practice assists individuals in managing cravings when faced with real-life challenges.

In conclusion, the present study implemented an MBRP intervention for female MA-dependent young adults. In addition to a traditional self-report scale, an instrumental measure was introduced to assess mindfulness ability. The results confirmed that the MBRP training effectively reduced drug craving in MA-dependent young adults. Additionally, it facilitated trait mindfulness and non-judgmental acceptance of negative thoughts and emotions, while reducing negative cognitive and affective patterns. This led to improved physical and mental health, and a significant reduction in impulsive substance abuse. However, since mindfulness training requires long-term, persistent practice, and drug addicts face many challenges in life after discharge, its long-term effects need further research.