Psychological mechanisms of behavior change in mindfulness-based interventions for substance use disorders: A systematic review.

OBJECTIVE: Mindfulness-based interventions (MBIs) have demonstrated efficacy in treating substance use disorders (SUDs). To further optimize MBIs, there is a need to identify the mechanisms of behavior change (MOBC) that underlie their efficacy. The current preregistered systematic review provides an overview of existing research on the MOBC in MBIs for SUD while attending to the sociocultural contexts in which these mechanisms were tested. Further, the review evaluates the variety and quality of methods used to operationalize and measure MOBC within this literature. METHOD: Inclusion criteria were focused on studies that explicitly tested MOBC associated with treatment outcomes. Further, only studies focused on MBIs for individuals with diagnosed SUD, or individuals with substance misuse, were included. Studies that did not examine SUD populations or did not explicitly focus on MOBC were excluded. The review was conducted from July to September 2023 and updated in December 2025. A total of 23 studies met criteria for review. RESULTS: Current evidence supports a variety of complementary MOBC, such as greater awareness and acceptance and reductions in craving, as key drivers of change in MBIs for SUD. Very little attention has been paid to contextual factors. Critically, only one study was a replication of prior work. CONCLUSIONS: While there are salient mechanisms relevant to MBIs for SUD, much of this literature requires replication. There is a critical need for attention to the contexts in which MOBC of MBIs are effective, including more rigorous methodologies to test the validity of these mechanisms across populations. (PsycInfo Database Record (c) 2026 APA, all rights reserved).