Mindfulness-based interventions for substance use typically require intensive upfront training. For instance, training to deliver the Mindfulness-Oriented Recovery Enhancement (MORE) protocol consists of a two-day workshop, combining didactic and experiential instruction with frequent opportunities to practice the therapeutic techniques and receive continual, real-time feedback: MORE training generally culminates in 13 contact hours. Training to deliver Mindfulness-Based Relapse Prevention (MBRP) likewise consists of a two-day workshop, preceded by a series of eight 1.5-hour training sessions and followed by two final 1.5-hour sessions: MBRP training generally culminates in 25-30 contact hours.

Notably, the level of training of instructors of mindfulness-based programs has been found to have a large impact on health outcomes for study participants. In one study on instructors of mindfulness-based programs, course attendees had significant gains in well-being and reductions in stress for each additional year of training completed by their instructor.

Fidelity measures and fidelity monitoring procedures have been used to improve the training of clinicians. Accurate delivery of mindfulness-based treatments is crucial to their success. The Mindfulness-Oriented Recovery Enhancement (MORE) protocol has a set of MORE fidelity measures that can be used as part of the training process.

Clinical supervision represents a common but rarely reported or studied implementation strategy. Studies of Mindfulness-Based Relapse Prevention (MBRP) have tested MBRP with a high level of supervision, provided by therapists experienced in mindfulness.

Mindfulness-based interventions can be billed through standard psychotherapy procedure codes, but the bundled reimbursement rates do not incentivize providers to integrate them into standard care. Specific coverage of mindfulness-based interventions by socialized healthcare plans like Medicaid and/or programmatic strategies to incentivize providers could expand implementation to a wider range of providers.

Adaptations have been made for different settings and populations, like changing session numbers or content. Rolling group sessions have also been tested as a more accessible format for patients. Mindfulness-Oriented Recovery Enhancement has been delivered through virtual reality and telehealth, and Mindfulness-Based Stress Reduction has been delivered with protocol adjustments to improve time and resource efficiency.

Some illustrative adaptations are described below:

• Tailor treatment protocol to be less resource- and time-intensive. The treatment protocol for Mindfulness-Based Stress Reduction typically includes two and a half-hour sessions and a half-day retreat, which requires a high level of facility-level resources, such as provider time and physical space. Treatment protocols can be adapted.. One study used a four-week protocol with 90-minute sessions and no half-day retreat, which participants reported made it much more manageable to fit into their schedules.
• Offering trauma-informed modifications. Mindfulness-based interventions for substance use can be adapted to meet the needs of participants with a trauma history, including giving participants the opportunity to modify or opt out of specific components of the intervention that may be difficult to practice.
• Telehealth delivery. Mindfulness-based interventions have been adapted to be delivered via telehealth in both live, group-based, and self-guided formats. In the group-based format, eight 90-minute weekly group sessions were delivered via telehealth supplemented by a workbook, mobile application, and study website. The self-guided version included the same supplemental materials along with three (25-60 minute) phone calls from a facilitator at the beginning, middle, and end of the program to discuss logistical challenges and participant progress.
• Virtual-reality delivery. In an effort to deliver Mindfulness-Oriented Recovery Enhancement (MORE) in a more cost-effective manner while maintaining fidelity, a virtual reality (VR) adaptation of MORE was developed. MORE-VR sessions were self-guided under the supervision of a research assistant. Notable adaptations from the MORE protocol include immersive mindfulness practices and the use of virtual cues (e.g., drug-related cues during cue-exposure exercises) in lieu of mental visualizations.