Mindfulness training enhances opioid addiction treatment

Supplementing standard opioid addiction treatment with Mindfulness Oriented Recovery Enhancement (MORE) — an intervention that incorporates mindfulness training, savoring skills, and cognitive reappraisal — cuts program dropout rates by 59 percent and relapses by 42 percent, according to Rutgers-led research.

These trial results come from Rutgers Health amid unprecedented opioid abuse. An estimated 10 million Americans misuse opioids or have opioid use disorder, while annual overdose deaths have exceeded 80,000.

Treatment with methadone or buprenorphine – alone or in combination with cognitive behavioral therapy – is imperfect. Half of all people drop out of treatment within a year, and half of all people who continue treatment keep using opioids.

“Better treatment protocols could save thousands of lives per year, and the data we have from our pilot study and this phase II trial suggest mindfulness training may create a genuinely better treatment protocol,” said Nina Cooperman, an associate professor of psychiatry at Rutgers Robert Wood Johnson Medical School and first author of the study published in JAMA Psychiatry.

Mindfulness training teaches people to focus on the present moment, without judgment, and on sensory inputs such as the feeling of breathing in and out. Previous studies demonstrating that such training can prevent addiction to opioid pain medication led Cooperman’s team to ask whether similar techniques could help people who already have an opioid use disorder.

A small pilot study found that mindfulness training combined with methadone treatment produced good outcomes. The pilot’s success paved the way for this larger study, which, in turn, has justified two large-scale studies that could change standards of care.

The current trial provided eight two-hour sessions to 77 of 154 patients in methadone treatment for opioid use disorder.

“Opioid use disorder changes your brain so that opioid use becomes the only thing that feels rewarding. MORE helps people retrain themselves to find healthy experiences rewarding again by focusing mindfully on the taste of a meal, the beauty of a landscape or the smell of a flower,” said Cooperman, who added the program literally includes observing and smelling roses during sessions.

Mindfulness training also gives people another tool for handling cravings.

“Cognitive behavioral therapy, which is common in treatment programs, teaches people to reframe their thoughts and distract themselves from cravings,” Cooperman said. “Mindfulness training teaches them to stay present with the craving and notice that they pass. Both strategies can work, so both are valuable.”

The success of mindfulness training in Cooperman’s study may stem from its ability to help patients manage pain. Most patients began the study with significant chronic pain — and, thus, a strong incentive to use pain-killing opioids — but patients who received MORE reported a 10 percent reduction in pain over the 16 weeks of the study.

Looking forward, Cooperman and her team are working on larger studies, which are designed to provide further evidence for the efficacy of MORE and to optimize protocols for use in the real world.

“We still have lots of open questions. How can we train clinicians to implement MORE in treatment programs? What is the best structure for implementing MORE—in-person or virtual? Our current research is working to answer some of these questions,” Cooperman said. “The findings from this study suggest MORE really can improve outcomes for a lot of people in substance abuse treatment.”