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Take A Deep Breath…

Mindfulness Vs. Opioid Use Disorder

Among individuals receiving methadone maintenance treatment (MMT), a medication for the treatment of opioid use disorder, nearly half relapse to drug use within six months. Further, chronic pain is associated with an increased risk for drug use relapse. Many individuals experiencing opioid use disorder (OUD) were originally prescribed opioid painkillers for chronic pain, leading to their addiction, and their ongoing chronic pain impacts their recovery.

Dr. Nina Cooperman, PsyD, an associate professor of Psychology at Rutgers University, conducted this study with her colleague, Dr. Anna Kline, PhD, to test the feasibility and effectiveness of Mindfulness-Oriented Recovery Enhancement (MORE) among those in MMT. A paper describing the results of this study was recently published in the journal Drug and Alcohol Dependence

Mindfulness involves focusing attention only to the current moment. Individuals that practice mindfulness focus on the sensations, cravings, emotions and environment that they are currently experiencing. 

“Mindfulness-based interventions are known to be effective for helping people cope with pain,” said Dr. Cooperman. “There’s also evidence that mindfulness helps people deal with cravings and manage stress, factors that are known to be associated with risk for drug relapse, but a mindfulness-based intervention that focuses on coping with pain and preventing relapse among people with chronic pain in methadone treatment has never been evaluated.”

Dr. Cooperman & Dr. Kline enlisted Dr. Eric Garland, PHD, to collaborate with them on the study. Dr. Garland is the Associate Director of Integrative Medicine at the University of Utah as well as the original creator of the MORE treatment program.

This study recruited a total of thirty, English-speaking, adult participants with chronic pain and who were in MMT. Dr. Cooperman made special note this was  a “pilot study” to determine feasibility and estimate the effectiveness of MORE for a future larger study.

The thirty individuals were randomized to two groups. One group received MMT as usual, and the other group received MMT treatment plus MORE sessions. According to Dr. Cooperman and Colleagues, “MORE is a manualized 8-session group therapy intervention involving training in mindfulness, reappraisal, and savoring skills to address OUD and chronic pain”.

During the study, all participants received survey questions via smartphones twice per day. Questions were varied, with some asking participants to rate their stress level on a scale of 1-10 and others asking them to rate their urge to use opioids.

Participants were also asked to complete opioid craving reports whenever they found themselves experiencing strong cravings, which were also done via their smartphones.

After the completion of the treatment, the survey results showed significant differences between those who underwent treatment as usual versus those in the MORE program. As compared to participants who only received MMT as usual, participants in MORE reported  significantly greater decreases in craving intensity, pain unpleasantness, and stress.

However, those in MORE treatment reported over three times as many cravings for opioids as did those in treatment as usual: 303 total reports to the control groups’ 87. Dr. Cooperman explained that MORE teaches people to become more aware of their physical experiences, thoughts, emotions, and environment.

“Often, when people have a substance use disorder, they react reflexively”, explains Dr. Cooperman. “It’s not something that they’re necessarily aware of. But mindfulness teaches you to become more aware. Those who were in the MORE group may have reported more cravings because they were simply more aware of them than those in treatment as usual.“ 

She also mentioned that the data here suggests that while MORE helps people to become more aware of their cravings, the greater reductions in craving intensity among those in the MORE groups as compared to the MMT as usual group suggests that MORE may also better help them to cope with their cravings.

This study’s research team will soon begin a larger study that will greatly expand the number of participants to at least 150 .

Nina Cooperman, PsyD, Associate Professor Psychiatry, cooperna@rwjms.rutgers.edu

Full Text: https://doi.org/10.1111/add.14699

Written by Joseph Detrano, CAS Science Writer
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Center of Alcohol & Substance Use Studies.