Mindfulness-Oriented Recovery Enhancement reduces opioid craving among individuals with opioid use disorder and chronic pain in medication assisted treatment: Ecological momentary assessments from a stage 1 randomized controlled trial
Abstract
Background Methadone maintenance therapy (MMT) is an efficacious form of medication assisted treatment for opioid use disorder (OUD), yet many individuals on MMT relapse. Chronic pain and deficits in positive affective response to natural rewards may result in dysphoria that fuels opioid craving and promotes relapse. As such, behavioral therapies that ameliorate chronic pain and enhance positive affect may serve as useful adjuncts to MMT. This analysis of ecological momentary assessment (EMA) data from a Stage 1 randomized clinical trial examined effects of Mindfulness-Oriented Recovery Enhancement (MORE) on opioid craving, pain, and positive affective state.Methods Participants with OUD and chronic pain (N = 30) were randomized to 8 weeks of MORE or treatment as usual (TAU). Across 8 weeks of treatment, participants completed up to 112 random EMA measures of craving, pain, and affect, as well as event-contingent craving ratings. Multilevel models examined the effects of MORE on craving, pain, and affect, as well as the association between positive affect and craving.Results EMA showed significantly greater improvements in craving, pain unpleasantness, stress, and positive affect for participants in MORE than for participants in TAU. Participants in MORE reported having nearly 1.3 times greater self-control over craving than those in TAU. Further, positive affect was associated with reduced craving, an association that was significantly stronger among participants in MORE than TAU.Conclusion MORE may be a useful non-pharmacological adjunct among individuals with OUD and chronic pain in MMT.
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Of the 4 SUD trials with a short-term follow-up, two out of 4 studies reported statistically significant improvements in pain intensity in the intervention group.
“Of the 4 trials with a shortterm follow-up, 20,27,28,36 two out of 4 studies reported statistically significant improvements in pain intensity in the intervention group, 27,36”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [28]
The Results section (“Craving, Pain, and Affective State”; page unavailable) reports a statistically significant decrease in pain unpleasantness for MORE compared with usual treatment, but explicitly says the decrease in pain intensity was not significant (p>.10). The paper therefore does not support counting this trial among those with a statistically significant improvement in pain intensity. (LLM, conf=0.89)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredMindfulness has shown promise as an acceptable behavioral treatment for OUD comorbidities such as chronic pain and anxiety when used with buprenorphine/naloxone, even in primary care.
“Mindfulness has shown promise as an acceptable behavioral treatment for OUD comorbidities such as chronic pain and anxiety when employed in conjunction with buprenorphine/naloxone treatment, even within primary care 23,24.”
From Effects of a trauma-informed mindful recovery program on comorbid pain, anxiety, and substance use during primary care buprenorphine treatment: A proof-of-concept study (2023) · cites this paper as [23]
The Results (Craving, Pain, and Affective State; page unavailable) report reduced pain unpleasantness and stress with Mindfulness-Oriented Recovery Enhancement, supporting its promise as an adjunctive behavioral treatment. But the Method (Participants and Procedure; page unavailable) places the trial in methadone-maintenance clinics, not buprenorphine/naloxone treatment or primary care. The cited passages do not establish acceptability or an effect on anxiety specifically. (LLM, conf=0.89)
Experimental — accuracy not yet measuredReduced opioid craving post-treatment was found in 3 of those 4 SUD trials.
“All 4 trials included drug screens, and reduced opioid craving post-treatment was also found in 3. 20,27,28”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [28]
The Results (Craving, page unavailable) report significantly greater decreases in opioid wanting and urges with MORE than with treatment as usual during the eight-week intervention. The Discussion (page unavailable) says the study could not assess whether those changes lasted beyond treatment, so it does not establish a post-treatment reduction. This single trial also cannot establish the citing document’s count of three trials. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAmong the 10 SUD trials, two evaluated a CBT-based intervention, three included a MBI (one of which involved integrated MBI and ACT), two examined a MCI, one included a pharmacological-based treatment, and 2 involved a body-based intervention.
“Two trials eval uated a CBT-based intervention, 20,23 three included a MBI, 27,28,30 one of which involved integrated MBI and ACT, 30 two examined a MCI, 39,40 one included a phar macological-based treatment, 45 and 2 involved a bodybased intervention. 35,36”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [28]
Six trials evaluated an MBI, mostly among patients with OUD.
“In total, 6 trials evaluated an MBI, mostly among pa tients with OUD, 24-30”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [28]
Less opioid use was reported in one trial.
“less opioid use was also only reported in 1 28”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [28]
The Results section ('Craving, Pain, and Affective State'; page unavailable) reports reduced opioid wanting and urges, not reduced opioid use. The Methods section ('Measures'; page unavailable) describes craving ratings; searches for opioid-use frequency, abstinence, and toxicology found no treatment-period opioid-use outcome in our copy. (LLM, conf=0.78)
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Cites
Ecological momentary assessment
Shiffman, S., Stone, A. A., & Hufford, M. R. (2008) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.3.022806.091415 · Cited by 6,454 · see citing works
Farrar, J. T., Young, J. P., LaMoreaux, L., Werth, J. L., & Poole, M. R. (2001) · Pain · doi:10.1016/s0304-3959(01)00349-9 · Cited by 5,808 · see citing works
Validity and reliability of the Experience-Sampling Method
CSIKSZENTMIHALYI, M., & LARSON, R. (1987) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-198709000-00004 · Cited by 2,544 · cited 1× · see citing works
“Ecological Momentary Assessment (EMA) is a method of data collection that overcomes retrospective biases by gathering data via real-time reports of momentary experiences in the context of everyday life (Csikszentmihalyi and Larson, 1987; Shiftman et al., 2008).”
BackgroundA cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes
Tiffany, S. T. (1990) · Psychological Review · doi:10.1037/0033-295x.97.2.147 · Cited by 1,554 · see citing works
Incentive-sensitization and addiction
Robinson, T. E., & Berridge, K. C. (2001) · Addiction · doi:10.1046/j.1360-0443.2001.9611038.x · Cited by 1,435 · see citing works
Medication-Assisted Therapies — Tackling the Opioid-Overdose Epidemic
Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014) · New England Journal of Medicine · doi:10.1056/nejmp1402780 · Cited by 1,014 · see citing works
Garland, E. L., Farb, N. A., R. Goldin, P., & Fredrickson, B. L. (2015) · Psychological Inquiry · doi:10.1080/1047840x.2015.1064294 · Cited by 810 · see citing works
Self-citationEcological momentary assessment (EMA) in studies of substance use.
Shiffman, S. S. (2009) · Psychological Assessment · doi:10.1037/a0017074 · Cited by 764 · see citing works
Prefrontal–striatal pathway underlies cognitive regulation of craving
Kober, H., Mende-Siedlecki, P., Kross, E. F., Weber, J., Mischel, W., Hart, C. L., & Ochsner, K. N. (2010) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1007779107 · Cited by 695 · see citing works
Neurobiology of opioid addiction: Opponent process, hyperkatifeia, and negative reinforcement
Koob, G. F. (2020) · Biological Psychiatry · doi:10.1016/j.biopsych.2019.05.023 · Cited by 477 · see citing works
Garland, E. L., Manusov, E. G., Froeliger, B., Kelly, A., Williams, J. M., & Howard, M. O. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0035798 · Cited by 431 · see citing works
Self-citationCommon brain mechanisms of chronic pain and addiction
Elman, I., & Borsook, D. (2016) · Neuron · doi:10.1016/j.neuron.2015.11.027 · Cited by 303 · see citing works
Garland, E. L., Froeliger, B., Zeidan, F., Partin, K., & Howard, M. O. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.08.006 · Cited by 277 · see citing works
Self-citationGarland, E. L., Froeliger, B., & Howard, M. O. (2014) · Psychopharmacology · doi:10.1007/s00213-014-3504-7 · Cited by 216 · see citing works
Self-citationCognitive concepts of craving.
Tiffany, S. T. (1999) · PubMed Central · Cited by 206 · see citing works
Regulation of craving by cognitive strategies in cigarette smokers
Kober, H., Kross, E. F., Mischel, W., Hart, C. L., & Ochsner, K. N. (2010) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2009.07.017 · Cited by 178 · see citing works
Interventions for the reduction of prescribed opioid use in chronic non-cancer pain
Eccleston, C., Fisher, E., Thomas, K. H., Hearn, L., Derry, S., Stannard, C., Knaggs, R., & Moore, A. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010323.pub3 · Cited by 173 · see citing works
Garland, E. L., Hanley, A. W., Riquino, M. R., Reese, S. E., Baker, A. K., Salas, K., Yack, B. P., Bedford, C. E., Bryan, M. A., Atchley, R., et al. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000390 · Cited by 167 · see citing works
Self-citationGarland, E. L. (2016) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13034 · Cited by 137 · cited 2× · see citing works
“Consistent with the restructuring reward hypothesis (Garland, 2016), participants in MORE may have utilized savoring to magnify the craving reducing effects of positive emotions, thereby reducing the intensity of their cravings.”
BackgroundSelf-citationGarland, E. L., Froeliger, B., & Howard, M. O. (2015) · Journal of Behavioral Medicine · doi:10.1007/s10865-014-9607-0 · Cited by 136 · see citing works
Self-citationCraving of Prescription Opioids in Patients With Chronic Pain: A Longitudinal Outcomes Trial
Wasan, A. D., Ross, E. L., Michna, E., Chibnik, L. B., Greenfield, S. F., Weiss, R. D., & Jamison, R. N. (2012) · Journal of Pain · doi:10.1016/j.jpain.2011.10.010 · Cited by 100 · see citing works
Froeliger, B., Mathew, A. R., McConnell, P. A., Eichberg, C., Saladin, M. E., Carpenter, M. J., & Garland, E. L. (2017) · Evidence-Based Complementary and Alternative Medicine · doi:10.1155/2017/7018014 · Cited by 83 · see citing works
Self-citationChronic and Acute Pain and Pain Management for Patients in Methadone Maintenance Treatment
Eyler, E. C. H. (2013) · American Journal on Addictions · doi:10.1111/j.1521-0391.2013.00308.x · Cited by 82 · see citing works
Garland, E. L., Bryan, C. J., Nakamura, Y., Froeliger, B., & Howard, M. O. (2016) · Psychopharmacology · doi:10.1007/s00213-016-4494-4 · Cited by 82 · see citing works
Self-citationPredictors of Attrition from a National Sample of Methadone Maintenance Patients
Mancino, M. J., Curran, G. M., Han, X., Allee, E., Humphreys, K. N., & Booth, B. M. (2010) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952991003736389 · Cited by 78 · see citing works
Shiffman, S. M. (2000) · Addiction · doi:10.1080/09652140050111744 · Cited by 76 · see citing works
Griffin, M. L., McDermott, K. A., McHugh, R. K., Fitzmaurice, G. M., Jamison, R. N., & Weiss, R. D. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.04.023 · Cited by 71 · see citing works
Garland, E. L., Bryan, C. J., Finan, P. H., Thomas, E. A., Priddy, S. E., Riquino, M. R., & Howard, M. O. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.07.033 · Cited by 71 · see citing works
Self-citationInterventions for the reduction of prescribed opioid use in chronic non‐cancer pain
Whitehead, P. B. (2018) · Research in Nursing & Health · doi:10.1002/nur.21879 · Cited by 60 · see citing works
Garland, E. L., & Howard, M. O. (2014) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2014.09.014 · Cited by 55 · see citing works
Naji, L., Dennis, B. B., Bawor, M., Plater, C., Paré, G., Worster, A., Varenbut, M., Daiter, J., Marsh, D. C., Desai, D., et al. (2016) · Substance Abuse Research and Treatment · doi:10.4137/sart.s37030 · Cited by 51 · see citing works
Garland, E. L., Hanley, A. W., Bedford, C. E., Zubieta, J., Howard, M. O., Nakamura, Y., Donaldson, G. W., & Froeliger, B. (2018) · Journal of Addictive Diseases · doi:10.1080/10550887.2018.1459148 · Cited by 36 · see citing works
Self-citationShiffman, S. M. (2000) · Addiction · doi:10.1046/j.1360-0443.95.8s2.6.x · Cited by 29 · see citing works
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- Garland EL, 2013 Mindfulness-oriented recovery enhancement for addiction, stress, and pain. NASW Press, Washington, D.C.
Cited by
Sorted by citations
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Korecki, J. R., Schwebel, F. J., Votaw, V. R., & Witkiewitz, K. (2020) · Substance Abuse Treatment, Prevention, and Policy · doi:10.1186/s13011-020-00293-3 · Cited by 145 · see citing works
Hanley, A. W., Gililland, J., & Garland, E. L. (2021) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000657 · Cited by 63 · see citing works
Cooperman, N. A., Hanley, A. W., Kline, A., & Garland, E. L. (2021) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2021.108468 · Cited by 61 · see citing works
Self-citationMindfulness in Treatment Approaches for Addiction — Underlying Mechanisms and Future Directions
Rosenthal, A., Levin, M. E., Garland, E. L., & Romanczuk-Seiferth, N. (2021) · Current Addiction Reports · doi:10.1007/s40429-021-00372-w · Cited by 54 · see citing works
Self-citationGarland, E. L., Gullapalli, B. T., Prince, K. C., Hanley, A. W., Sanyer, M., Tuomenoksa, M., & Rahman, T. (2023) · Mindfulness · doi:10.1007/s12671-023-02137-0 · Cited by 34 · see citing works
Self-citationMillett, G., D'Amico, D., Amestoy, M. E., Gryspeerdt, C., & Fiocco, A. J. (2021) · Consciousness and Cognition · doi:10.1016/j.concog.2021.103195 · Cited by 25 · see citing works
Ma, R., Romano, E., Ashworth, M., Smith, T. O., Vancampfort, D., Scott, W., Gaughran, F., Stewart, R., & Stubbs, B. (2024) · The Journal of Pain · doi:10.1016/j.jpain.2023.11.004 · Cited by 19 · see citing works
Hanley, A. W., & Garland, E. L. (2021) · Journal of Evidence-Based Social Work · doi:10.1080/26408066.2020.1833803 · Cited by 16 · see citing works
Self-citationSchuman‐Olivier, Z., Fatkin, T., Creedon, T. B., Samawi, F., Moore, S. K., Okst, K., Fredericksen, A. (., Oxnard, A. (., Roll, D., Smith, L., et al. (2023) · The American Journal on Addictions · doi:10.1111/ajad.13364 · Cited by 15 · see citing works
- Authors
- Garland, E. L., Hanley, A. W., Kline, A., & Cooperman, N. A.
- Affiliations
- University of Utah (US)
- Rutgers, The State University of New Jersey (US)
- Corresponding author
- Garland, Eric L.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 203
- Pages
- 61-65
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC6939880
- OpenAlex
- W2965466047
- Cited by
- 105
- References
- 33
- Citations by year
- 2026: 16 · 2025: 14 · 2024: 17 · 2023: 17 · 2022: 17 · 2021: 14 · 2020: 8 · 2019: 2
- FWCI
- 9.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Complementary and Integrative Health
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- Mindfulness-Oriented Recovery Enhancement, opioid craving, opioid use disorder, chronic pain, methadone maintenance treatment, medication-assisted treatment, positive affect, pain unpleasantness, stress, relapse prevention
- MeSH terms
- Ecological Momentary Assessment, Adolescent, Adult, Affect, Analgesics, Opioid, Combined Modality Therapy, Female, Humans, Male, Methadone, Middle Aged, Opioid-Related Disorders, Young Adult, Opiate Substitution Treatment, Chronic Pain, Mindfulness, Craving
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