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Cited by 61Opioid Use Disorder TreatmentMindfulness and Compassion InterventionsSubstance Abuse Treatment and Outcomes

A pilot randomized clinical trial of mindfulness-oriented recovery enhancement as an adjunct to methadone treatment for people with opioid use disorder and chronic pain: impact on illicit drug use, health, and well-being

Open access
Cooperman, Nina A., Hanley, Adam W., Kline, Anna, Garland, Eric L.·2021·Journal of Substance Abuse Treatment
DOI 10.1016/j.jsat.2021.108468PMC PMC8281569
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Abstract

Background Chronic pain is highly prevalent among people in methadone maintenance treatment (MMT) for opioid use disorder and is known to be an important contributor to treatment discontinuation and opioid relapse. Mindfulness-Oriented Recovery Enhancement (MORE) is one of the few interventions developed and tested as an integrated treatment to simultaneously address both pain and illicit opioid use; however, this study is the first to evaluate MORE as an adjunct to MMT. Methods Randomized individuals in MMT (N = 30) received MORE plus methadone TAU (n = 15) or methadone TAU, only (n = 15). Participants in the MORE arm received their MMT, as usual, and attended eight, weekly, two-hour MORE groups at their MMT clinics. Participants in the TAU arm received their MMT, as usual, and group or individual counseling, as required by the clinic. TAU counseling consisted of relapse prevention, cognitive-behavioral therapy, and supportive treatment. TAU participants did not receive any mindfulness-based intervention. Participants completed assessments at baseline, post-treatment (i.e., 8-weeks post-baseline), and follow-up (i.e., 16-weeks post-baseline). Results Participants in MORE evidenced significantly fewer baseline adjusted days of illicit drug use and significantly lower levels of craving through 16-week follow-up compared to TAU. Also, Participants in MORE reported significantly lower levels of pain, physical and emotional limitations, depression, and anxiety through 16-week follow-up compared to TAU. Conversely, participants in MORE reported significantly higher levels of well-being, vitality, and social functioning through 16-week follow-up compared to TAU. Conclusion MORE could be an effective adjunct to MMT, and larger trials are warranted.

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Crossref · 10.1016/j.jsat.2021.108468

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  • Patients participating in MORE as addition to rotation to methadone had more reductions in craving, illicit opioid use, and pain compared to patients rotating to methadone with counseling.

    “Furthermore, patients participating in MORE, as addition to rotation to methadone, had more reductions in craving, illicit opioid use, and pain compared to patients rotating to methadone with counseling (Cooperman et al., 2021).”

    From Mindfulness-based cognitive therapy for chronic noncancer pain and prescription opioid use disorder: A qualitative pilot study of its feasibility and the perceived process of change (2023) · cites this paper as Cooperman et al., 2021

    The Discussion reports less illicit opiate use, craving, and physical pain with MORE than with treatment as usual. However, the Participants and Procedure section says patients were already receiving methadone maintenance treatment; it does not describe either group as rotating to methadone. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Other studies find moderate effect sizes on reducing craving and opioid use.

    “Other studies find moderate effect sizes on reducing craving and opioid use (Cooperman et al., 2021; Garland et al., 2014, 2016).”

    From Mindfulness-based cognitive therapy for chronic noncancer pain and prescription opioid use disorder: A qualitative pilot study of its feasibility and the perceived process of change (2023) · cites this paper as Cooperman et al., 2021

    The Results (Outcomes; page not provided) report significantly lower craving and fewer days of illicit drug use with MORE than with treatment as usual through 16 weeks. The Discussion also reports reduced opiate-use days in the MORE group. Our copy does not establish that the effect sizes for craving and opioid use were moderate. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Trials from Cooperman and colleagues and Wiest and colleagues also included measures for depression and anxiety, with both finding significant improvements in these outcomes.

    “Trials from Cooperman and colleagues 27 and Wiest and colleagues 36 also in­ cluded measures for depression and anxiety with both finding significant improvements in these outcomes.”

    From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [27]

    The Measures section confirms that the Cooperman trial assessed depression and anxiety. The Results section reports significantly lower levels of both in the MORE group than in the treatment-as-usual group, but it also says depressive symptoms increased over time in both groups. Thus the trial supports a comparative benefit, not an improvement in depression over time; this verdict does not assess the separately cited Wiest trial. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Reduced 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 [27]

    The Discussion (page unavailable) reports lower craving in the MORE group across the 16-week study, which included the post-treatment assessment at eight weeks. This paper supports one trial’s finding, but cannot establish that three of four trials found reduced craving. The citing sentence’s separate drug-screen claim is also contrary to the Discussion, which says drug use was not biochemically verified. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In a recent pilot study, there was little dropout in both MORE and counseling arms during methadone substitution therapy, indicating this timing is feasible for an MBI.

    “In both treatment arms, there was little dropout during this period (Cooperman et al., 2021), indicating that this timing is feasible for an MBI.”

    From Mindfulness-based cognitive therapy for chronic noncancer pain and prescription opioid use disorder: A qualitative pilot study of its feasibility and the perceived process of change (2023) · cites this paper as Cooperman et al., 2021

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Research works printed but not linked: 2

  1. Garland EL (2013). Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain. NASW Press.
  2. Wills TA, & Shiffman S (1985). Coping and substance use: A conceptual framework. In Shiffman S & Wills TA (Eds.), Coping and Substance Use. Academic Press.

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Authors
Cooperman, N. A., Hanley, A. W., Kline, A., & Garland, E. L.
Affiliations
  • Rutgers, The State University of New Jersey (US)
  • University of Utah (US)
Corresponding author
Cooperman, Nina A.
ORCID
Venue
Journal of Substance Abuse Treatment
Publisher
Elsevier BV
Published
2021-08
Volume
127
Pages
108468
ISSN
0740-5472 (ISSN-L)
DOI
10.1016/j.jsat.2021.108468
PMC
PMC8281569
OpenAlex
W3161686724
Cited by
61
References
41
Citations by year
2026: 11 · 2025: 7 · 2024: 13 · 2023: 15 · 2022: 12 · 2021: 3
FWCI
9.32
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Substance Abuse Treatment (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Center for Complementary and Integrative Health
  • National Institute on Drug Abuse
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, mindfulness-based interventions, opioid use disorder, chronic pain, methadone maintenance treatment, adjunct treatment, opioid craving, illicit drug use, depression, anxiety, well-being, social functioning, treatment retention
MeSH terms
Analgesics, Opioid, Humans, Methadone, Opioid-Related Disorders, Pilot Projects, Illicit Drugs, Opiate Substitution Treatment, Chronic Pain, Mindfulness

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