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Cited by 15Opioid Use Disorder TreatmentMindfulness and Compassion InterventionsSubstance Abuse Treatment and Outcomes

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

Open access
Schuman‐Olivier, Zev, Fatkin, Thomas, Creedon, Timothy B., Samawi, Farah, Moore, Sarah K., Okst, Kayley, Fredericksen, Alaine (Kiera), Oxnard, Alexandra (Sasha) +4 more·2023·The American Journal on Addictions
DOI 10.1111/ajad.13364PMC PMC12616818
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Abstract

Background: A mindfulness-based intervention that reduces comorbid pain, anxiety, and substance use during office-based opioid treatment (OBOT) could enhance retention and prevent overdose. We conducted a pilot study of the Mindful Recovery OUD Care Continuum (M-ROCC), a 24-week trauma-informed program with a motivationally-sensitive curriculum. Methods: Patients prescribed buprenorphine (N = 18) enrolled in M-ROCC. We collected urine toxicology biweekly. At 0, 4, and 24 weeks, participants completed PROMIS-Pain, PROMIS-Anxiety, Mindfulness (FFMQ), Experiential Avoidance (BEAQ), Interoceptive Awareness (MAIA), and Self-Compassion (SCS-SF) scales. We estimated changes over time using mixed models. Participants completed qualitative interviews at 4 and 24 weeks. Results: Positive urine toxicology decreased over time for cocaine (β = −.266, p =.008) and benzodiazepines (β = −.208, p =.028). M-ROCC reduced PROMIS-Pain (Z = −2.29; p =.022), BEAQ (Z = −2.83; p =.0005), and increased FFMQ (Z = 3.51; p <.001), MAIA (Z = 3.40; p =.001), and SCS-SF (Z = 2.29; p =.022). Participants with co-morbid anxiety had decreased PROMIS-Anxiety (Z = −2.53; p =.012). Interviewed participants commonly used mindfulness practices for stress and anxiety (12/12, 100%), and to reduce pain catastrophizing and rumination (7/12, 58%). Conclusion and Scientific Significance: This is the first study to report the effects of a 24-week mindfulness program during buprenorphine treatment on common comorbidities, including pain interference, anxiety, cocaine, and benzodiazepine use. The findings that M-ROCC is associated with reduced experiential avoidance, as well as increased interoceptive awareness and self-compassion, align with proposed mechanisms that are now extended to OUD treatment. Future larger randomized controlled trials are needed before effectiveness can be established and the role of these mechanisms can be confirmed. © 2022 The American Academy of Addiction Psychiatry (AAAP).

Integrity signals

Registry

Crossref · 10.1111/ajad.13364

Cites

60 of 60 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

35 of 51 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Childhood trauma and emotional abuse may cause trauma survivors to introject self-critical and self-blaming attitudes, leading to increased shame and difficulty engaging with some mindfulness and self-compassion practices.

    “Childhood trauma and emotional abuse may cause trauma survivors to introject self-critical and self-blaming attitudes, leading to increased shame and difficulty engaging with some mindfulness and self-compassion practices 53.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [53] source

      The Introduction links childhood maltreatment with self-blame and shame, and the Discussion says some survivors find mindfulness practices challenging and may feel overwhelmed while learning self-compassion. The paper does not say that emotional abuse causes survivors to introject self-critical attitudes, or that those attitudes are what makes the practices difficult. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    High ACE rates and trauma may cause individuals with SUDs to self-medicate as a means of escaping self-critical feelings.

    “High ACE rates and trauma may cause individuals with SUDs to self-medicate as a means of escaping self-critical feelings 14,54.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [14] source
    • cites [54] source

      The paper’s discussion of shame and experiential avoidance (page not available in our copy) says self-critical thoughts can increase substance use and that substances may be used to avoid shame and other negative emotions. It does not connect that behavior to high rates of adverse childhood experiences (ACEs) or trauma. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    Anxiety disorders can increase risk of relapse among patients undergoing buprenorphine/naloxone treatment.

    “anxiety disorders can increase risk of relapse among patients undergoing buprenorphine/naloxone treatment 49,50.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [49] source
    • cites [50] source

      Table 2 reports the prevalence of anxiety among primary care patients with opioid use disorder, and the Methods describe a cross-sectional analysis of comorbidities. The paper does not address whether anxiety increases relapse risk during buprenorphine/naloxone treatment (searched: anxiety relapse buprenorphine/naloxone; risk of relapse during medication treatment). (LLM, conf=0.78)

      Experimental — accuracy not yet measured
  • Premisecitation

    The fear-avoidance model of chronic pain explains the relationship between pain and anxiety present among many patients with OUD.

    “The fear-avoidance model of chronic pain helps to explain the relationship between pain and anxiety that is present among many patients with OUD 47.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [47] source

      The Fear-Avoidance Model and Pain-Related Fear section (page not provided) describes pain-related anxiety as an anxious or fearful response to pain and explains how pain-related fear and avoidance can reinforce each other. The Psychosocial Factors section discusses other forms of substance use, but does not establish that this relationship is present among many patients with opioid use disorder (OUD). (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Anxiety and chronic pain diagnoses co-occur at a high rate, particularly among the OUD population.

    “Anxiety and chronic pain diagnoses co-occur at a high rate, particularly among the OUD population”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [49] source

      The Results and Discussion report anxiety disorders among patients receiving buprenorphine for opioid dependence, but they examine anxiety in relation to relapse, not chronic pain. Searches for chronic pain and pain diagnoses found no passage assessing whether anxiety and chronic pain diagnoses co-occur or how often they do so. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [50] source

      The Results and Table 1 report high rates of pain and anxiety among primary care patients with OUD, and the Discussion describes pain and mental-health comorbidity in this group. The paper does not report the rate at which anxiety and chronic pain diagnoses occur together; its measured pain category is not limited to chronic pain. It also does not compare that co-occurrence rate with people without OUD. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 15
  • May combine two claims. 21

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study used the 10-item ACE Study questionnaire to measure childhood trauma.

    “Adverse childhood experiences (ACEs) were documented at baseline using the 10-item ACE Study questionnaire to measure childhood trauma, and were grouped as either “0–3” or “4+” due to the high rate of chronic health problems among individuals with scores of 4 or more 37.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [37] source

      The Survey Methods and Questionnaire Design sections confirm that the paper used an ACE Study questionnaire about childhood abuse and household dysfunction. But the Adverse Childhood Exposures section says it included 17 questions across seven categories, not 10 items. Page numbers are unavailable in our copy. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study used the PROMIS short forms to assess anxiety, pain, and depression.

    “Anxiety, pain, and depression were assessed using the Patient Reported Outcomes Measurement Information System (PROMIS), Anxiety Short Form 8a (PROMIS-ASF), Pain Interference Short Form (PROMIS-PISF), and Depression Short Form 8a (PROMIS-DSF) 36.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [36] source

      The Results (Validity and Interpretation Tables; page not provided) describe PROMIS short forms for anxiety, pain interference, and depression, supporting the citation as an identification of those measures. However, the paper describes a 7-item anxiety short form, not the specifically named Anxiety Short Form 8a; it does not establish that exact version. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    When people use experiential avoidance to manage psychiatric symptoms, a pattern of increasing emotional dysregulation may result, which among those with OUD generally leads to urges for or use of opioids or other substances for relief.

    “When people employ experiential avoidance to manage symptoms of anxiety, panic, depression, trauma, or other psychiatric symptoms, a similar pattern of increasing emotional dysregulation may result, which among those with OUD generally leads to urges for or use of opioids or other substances (e.g. benzodiazepines) for relief 11,22,48.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [11] source
    • cites [22] source

      The paper’s Mindfulness-Based Treatment section links negative affect and craving to relapse and describes an urgency to alleviate discomfort through substance use. Its discussion of avoiding affective discomfort also supports the general premise. It does not establish an escalating pattern of emotional dysregulation caused by experiential avoidance, or show that this generally leads people with OUD to seek opioids or benzodiazepines for relief; its findings concern substance use disorders more broadly. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [48] source

  • May combine two claims.

    Study design and conductcitation

    The study had a single-arm design, small sample size, lack of racial and gender diversity, lack of systematic tracking of adjunctive mental health treatment, and lack of participant blinding.

    “Notable limiting factors were the study’s single arm design, small sample size, lack of diversity (both racial and gender), lack of systematic tracking of adjunctive mental health treatment, and a lack of participant blinding 29.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [29] source

      The Study Aims section calls this a single-arm pilot study, and the Limitations section identifies the small sample, predominantly white male participants, lack of a control group, and participants being told they would receive a mindfulness intervention. Those passages support the design, diversity, and participant-blinding points. Our copy does not identify a lack of systematic tracking of adjunctive mental health treatment as a limitation (searched: adjunctive mental health treatment, tracking). Page numbers were not available. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study used the MAIA to assess interoceptive awareness.

    “Interoceptive awareness was assessed by the Multidimensional Assessment of Interoceptive Awareness (MAIA), with 32 items scored from 0 (Never) to 5 (Always) 42.”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    Patients with SUDs often experience altered function of the insula, which plays a crucial role in interoceptive processes.

    “Patients with SUDs often experience altered function of the insula, which plays a crucial role in interoceptive processes 51.”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    Patients with SUD have overactivation of the insula in response to drug-related cues and show attenuated insula activation when processing standard interoceptive cues.

    “Specifically, patients with SUD have overactivation of the insula in response to drug related cues and show attenuated insula activation when processing standard interoceptive cues 18,19.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [18] source

      Section 4 (Cocaine; page unavailable) reports heightened insula responses to cocaine-related cues, and the Cannabis subsection describes a similar response to marijuana cues. It reports attenuated activation during inhibitory or cognitive-control tasks, not during processing of standard interoceptive cues; the section also says direct assessments of interoceptive sensitivity in substance users were lacking. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [19] source

      The “Interoceptive Dysfunction in Drug Addiction” section reports enhanced insula responses to drug-related cues and reduced activation during cognitive-control tasks. It cautions against inferring from those findings that interoceptive processing itself is impaired. The source therefore does not establish attenuated insula activation specifically while processing standard interoceptive cues; page numbers were unavailable in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Combined interventions for psychiatric disorders and SUDs may be more effective, less burdensome, and less costly than separate treatment plans.

    “Combined interventions for psychiatric disorders and SUDs may therefore be more effective, less burdensome, and less costly than separate treatment plans, so integrated treatments that address opioid use and common co-morbidities may enhance long-term retention 6.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [6] source

      The Introduction says integrated treatment is superior to separate, single-focused treatment for co-occurring psychiatric and substance use disorders. The passages do not establish that it is less burdensome or less costly; searches for cost and burden found no supporting passage. No page numbers were supplied in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    MBIs show promise as a treatment for SUDs, possibly because they develop mindfulness, self-compassion, and interoceptive awareness.

    “MBIs show promise as a treatment for SUDs, possibly because they develop mindfulness, self-compassion, and interoceptive awareness – three key processes involved in coping with pain and anxiety, and healthy emotion regulation 9,10.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [9] source
    • cites [10] source

      The Conclusion describes MBIs as a promising treatment for addiction, and the ‘Mindfulness operationalized’ section says practice may cultivate mindfulness and awareness of bodily sensations. The cited passages do not identify self-compassion as a treatment mechanism, and they do not establish that the three named processes together explain MBIs’ promise for substance use disorders. Page numbers are unavailable in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A well-designed RCT found significantly fewer days of substance use in MBRP compared to Relapse Programs alone at 12 months.

    “A well-designed RCT examining the effects of MBRP compared to Relapse Programs (RP) alone found significantly fewer days of substance use in MBRP at 12 months, emphasizing the potential for long-term benefit of mindfulness programs 22.”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    Self-compassion shows promise as a strategy to address emotional dysregulation and addiction severity associated with childhood trauma, and may help behavioral interventions become more trauma sensitive and reduce the toxicity of shame.

    “Self-compassion shows promise as a strategy to address the emotional dysregulation and addiction severity associated with childhood trauma, and may help behavioral interventions become more trauma sensitive and reduce the toxicity of shame 45,55.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [45] source
    • cites [55] source

  • May combine two claims.

    Premisecitation

    Pilot trials comparing an 8-week Mindfulness Based Relapse Prevention Program to treatment as usual have found significant decreases in stress, craving, and substance use, with similar effects after cultural adaptation.

    “Pilot trials comparing an 8-week Mindfulness Based Relapse Prevention Program (MBRP) to TAU have found significant decreases in stress, craving, and substance use, with similar effects after cultural adaptation for ethnically and racially diverse populations 20,21.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [20] source

      The Methods (Treatment) describe an eight-week MBRP program, and the Discussion reports significant improvements versus treatment as usual in substance-use days and craving. The paper describes an ethnically diverse sample, but our copy does not report a significant decrease in stress or test a culturally adapted MBRP program. The cultural-adaptation result therefore cannot be attributed to this trial. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [21] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Between 65% and 75% of patients with OUD suffer from chronic pain, which is frequently comorbid with anxiety, depression, and trauma.

    “In addition, between 65% and 75% of patients with OUD suffer from chronic pain, which is in turn frequently co-morbid with anxiety, depression, and trauma 4,5.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [4] source
    • cites [5] source

      The Results (Patient characteristics; page not provided) report chronic pain in 64.4% of patients with OUD, approximately the lower end of the claimed range but below 65%. The Results (Co-morbid substance use disorder and psychiatric diagnoses; page not provided) report frequent depression and anxiety among the groups with chronic pain. Our copy does not establish that trauma is frequently comorbid. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Study design and conductreasoning

    Most participants did not report baseline opioid use because they were required to have been on a stable buprenorphine/naloxone dose for 30 days prior to screening, which may limit generalization to the induction phase.

    “study participants were required to have been taking a stable dose of buprenorphine/naloxone for 30 days prior to screening, so most study participants did not report baseline opioid use, which may limit generalization, especially for the buprenorphine/naloxone treatment induction phase when active opioid use is most common.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The beneficial effects of M-ROCC on anxiety, mindfulness, interoceptive awareness, and experiential avoidance suggest that mindfulness skills enabled participants to come to terms with pain using mindful, compassionate awareness rather than fear and avoidance.

    “The beneficial effects of M-ROCC on anxiety, mindfulness, interoceptive awareness, and experiential avoidance, seem to suggest that practicing mindfulness skills enabled participants to come to terms with their pain using mindful, compassionate awareness, rather than falling into familiar patterns of fear and avoidance.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study used the BEAQ to assess experiential avoidance.

    “Experiential avoidance was assessed by the 15-item Brief Experiential Avoidance Questionnaire (BEAQ), with items scored from 1 (Strongly Disagree) to 6 (Strongly Agree) 38.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] source

  • May combine two claims.

    Interpretationreasoning

    Reductions in comorbid substance use suggest M-ROCC is no worse than treatment as usual and may represent a meaningful outcome if replicated in a controlled study.

    “reductions in co-morbid substance use suggest M-ROCC is no worse than treatment as usual and may represent a meaningful outcome if replicated in a controlled study”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study was approved by the Institutional Review Board and had a NCCIH-approved data safety monitoring plan with an independent monitoring committee.

    “This study was approved by the Institutional Review Board as listed on Clinical Trials.gov (NCT 03798431) and had a NCCIH-approved data safety monitoring plan with an independent monitoring committee.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    M-ROCC is associated with reduced experiential avoidance and increased interoceptive awareness and self-compassion, aligning with proposed mechanisms now extended to OUD treatment.

    “The findings that M-ROCC is associated with reduced experiential avoidance as well as increased interoceptive awareness and self-compassion aligns with proposed mechanisms that are now extended to OUD treatment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study used the SCS-SF to assess self-compassion.

    “Self-compassion was assessed using the Self-Compassion Scale Short Form (SCS-SF), a 12-item scale with items scored from 1 (Almost Never) to 5 (Almost Always) 41.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    A statistical methodologist outside the intervention team oversaw database management, data cleaning, and analysis to prevent bias.

    “To prevent bias during analysis, a statistical methodologist outside CMC’s study intervention team (T.C.) oversaw database management and data cleaning and conducted the analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Qualitative interviews were conducted with 12 unique participants (66% of the initial sample).

    “Qualitative interviews were conducted at 4 (n= 9) and 24 weeks (n=7) with 12 unique participants (66% of initial sample: 12/13 who completed the 24-week battery).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Greater interoceptive awareness facilitated by mindfulness meditation during M-ROCC may have helped participants interpret embodied signals related to substance use more accurately, differentiate drug desire from other unpleasant affective states, and respond appropriately.

    “Greater interoceptive awareness, facilitated by mindfulness meditation during the M-ROCC program, may have helped participants to interpret embodied signals related to substance use more accurately, differentiate drug desire from other unpleasant affective states, and respond to them appropriately.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study used the PSS-14 to assess life stress.

    “The Perceived Stress Scale (PSS-14) was used determine life stress levels with 14 items scored from 0 (Never) to 4 (Very Often) 43.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] source

  • May combine two claims.

    Study design and conductreasoning

    The study was not powered to detect statistically significant differences between timepoints; the intention was to evaluate effect sizes for powering a randomized comparative effectiveness trial.

    “Due to its low sample size, this study was not powered to detect a statistically significant difference between timepoints, rather, the intention was to evaluate the effect sizes that would be necessary for powering a randomized comparative effectiveness trial of the M-ROCC intervention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    This study suggests M-ROCC may enhance self-regulation, interoception, mindfulness, and self-compassion while reducing experiential avoidance.

    “this study suggests that M-ROCC may enhance self-regulation, interoception, mindfulness, and self-compassion while reducing experiential avoidance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    M-ROCC shows promise as an option for OUD treatment in primary care and has potential to be therapeutic for multiple common comorbidities including chronic pain, anxiety, and other SUDs (cocaine, benzodiazepines).

    “These findings demonstrated that the M-ROCC intervention shows promise as an option for OUD treatment in primary care and has potential to be therapeutic for multiple common comorbidities, including chronic pain, anxiety, and other SUDs (i.e., cocaine, benzodiazepines).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study used the FFMQ to assess mindfulness.

    “The Five Facet Mindfulness Questionnaire (FFMQ) was used to examine participant mindfulness with 39-items scored from 1 (Never or Very Rarely True) to 5 (Very Often or Always True) 39.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] source

  • May combine two claims.

    Interpretationreasoning

    These changes were observed even among patients who had largely stabilized their opioid use, indicating potential of mindfulness practice to foster long-term well-being and elicit meaningful life changes.

    “These changes were observed even among patients who had largely stabilized their opioid use, indicating the potential of mindfulness practice to foster long term well-being and elicit meaningful life changes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study used the DERS to assess emotion regulation capability.

    “Emotion regulation capability was assessed using the Difficulties in Emotion Regulation Scale (DERS), a 36-item scale 40.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Following the six principles of a trauma-informed approach requires time for orientation and flexibility in group timing.

    “In addition, following the six principles of a trauma-informed approach (safety, trust/transparency, peer support, collaboration/mutuality, empowerment/voice/choice, cultural/historical/gender issues) requires some time for orientation to build safety and trust and more flexibility in group timing to allow choice, including breaks 28.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    An extended mindfulness program longer than the standard 8 weeks may be needed.

    “Therefore, an extended mindfulness program longer than the standard 8-weeks may be needed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Substance use disorders and psychiatric disorders may be bi-directionally linked, making treatment difficult.

    “Substance use disorders (SUDs) and psychiatric disorders may be bi-directionally linked, making treatment difficult 3.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] source
33 of 33

  • The paper relies on this without support.

    Reducing comorbid pain, anxiety, and substance use during office-based opioid treatment would enhance retention and prevent overdose.

    “A mindfulness-based intervention that reduces co-morbid pain, anxiety, and substance use during office-based opioid treatment (OBOT) could enhance retention and prevent overdose.”

  • The paper relies on this without support.

    This is the first study to report the effects of a 24-week mindfulness program during buprenorphine treatment on common comorbidities including pain interference, anxiety, cocaine and benzodiazepine use.

    “This is the first study to report the effects of a 24-week mindfulness program during buprenorphine treatment on common co-morbidities, including pain interference, anxiety, cocaine and benzodiazepine use.”

  • The paper relies on this without support.

    Changes in adjunctive mental health treatment did not account for the observed improvements.

    “Psychiatric medication and counseling changes were discouraged during the study, unless deemed clinically necessary by existing providers for patient safety.”
    “lack of systematic tracking of adjunctive mental health treatment”

  • The paper relies on this without support.

    The observed improvements were not due to participant expectancy or placebo effects.

    “lack of participant blinding”

  • The paper relies on this without support.

    The observed changes are not solely due to ongoing buprenorphine/naloxone treatment or other concurrent care.

    “Notable limiting factors were the study’s single arm design, small sample size, lack of diversity (both racial and gender), lack of systematic tracking of adjunctive mental health treatment, and a lack of participant blinding 29.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting p-values for experiential avoidance

    Minor

    The abstract and Results report different p-values for the same experiential-avoidance result: .0005 and .005, respectively.

1 of 1

Cites

Flagged first, then by citations

1 of the 61 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Ahmad FB, 2022, Provisional drug overdose death counts

Cited by

Sorted by citations

Related

Authors
Schuman‐Olivier, Z., Fatkin, T., Creedon, T. B., Samawi, F., Moore, S. K., Okst, K., Fredericksen, A. (., Oxnard, A. (., Roll, D., Smith, L., Cook, B. L., & Weiss, R. D.
Affiliations
  • Dartmouth College (US)
  • Cambridge Health Alliance (US)
  • Harvard University (US)
Corresponding author
Schuman‐Olivier, Zev
ORCID
Venue
The American Journal on Addictions
Publisher
Wiley
Published
2022-12-05
Volume
32
Issue
3
Pages
244-253
ISSN
  • 1055-0496 (ISSN-L)
  • 1521-0391
DOI
10.1111/ajad.13364
PMC
PMC12616818
OpenAlex
W4310776654
Semantic Scholar
3afcec8bc350f8937843fd84ec649882f8dcdfa9
Cited by
15
References
61
Citations by year
2026: 2 · 2025: 6 · 2024: 5 · 2023: 2
FWCI
2.87
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • American Journal on Addictions (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
Funders
National Center for Complementary and Integrative Health (R21AT010125)
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
opioid use disorder, buprenorphine, mindfulness-based interventions, trauma-informed care, pain interference, anxiety, cocaine use, benzodiazepine use, experiential avoidance, interoceptive awareness, self-compassion, primary care, treatment retention, overdose prevention, urine toxicology, pain catastrophizing, rumination
MeSH terms
Anxiety, Buprenorphine, Cocaine, Humans, Pain, Pilot Projects, Primary Health Care, Substance-Related Disorders, Mindfulness

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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