Could Mindfulness Decrease the Severity of Opioid Cravings?

Mindfulness may ease symptoms and enhance recovery for people with opioid use disorder and chronic pain.

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Opioid addiction can be very difficult to treat, particularly for those suffering from acute or chronic pain. Now, a new study finds that people suffering from opioid addiction and chronic pain may have fewer cravings and less pain when adding mindfulness to the traditional methadone treatment.

Roughly half of people who are addicted to opioids also suffer from acute or chronic pain. In a study published in Drug and Alcohol Dependence, researchers at the University of Utah and Rutgers University found that adults who received methadone treatment combined with mindfulness training were 1.3 times more effective at controlling their cravings. They also were more likely to report less stress, a more positive mood, and less pain than those receiving typical methadone treatment and counseling. 

Methadone maintenance therapy (MMT) is a key strategy in the fight against the opioid epidemic. Unfortunately, roughly one half of people receiving methadone treatment either continue to use opioids during MMT treatment, or relapse within six months. Part of the reason for this lack of success may be the fact that many suffer from depression, anxiety, and acute or chronic pain

Treating Opioid Addiction with Mindfulness

For this study, thirty adults with opioid use disorder and acute or chronic pain who were undergoing MMT were randomly assigned to either a Mindfulness-Oriented Recovery Enhancement (MORE) group, or a treatment-as-usual control group. 

MORE integrates mindfulness training with reappraisal skills, which include observing and reappraising thoughts, and savoring skills, such as increasing time spent on rewarding activities. Preliminary research has shown MORE to be effective in reducing pain and opioid use, but researchers had yet to test its effectiveness for those with opioid use disorder combined with pain. 

The study participants in the MORE group attended two-hour weekly group sessions of MORE therapy for eight weeks, as well as approximately four additional hours of individual and/or group therapy per week.

Those in the treatment-as-usual group received approximately six hours of individual and group therapy per week for eight weeks. Therapy often involved cognitive-behavioral coping skills training and process-oriented present-centered approaches. No mindfulness skills or practices were included.

Among the mindfulness-trained participants, cravings were 56% less intense, and they had 129% more control over those cravings than the treatment-as-usual group.

During treatment, participants in both groups were asked to provide ratings of their stress, pain intensity, and mood on a smartphone app twice per day. They also indicated how much they craved opioids, as well as whether they felt able to control those feelings. 

How Mindfulness Eases Opioid Cravings

Results of the study showed MORE participants had roughly three times more cravings than control group members. They also said that their desire for opioids was roughly two-thirds less than control group members. (Craving is defined in addictions research as an insatiable hunger for something, and is different from desire, which is closer to a sense of longing.)

What’s more, among the mindfulness-trained participants, cravings were 56% less intense, and they had 129% more control over those cravings than the treatment-as-usual group. Their stress and pain also went down, and they experienced more positive mood—the more positive their mood, the less craving the mindfulness group experienced.

This suggests that MORE, combined with medication-assisted treatment for opioid use disorder, may be an effective treatment for those who experience chronic or acute pain as well as opioid cravings. Researchers attribute some of MORE’s success to its emphasis on paying attention to positive emotions and events, which may lessen the experience of pain and stress and potentially reduce the intensity of opioid cravings.