Adding Mindfulness-Oriented Recovery Enhancement (MORE) to Methadone Treatment Provides Therapeutic Benefits for People With Opioid Use Disorder and Chronic Pain

According to a recent study, adding a remote group therapy mindfulness program to standard methadone treatment leads to therapeutic benefits in people with opioid use disorder and chronic pain. The study, conducted by researchers at the Robert Wood Johnson Medical School, Rutgers School of Public Health, and University of Utah, was funded by the National Center for Complementary and Integrative Health (NCCIH) and published in the journal JAMA Psychiatry.

Misuse of and dependence on opioid drugs continue to harm millions of Americans. The most widely used treatment for opioid users is methadone, a medication that helps prevent withdrawal symptoms in people trying to stop using opioid drugs. However, half of people who start methadone treatment stop the treatment within a year. Of those who remain in methadone treatment, half either continue using opioids and other illicit drugs or return to using them within 6 months. 

Mindfulness-oriented recovery enhancement, also called MORE, is a behavioral group therapy program that uses mindfulness, reappraisal, and savoring to help reverse dysregulation in the brain reward systems of opioid users. MORE is designed to restructure a person’s reward processing from valuing drug rewards to valuing natural rewards.

In the study of 154 racially diverse opioid users with chronic pain, adding 8 weeks of the MORE program to standard methadone treatment resulted in lower risks of returning to drug use and treatment dropout as well as fewer days of any drug use at 16 weeks. Standard methadone treatment included daily medication and individual or group counseling (without mindfulness) that was usually done remotely through telehealth. The MORE program included eight weekly 2-hour group therapy sessions over videoconferencing plus weekly homework practice. 

At 16 weeks, 83.6 percent of those in standard methadone treatment continued to take methadone, whereas the treatment adherence increased to 95.5 percent in participants receiving MORE plus standard treatment. The MORE participants also had a greater reduction in depression and pain at 16 weeks when compared to the standard treatment participants. 

Physical pain, emotional distress, and reward deficiency are thought to be obstacles for staying in standard treatment and abstaining from opioids and other drugs. To tackle these challenges, the MORE program focuses on the development of three main skills: (1) mindfulness to improve self-regulation of drug use and to reduce pain, (2) reappraisal, or looking at something in a different way, to regulate negative emotions and reduce craving, and (3) savoring, or appreciation and enjoyment, to increase natural reward processing and call to mind positive emotions.

The study results, according to the researchers, suggest that integrating MORE into standard methadone treatment could improve addiction treatment and the quality of life of people with opioid use disorder and chronic pain. The researchers also say that the findings warrant large-scale, phase III clinical trials comparing MORE to other behavioral interventions as well as strategy development to train clinicians on using MORE in existing treatment programs.