The ancient practice of mindfulness may be a powerful tool in fighting the modern-day epidemic of opioid addiction, new research suggests.
In a series of studies, an eight-week course in mindfulness techniques appeared to loosen the grip of addiction in people who had been taking prescription painkillers for years and experienced powerful cravings for the drugs.
Compared to research subjects who discussed their pain and opioid use in group sessions for eight weeks, those who focused on their breathing, bodily sensations and emotions showed evidence of reduced drug-craving and greater control over those powerful impulses.
The brains of subjects who got mindfulness training also evinced a renewal of pleasure in people, places and things that typically falls away as addiction takes hold. The brain activity of those who attended group sessions showed no evidence of having recaptured a sense of joy in life’s positive offerings.
The results were published this week in the journal Science Advances.
If borne out in further research, the findings may open a new front in a battle against an epidemic that has claimed 400,000 lives and holds roughly 2 million Americans in its grip. The study suggests that mindfulness training can help to reverse the process by which opioid drugs hijack the brain’s reward and pleasure-seeking networks, making drug use the central focus of a person’s life.
In so doing, it could become a powerful addition to — or, for some patients, a replacement for — medication-assisted treatment. That approach uses drugs such as methadone, buprenorphine and extended-release naltrexone to wean people with addiction back to a lower and safer opioid dose, or off the painkillers altogether.
Those medications are considered the most effective addiction treatments available. But a report issued in March by the National Academies of Sciences, Engineering and Medicine concluded that they are not yet widely available to most who need them. The report also noted that many patients would need to take these medications over a lifetime, as treatment for a chronic brain disease.
These drawbacks have made the search for better or complementary treatments an urgent one.
“This is another potential tool in the toolbox” of addiction treatments, said Dr. Cecilia Westbrook, a researcher and resident physician at the University of Pittsburgh’s Western Psychiatric Hospital who was not involved in the new study. Not every patient will be open to it, or have the mental powers to practice these techniques, and making it widely available to people with addiction could be a challenge, she said.
But for many, mindfulness training might be part of a powerful cocktail to fight addiction, said Westbrook, whose own work found that mindfulness can aid in smoking cessation. Just as depression treatment appears more effective when medication and psychotherapy are used together, mindfulness might help boost the impact of medication-assisted addiction treatment.
Those who study the effects of substance abuse have observed for more than a decade that as addiction takes hold, the human brain experiences profound changes. Brain regions that drive us toward pleasurable activities — to eat, play, socialize, have sex — begin to discount those normally healthy behaviors as the reward-seeking network turns up the volume on cues linked to the addictive substance.
Scientists call the result “hedonic dysregulation.” Addicts call it jones-ing.
Evolved to ensure the survival of species, these impulses to identify and move toward rewards are powerful drivers of behavior. When they’re hijacked by unhealthy substances or activities, the new normal can be a spiraling, and self-reinforcing, loss of pleasure from healthy activities.
Eric L. Garland, director of the Center on Mindfulness and Integrative Health Intervention Development at the University of Utah, wondered whether mental training could help reverse this implacable dynamic. So he recruited 135 chronic pain patients with opioid use disorder and ran some experiments.
The study participants were white men in their mid-50s on average who had typically taken opioid medications for about a decade. Many did not consider themselves addicted to painkillers, but most recognized that their opioid use had become problematic.
Garland and his team gauged the subjects’ level of hedonic dysregulation with an electroencephalogram, a device that can capture the brain’s distinct electrical signals through the scalp.
At moments when a person is viewing, pondering or reacting to a cue the elicits strong emotions, the brain’s electrical activity offers up a tell: there’s a spike in the amplitude of an electrical signal called the late positive potential, or LPP. That distinctive signal typically reflects broad activation in deeper regions of the brain that are key to the processing of emotions.
In his first experiment, using 40 subjects, Garland established that when his opioid-using subjects were shown pictures of opioid pills or pill bottles, their brains responded with much higher LPP amplitudes than when they looked at pictures of household objects unrelated to their medication.
In two experiments that followed, 95 veterans with long-term, problematic opioid use were divided into two groups. One group attended eight weekly meetings where a social worker prompted participants to express their emotions and discuss topics pertinent to chronic pain and opioid use (or misuse).
The other group got eight weeks of mindfulness training for two hours a week, and were asked to practice meditative techniques for 15 minutes a day. Subjects learned to control and focus on their breathing, progressively relax their bodies, and take note of their emotions and sensory experiences as if from a distance. They learned to recognize the longing, jitters, tightness and tingling of a drug craving. In a process sometimes called “urge surfing,” they practiced breaking cravings down into their component parts and noticing how those feelings changed as they focused their attention on them, rather than acting on them.
The mindfulness training also contained a cognitive-behavioral component. As subjects practiced conscious control of their breathing and attention to sensations, they were instructed to contemplate the consequences of indulging the craving versus remaining abstinent.
Finally, they got an intensive course in savoring the pleasures and meaning of beautiful or moving things — first a rose, and then an object, place or experience of their choosing. They practiced shifting attention away from drug cravings to those powerful objects.
After the eight weeks were up, researchers attached an array of electrodes to the participants’ scalps and measured their brains’ responses to images of pills and pill bottles.
The brain signals of those who attended group therapy suggested their emotional response to cravings had increased over eight weeks. But those who got the mindfulness training exhibited a significant downward change in their LPP response to pictures of opioids. When viewing cues that would ordinarily induce cravings, they showed a marked ability to manage those powerful prompts to action.
In a third experiment, participants were shown photos that elicit happy emotions in healthy people: friends laughing and socializing, scenes of natural beauty, and moments of athletic triumph. Then they were asked to imagine themselves being in the picture and savoring the feeling.
Those who got the mindfulness training had LPP responses that were significantly higher than their pre-treatment scores, a sign that their brains had shifted to attach more meaning and positive emotion to these happy scenes. Participants who attended group therapy sessions, by contrast, saw their LPP responses decline.
In a final test, Garland and his team asked participants to rate their feelings of drug-craving or happiness as they viewed those pictures of happy, beautiful or inspiring scenes. The graduates of mindfulness training — and especially those who were most successful at “savoring” these happy moments — assessed their opioid cravings as much less urgent than their counterparts who got group therapy.
Subjects who spent the most time spent practicing mindfulness techniques outside of class were more keenly attuned to positive pictures and less triggered by pictures of opioids. In other words, dose mattered.
“The idea that ... with care and effort you can begin to undo that rewiring that comes with addiction — that is significant,” Westbrook said.
Now the research team is extending these studies under grants from the Defense Department and National Institutes of Health. To Garland, treating addiction with mindfulness training holds the promise of making recovery stronger, more durable, and more meaningful.
“Recovery is much more than relapse prevention,” he said. “Recovery is a holistic process, and one part of that is for a patient to reclaim a meaningful life in the face of all the hardships he or she has experienced. Giving patients a specific set of tools to cultivate meaning in life is important.”