Psychiatry · 3 h ago
Mindfulness-Based Therapy Alters Prefrontal Responses in Opioid Use Disorder Trial
A randomized clinical trial compared Mindfulness-Oriented Recovery Enhancement (MORE) with psychoeducational supportive therapy in people with opioid use disorder recruited from an inpatient rehabilitation facility. MORE was associated with changes in prefrontal responses to drug and natural-reward cues, lower cue-induced craving in relation to those changes, and longer abstinence at follow-up.
- Randomized trial compared MORE with active supportive therapy.
- Drug-cue fMRI analyses included 59 participants.
- MORE was associated with longer abstinence at four-month follow-up.
- Neuroimaging and follow-up analyses used smaller subsets.
This randomized clinical trial enrolled people with opioid use disorder at an inpatient rehabilitation facility in New York between November 2020 and September 2024. Participants received eight weekly, two-hour group sessions of Mindfulness-Oriented Recovery Enhancement (MORE), which includes mindfulness, drug-cue reappraisal and savoring positive experiences, or psychoeducational supportive therapy (PST), an active control. Drug-cue fMRI analyses included 59 participants (24 MORE; 35 PST); other analyses used subsets of 37 and 38 participants.
Compared with PST, MORE reduced drug-biased activity in the middle frontal gyrus and other regions, including the precuneus, during regulation of responses to drug cues relative to natural-reward cues. In the MORE group, shifts in lateral and ventromedial prefrontal responses were associated with lower cue-induced craving. MORE also reduced medial prefrontal synchronization during drug-related movie scenes and was associated with longer abstinence at follow-up approximately four months after treatment (χ²=6.7; P=.04; Cohen w=0.19).
The findings suggest a potential neurobehavioral mechanism and support further study of MORE as an adjunct to OUD pharmacotherapy, not a replacement for it. The results are based on a modest sample, with some analyses involving fewer participants; the abstract does not provide absolute abstinence durations or effect estimates for craving. The study was registered as NCT04112186.
In practice
For people with opioid use disorder receiving care in an inpatient rehabilitation setting, this randomized trial suggests that eight weeks of Mindfulness-Oriented Recovery Enhancement may be a useful adjunct to existing treatment: compared with active psychoeducation, it was associated with longer abstinence at approximately four-month follow-up and changes in brain responses to drug and natural-reward cues. The findings do not establish that MORE should replace pharmacotherapy or support changing routine practice. The trial was modest in size, some analyses involved subsets, and the abstract provides no absolute abstinence durations.
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JAMA Psychiatry: Prefrontal Cortical Changes With Mindfulness-Oriented Recovery Enhancement in Opioid Use Disorder ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.