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SALT LAKE CITY — A series of studies headed by a University of Utah professor suggest that mindfulness training — or meditation — can help those struggling with opioid addiction.
Mindfulness-Oriented Recovery Enhancement, or MORE, is a program developed by Eric Garland, director of the Center on Mindfulness and Integrative Health Intervention Development and the associate dean for research in the U.'s College of Social Work.
Through several studies, one of which is slated to be published this summer, he found the program helped people recover from and even prevent opioid addiction, more so than traditional group therapy.
He calls opioid addiction the "disease of despair" and said logically it should then be treated with positive therapy.
But mindfulness training doesn't just help people overcome addiction — it can potentially reduce the actual pain in those experiencing chronic pain, he said.
In his 2014 study of 115 opioid prescribed participants, Garland said the results were "pretty promising."
He said the study showed that Mindfulness-Oriented Recovery Enhancement significantly decreased pain, functional impairment, opioid craving and opioid misuse.
The 115 patients were divided into two groups: One underwent eight weeks of weekly mindfulness training and the other completed eight weeks of traditional group therapy sessions.
"To do that we started using neuroscience methods to examine how the (mindfulness) therapy was changing people's brains and changing their bodies and we found, pretty amazingly, that one of the ways the therapy seemed to be working was by teaching people how to become more sensitive to natural pleasure."
This idea is important when looked at through the lens of addiction neuroscience, he noted.
"What happens when people become more and more addicted is that they become less responsive to natural pleasure," he said. In other words, the things that used to make them feel happy or used to matter to them, no longer evoke the same response.
"They become blunted to joy from everyday events and experiences and that kind of pushes them to take higher and higher doses of the drug just to feel OK," he added.
He explained this process happens because of changes that occur in the brain, specifically the reward system of the brain.
"Mindfulness Oriented Recovery Enhancement seemed to be reversing this process by increasing physiological sensitivity to natural pleasure," he said. "We saw this by changes in people's heart rate as they were looking at pictures of smiling babies, beautiful sunsets, lovers holding hands, you know we showed them pictures of things that should be naturally rewarding."
After the eight weeks of hourlong weekly mindfulness training sessions, by using EEG to measure brain waves, researchers could see their brains became more responsive to the pleasurable stimuli as well.
"And what was really amazing was that the more physiologically responsive to the natural pleasure that people became, the less they craved their opioids," he said. "And then several years later we also found the more physiologically responsive to natural pleasure they became, the less they actually misused opioids. Those were some huge findings."
Six Utahns die every week from opioid overdose and the Beehive State has the seventh highest drug overdose rate in the nation, according to Utah Department of Health's website dedicated to ending the "opidemic."
As a result of the 2014 study findings, Garland said he received more than $15 million in federal research funding. He is now conducting a clinical trial, funded by National Institute on Drug Abuse, to examine if Mindfulness-Oriented Recovery Enhancement could be implemented in primary care as a regular therapy for patients with opioid-treated chronic pain.
Garland recently finished another clinical trial, funded by a private foundation and slated to be published this summer in the Journal of Consulting and Clinical Psychology, that looked at an opioid-prescribed chronic pain sample that hasn't progressed into clinical misuse of the drug. This study aimed to further test the results of the 2014 study, and to see whether mindfulness therapy could prevent opioid misuse in the future.
"So these are people who are in pain, they're taking pain pills everyday and they're compliant at this point, they're adhering to their doctor's prescription," he explained. "But because they're on high doses of opioids and because they've been taking opioids for many years, they're at risk for misusing opioids or becoming addicted."
He said these findings suggest that some of the key neurobiological changes that happen in addiction might be reversible through Mindfulness-Oriented Recovery Enhancement by decreasing pain and preventing development of opioid misuse.
Mindfulness Oriented Recovery Enhancement seemed to be reversing this process by increasing physiological sensitivity to natural pleasure. We saw this by changes in people's heart rate as they were looking at pictures of smiling babies, beautiful sunsets, lovers holding hands, you know we showed them pictures of things that should be naturally rewarding.
–Eric Garland
"Pretty much what it says is that if we increase people's positive psychological experiences, then this decreases their pain and opioid misuse," he said.
Since the results of the mindfulness therapy studies looked promising, Garland, along with another researcher completed a study to see if the treatment could prevent bad habits from developing in the first place in a non-opioid prescribed population.
Instead of training someone to automatically react to a stimuli, what Ivan Pavlov did in his famous experiments where he trained dogs to salivate anytime they heard a bell ring, researchers were looking to interrupt those automatic responses.
Adam Hanley, lead author of the study and a research assistant professor at the U.’s Center on Mindfulness and Integrative Health Intervention Development, said the implications of this study show the benefits of mindfulness therapy can be far-reaching.
The study looked to answer two questions: whether mindfulness would disrupt the initial formation of a habit and if it can disrupt the continuation of habits.
Hanley and Garland, associate author of the research, divided 49 healthy participants — made up of 36 women and 13 men between the ages of 18 and 43 — into two groups and trained one group to meditate using mindfulness, while the other group listened to excerpts of a book read aloud. Both groups were then conditioned to blink when they heard a "beep" that signaled an air-puff to one eye, causing them to blink.
The book group blinked at the sound of the beep, just like the sound of a bell made Pavlov’s dogs salivate. But the mindfulness group was slower to develop the conditioned response and blinked less often than the book group.
The findings suggest that meditation training can delay the development of Pavlovian conditioning and decrease the frequency of the behavior once developed, Hanley said.
This is the first study, according to Hanley, that shows mindfulness training can disrupt the development of conditioned behaviors and he said the study helped answer that basic scientific question.
"Maybe if we can catch children early and kind of integrate mindfulness into the education system, then potentially we can inoculate people against developing these bad habits," Hanley said. "So if they have these mindfulness skills to kind of regulate and be aware of when they're acting automatically then maybe we can stop drug addiction, mental health concerns from popping up before they emerge or before they dig in."
Garland is also conducting another study, funded by the Department of Defense, with an opioid-prescribed veteran population that, just like the previous studies, are split into two groups with different interventions: one undergoes eight weeks of mindfulness training and the other attends a typical weekly group therapy session.
Brandon Yabko, Mindfulness Center director at Salt Lake's Veterans Hospital, leads both groups in the veterans research study and noted that in the group therapy session, a lot of the support is based on group members holding each other accountable.
"My anecdotal kind of data gathering would venture to say that after the support group ends, that's where the decrease or anything in opiates ends as well," he said. "Whereas people in the mindfulness group are learning a skill to have with them for the rest of their life."
Yabko, who has chronic back pain, explained that chronic pain patients tend to amplify the pain by adding insult to injury. It's common to add suffering on top of the actual pain being experienced, which makes the overall pain worse, he said.
He said mindfulness training helps mitigate this issue by teaching patients not to focus only on the pain, but to look at the broader picture and focus on the parts of the body not in pain.
Garland said he is always looking for new opioid-prescribed patients to participate in his studies. He encouraged people to reach out to him if they are interested in participating at drericgarland.com.
