Researchers from the University of California San Diego have found that Mindfulness-Oriented Recovery Enhancement (MORE) can help rewire the brain’s response to natural healthy pleasure, leading to improved mood, greater attention to positive experiences and reduced opioid cravings. The findings, published on April 30 in the Journal of the American Medical Association (JAMA), suggest that this evidence-based therapy may be a promising tool in the fight against opioid use disorder (OUD).

Opioid addiction can develop when individuals misuse opioids originally prescribed for chronic pain, a condition affecting 50 million Americans each year, according to Proceedings of the National Academy of Sciences. As people become increasingly dependent on opioids, they begin to lose the ability to feel joy and meaning in everyday life, driving them to seek higher doses to maintain a fleeting sense of well-being — a cycle that can lead to opioid addiction.

MORE, a program developed by Eric Garland, Ph.D., professor of psychiatry at UC San Diego School of Medicine and endowed professor at the Sanford Institute for Empathy and Compassion, is an evidence-based therapy that integrates mindfulness training, cognitive behavioral therapy and positive psychology techniques to address addiction, emotional distress and chronic pain simultaneously. MORE teaches mindfulness skills to regulate craving, relieve pain and recover the ability to savor natural healthy pleasure, joy and meaning in life.

The study included 160 individuals with chronic pain — both with and without OUD — recruited from primary care and pain clinics. Participants completed a positive emotion regulation (ER) task and questionnaires. A subsample of participants at risk for opioid misuse were randomized to one-on-one, eight weeks of MORE or supportive group therapy and then completed the ER task at posttreatment and questionnaires through 3-month follow-up.

Participants with OUD showed difficulty enhancing positive emotions, as seen in weakened brain responses when they tried to savor images representing naturally rewarding objects and experiences, such as smiling babies, puppies or a beautiful sunset. This blunting or numbing of positive emotions was directly linked to higher opioid cravings. However, the MORE therapy helped to heal this inability to savor by increasing brain responses to positive stimuli, which was associated with 50% lower opioid craving than standard group therapy. The results indicate that MORE could play a vital role in helping people with OUD regain control over their emotions and cravings, potentially reducing opioid misuse.

“Opioid addiction decreases the brain’s ability to experience natural healthy pleasure, driving increased cravings for the drug,” said Garland, the study’s lead author. “Our research shows that MORE helps restore this capacity, reducing cravings and potentially preventing opioid misuse.”

To date, MORE has been tested in over 10 randomized clinical trials involving more than 1,000 people. In the largest clinical trial involving 250 patients — published in JAMA Internal Medicine in early 2022 — MORE decreased opioid misuse by 45% at a 9-month follow-up, nearly tripling the effect of standard group therapy. In addition, 50% of patients treated with MORE reported clinically significant decreases in chronic pain. A 2023 estudio published in JAMA Psychiatry, showed that adding MORE to standard addictions care resulted in 42% less relapse and 59% less dropout from treatment when compared to standard addictions care alone.

Over the previous 20 years, Garland’s research and development of MORE therapy has been supported by grants from the National Institutes of Health (NIH). New research shows that for every $1 spent on MORE, there are $798 in estimated cost savings on the prevention of fatal overdoses, reduced healthcare costs, decreased criminal justice involvement, and increased labor productivity. The lifetime economic impact of MORE is estimated to be $320,216 per person treated with MORE — a huge return on investment for society.

“This study is a crucial step, but we need more large-scale and long-term research to fully understand how treatments like MORE can help heal the brain to enhance recovery from opioid addiction,” Garland added. “Multiple rigorous, well-controlled clinical trials have demonstrated the efficacy of the MORE therapy. It is now the right moment to partner with policymakers, healthcare organizations, and administrators of the opioid legal settlement to disseminate this evidence-based treatment nationwide to help alleviate the opioid crisis.”