Effects of Mindfulness-Oriented Recovery Enhancement on Biobehavioral Indices of Reward Processing in Cigarette Addiction and Prescription Opioid Misuse

PURPOSE:

Addiction involves an allostatic shift in the salience of natural rewards relative to drug rewards, such that chronic exposure to drugs results in hypersensitivity to drug-related cues coupled with insensitivity to natural pleasure derived from healthy objects and events in the social environment. This reorganization of motivational brain circuitry function around cue-elicited drug seeking and away from seeking natural rewards is thought to drive the downward spiral of addiction. A novel social work intervention, Mindfulness-Oriented Recovery Enhancement (MORE), was designed to ameliorate reward dysregulation in addiction by teaching mindful savoring as a means of restructuring reward processing mechanisms from valuation of drug rewards back to valuation of natural rewards. This presentation will describe effects of MORE on biobehavioral indices of reward processing from three studies: a pilot neuroimaging study of MORE as a treatment for cigarette smokers (Study 1), a pilot randomized controlled trial (RCT) of MORE for opioid-treated chronic pain patients (Study 2), and an ongoing NIH-funded RCT of MORE as a treatment for prescription opioid misuse (Study 3). We hypothesized that MORE would enhance natural reward processing as indicated by fMRI indices of brain activity, cardiac-autonomic responses, and self-reports, and that these increases in reward processing would be associated with decreases in drug use/misuse and craving.

METHODS:

In Study 1, nicotine dependent smokers (N=13) participated in MORE or a time-matched comparison group. Participants performed an emotion regulation and drug cue-reactivity task during fMRI sessions at baseline amd 8 weeks later. In Studies 2 (N=115) and 3 (N=37), opioid-treated chronic pain patients were randomized to MORE or a social support control group. In addition to self-report measures of clinical outcome, psychophysiological responses (heart rate and EEG) to drug and natural reward cues were assessed at pre and post-treatment. Across all three studies, the MORE intervention sessions involved training in mindfulness, cognitive reappraisal, and techniques for positive emotion regulation (i.e., finding meaning in adversity, savoring pleasant events).

RESULTS:

In Study 1, relative to the comparison group, participants in MORE showed significantly reduced activation in brain reward circuits including the ventral striatum and rostral anterior cingulate during exposure drug cues, and significantly increased activation in these same brain regions during savoring of natural rewards that was correlated with the magnitude of reduction in smoking and increase in positive emotion. In Studies 2 and 3, in addition to clinically-significant improvements in opioid misuse, craving, and pain symptoms, MORE led to significantly greater increases in cardiac-autonomic and EEG responses to natural reward cues than the control group, and significantly greater increases in positive emotion during savoring, which were associated with reduced opioid misuse and craving.

 

IMPLICATIONS FOR PRACTICE:

Findings indicate that MORE may restructure brain and autonomic indices of reward processing from valuation of drug rewards to valuation of natural rewards, and thereby ameliorate addictive behavior. Trained in mind-body interventions like MORE, social workers may help “close the health gap” by producing measurable effects on neurobiological functions integral to health and well-being.