Healing Addiction and Pain in Communities Fighting Racism and Poverty with Mindfulness-Oriented Recovery Enhancement

Background: Addiction and chronic pain have been termed “diseases of despair” in the sociological and epidemiological literatures. This term is not a mere metaphor, but strikes right at the heart of the pathogenic mechanisms driving these crises. The diseases of despair have many sources, from the rising tide of income inequality and the lack of opportunity to racial disparities and intergenerational trauma. Unfortunately, there is a dearth of research on addiction and chronic pain outcomes from randomized clinical trials (RCTs) conducted in communities facing racism and poverty. Here we will report data from a secondary analysis of multiple RCTs of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative social work intervention designed to simultaneously address addictive behavior, emotional distress, and chronic pain, with a focus on NIH- and SAMHSA-funded studies including samples with substantial proportions of low-income and racially diverse participants.

Methods: In Study 1 (N=180), participants from an inpatient addictions treatment program in North Carolina were randomized to 8 weeks of MORE, cognitive-behavioral therapy (CBT), or treatment-as-usual (TAU). In Study 2 (N=115), participants from the community in Florida were randomized to MORE or a support group (SG). In Study 3 (N=30), participants from urban methadone clinics in New Jersey were randomized to MORE or TAU. And in Study 4 (N=250), participants from primary care clinics in Utah were randomized to MORE or SG. These trials examined outcomes including substance use/misuse, craving, chronic pain, depression, anxiety, trauma, and meaning-in-life; outcomes were assessed at post-treatment, and as far as a 9 month follow-up. Outcomes were analyzed with an intention-to-treat approach via linear mixed ANCOVA models with maximum likelihood estimation, and moderation analyses examined race/ethnicity and income as treatment response moderators.

Results: Study 1 found that MORE reduced craving (p=.03) and PTSD symptoms (p=.04) to a greater extent than CBT or TAU. Study 2 found that MORE reduced opioid misuse (p≤.05) and chronic pain (p=.003) to a greater extent than the SG. Study 3 found that MORE reduced days of heroin use (p=.032), craving (p=.02), depression (p=.01), and anxiety (p=.03) to a greater extent than TAU. Study 4 found that MORE improved opioid misuse (p=.01), pain (p<.001), and meaning in life (p=.049) to a greater extent that SG. Moderation analysis found that the interaction effect between race/ethnicity and treatment condition was non-significant, indicating that race-ethnicity did not moderate the effect of MORE on clinical outcomes. Similarly, the interaction effect between income and treatment condition was non-significant, indicating that MORE was as effective for individuals from a low socioeconomic status (SES) as those from a middle and upper SES.

Conclusions and Implications: Across multiple, federally-funded RCTs, MORE demonstrated efficacy for outcomes related to addiction and (physical and emotional) pain in participants from communities facing racism and poverty. Given the broad applicability and acceptability of this evidence-based social work intervention, MORE should now be disseminated for implementation by social workers in multiple practice settings to alleviate “diseases of despair” and improve health equity.