Improving treatment outcomes is a key factor in combatting the opioid epidemic. According to the 2023 National Survey on Drug Use and Health, more than 8.9 million people in the U.S. over the age of 12 misused opioids and 5.7 million had an opioid use disorder (OUD).¹ While methadone is the most common medication for OUD,² data shows more than half of people who begin treatment stop within the first year.³ Of those who continue to participate in methadone treatment programs, 50% return to substance use within six months.⁴

While work to improve these outcomes continues, a recent study published in JAMA Psychiatry provides hope. It shows that adding Mindfulness-Oriented Recovery Enhancement (MORE) therapy to methadone treatment may help to increase OUD treatment adherence and effectiveness in people with OUD and chronic pain.

The study revealed that participants who received eight weeks of MORE therapy along with the standard methadone treatment plan had a 42% greater reduction in substance use and a 59% greater decline in treatment discontinuation rates after 16 weeks compared to participants who were only on the standard methadone treatment plan.

Mindfulness-Oriented Recovery Enhancement (MORE) Therapy

MORE, an evidence-based behavioral group therapy developed by Eric Garland, Ph.D., LCSW, Endowed Professor at the Sanford Institute for Empathy and Compassion and professor in the Department of Psychiatry at University of California San Diego, combines mindfulness training, cognitive-behavioral therapy, and principles from positive psychology into a single, integrated therapeutic approach.

The MORE program seeks to improve standard methadone treatment outcomes by expanding skills in three key areas:

1. Mindfulness, or training present-moment attention and awareness, to improve self-regulation of substance use and reduce pain
2. Reappraisal, or reframing negative thoughts about a stressful situation, to regulate negative emotions and reduce craving
3. Savoring, or appreciation and enjoyment of natural healthy rewards, to increase pleasure and encourage positive emotions

Researchers have now studied MORE therapy in 12 clinical trials where it has demonstrated efficacy for reducing opioid use, craving, emotional distress, and pain.^5-10

Anna Parisi, Ph.D., assistant professor at George Mason University, is a clinical social worker who has provided MORE therapy since 2021. Her experience with the approach has also been positive.

“MORE is unique not only in its ability to reduce craving, substance use, and physical and emotional pain, but also its focus on teaching participants how to reconnect with the natural sources of pleasure and joy in their daily lives,” says Parisi. “I've seen participants strengthen their relationships with their children and families, rediscover lost hobbies and experience a renewed sense of connection and fulfillment with the world around them.”

MORE Study Results

Nina Cooperman, Psy.D., an associate professor of psychiatry at the Robert Wood Johnson Medical School at Rutgers University, led the most recent MORE study, which was funded by the National Center for Complementary and Integrative Health at the National Institutes of Health.

The study included 154 people with OUD and chronic pain. The participants were divided into two groups. The first group received the standard methadone treatment plan plus eight weeks of MORE therapy. The second group received only the standard methadone treatment plan.

After 16 weeks, nearly 84% of participants receiving only the standard care plan were still taking their methadone treatment as prescribed. In contrast, over 95% of the participants receiving MORE therapy plus the standard care plan adhered to their methadone treatment. Participants in the MORE therapy group also showed a significant decrease in substance use, pain, and depression. Further research is needed to provide additional long-term outcome data and compare MORE to other interventions.

Learn More About MORE

As clinicians have become aware of the research results, many have expressed interest in learning about MORE therapy. To date, over 1,000 providers, such as doctors, therapists, and others who specialize in OUD treatment, have completed MORE therapy training provided by the study team.

Many clinicians, like Trish Dooley Budsock, M.A., LPC, a program manager in the Division of Addiction Psychiatry in the Robert Wood Johnson Medical School at Rutgers, use MORE therapy in their practice and have provided positive feedback on the program results:

“As someone who has worked in a variety of addiction settings since 1995, I have witnessed an extraordinary amount of suffering in individuals struggling with addictive and co-occurring disorders. I was trained in MORE in late 2018 and began delivering sessions in 2019. This is an intervention that has demonstrated both during in-person and virtual settings a level of healing that I have not seen in any other treatment approach I have provided.”

Read the MORE Study manuscript

Learn about MORE training

REFERENCES

1. Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health (HHS Publication No. PEP24-07-021, NSDUH Series H-59). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report
2. Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies—tackling the opioid-overdose epidemic. N Engl J Med. 2014;370(22):2063-2066. doi:1056/NEJMp1402780
3. Bao YP, Liu ZM, Epstein DH, Du C, Shi J, Lu L. A meta-analysis of retention in methadone maintenance by dose and dosing strategy. Am J Drug Alcohol Abuse. 2009;35(1):28-33. doi:10.1080/00952990802342899
4. Naji L, Dennis BB, BaworM, et al. A prospective study to investigate predictors of relapse among patients with opioid use disorder treated with methadone. Subst Abuse. 2016;10:9-18. doi:4137/SART.S37030
5. Garland EL, Manusov EG, Froeliger B, Kelly A, Williams JM, Howard MO. Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial. J Consult Clin Psychol. 2014;82(3):448-459. doi:1037/a0035798
6. Garland EL, Hudak J, Hanley AW, Nakamura Y. Mindfulness-oriented recovery enhancement reduces opioid dose in primary care by strengthening autonomic regulation during meditation. Am Psychol. 2020;75(6):840-852. doi:1037/amp0000638
7. Garland EL, Hanley AW, Riquino MR, et al. Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: a randomized controlled trial. J Consult Clin Psychol. 2019;87(10): 927-940. doi:1037/ccp0000390
8. Garland EL, Manusov EG, Froeliger B, Kelly A, Williams JM, Howard MO. Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial. J Consult Clin Psychol. 2014;82(3):448-459. doi:1037/a0035798
9. Garland EL, Hanley AW, Nakamura Y, et al. Mindfulness-oriented recovery enhancement vs supportive group therapy for co-occurring opioid misuse and chronic pain in primary care: a randomized clinical trial. JAMA Intern Med. 2022; 182(4):407-417. doi:1001/jamainternmed.2022.0033
10. Garland EL, Nakamura Y, Bryan CJ, Hanley AW, Parisi A, Froeliger B, Marchand WR, Donaldson GW. Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial. Am J Psychiatry. 2024 Feb 1;181(2):125-134. doi: 10.1176/appi.ajp.20230272.

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