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Treatment Approach Addresses Chronic Pain, Opioid Misuse, and OUD
Recognizing a need for treatment options that simultaneously address chronic pain, opioid misuse, and opioid use disorder (OUD), Eric L. Garland, PhD, distinguished professor and associate dean for research in the University of Utah College of Social Work and director of the Center on Mindfulness and Integrated Health Intervention Development, has developed an intervention known as MORE—Mindfulness-Oriented Recovery Enhancement.
Dr Garland’s approach to recovery is rooted in affective neuroscience; it ties together complementary aspects of mindfulness training, cognitive behavioral therapy, and positive psychology. The result is an integrative therapy that targets the brain’s reward system and reduces addictive behaviors, stress, and chronic pain.
Dr Garland delivered a presentation on the MORE treatment model on Friday at the East Coast Symposium on Addictive Disorders. Ahead of his session in Baltimore, Dr Garland spoke with Addiction Professional by email to explain what makes the MORE approach unique, how it was developed, and how it has demonstrated efficacy.
Editor’s note: This interview has been edited for length and clarity.
Addiction Professional: What is Mindfulness-Oriented Recovery Enhancement, and what makes it different from other interventions that address chronic pain, opioid misuse, and opioid use disorder?
Dr Eric Garland: Mindfulness-Oriented Recovery Enhancement (MORE) is an evidence-based therapy grounded in neuroscience and supported by more than 10 clinical trials and over $40 million in grants from agencies like the National Institutes of Health and the Department of Defense. MORE unites complementary aspects of mindfulness training, cognitive behavioral therapy, and principles from positive psychology into an integrative treatment approach.
Unlike other interventions that treat pain and opioid use disorder separately, MORE was designed to address addictive behavior, emotional distress, and chronic pain simultaneously. We know that co-occurring disorders are very common: about 50% of individuals with an OUD (or other substance use disorder) also have chronic pain, and approximately one-third have a psychiatric disorder like major depression or anxiety. MORE provides a core set of therapeutic skills that can be used to help heal this complex comorbidity. MORE also stands out from other addiction treatments in that it provides training in unique, mind-body techniques that aim to increase the sense of natural healthy pleasure, joy, and meaning in life—teaching people in recovery how to use their brains to make themselves feel good, naturally.
AP: How was this approach developed?
EG: I developed the MORE program by translating fundamental discoveries from cognitive neuroscience into targeted therapeutic strategies designed to address the brain reward deficits that drive addiction and chronic pain. Addiction neuroscience shows that as a person becomes trapped in the downward spiral from chronic pain to opioid misuse and addiction. Their brain becomes more sensitive to stress, pain, and drug-related cues, while becoming less sensitive to natural healthy pleasures in life—driving them to take higher and higher doses of the drug to preserve a dwindling sense of well-being. MORE was designed to reverse this process by training the brain to shift from valuing drug-related rewards back to valuing natural, healthy rewards, thereby helping people to recover a sense of healthy pleasure, joy, and meaning in life.
AP: Can you share data and/or research findings that demonstrate the MORE approach’s efficacy?
EG: MORE has been extensively studied in multiple randomized clinical trials (RCTs) and neuroscientific experiments. In the largest study of MORE to date published in the journal JAMA Internal Medicine, MORE reduced opioid misuse by 45% by the 9-month follow-up, more than doubling the effect of standard psychotherapy. At the same time, 50% of patients reported clinically significant reductions in chronic pain. Finally, although nearly 70% of patients had major depression at the beginning of the trial, on average, patients treated with MORE no longer met the criteria for depression by the end of the study. In another study published in the journal Science Advances, MORE was shown to remediate addiction-related reward processes in the brain by training the brain to become less reactive to drug-related cues, while becoming more responsive to natural healthy pleasure. In a recent meta-analysis of MORE involving 816 patients, MORE was shown to significantly reduce addictive behavior, craving, psychiatric symptoms, and chronic pain.
AP: Is there anything you’d like to add that we have not touched on?
EG: I have provided MORE training programs to 580 addiction professionals and behavioral health clinicians around the US and internationally. Given MORE’s clear efficacy, I am now focused on disseminating this evidence-based therapy to treatment programs and healthcare systems throughout the country and around the world.
References:
Garland EL. Mindfulness-oriented recovery enhancement: an innovative neuroscience-based treatment to help heal the opioid crisis. Presented at: East Coast Symposium on Addictive Disorders. Aug. 19-21, 2022. Baltimore Maryland.
