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. 2019 Oct 16;5(10):eaax1569.
doi: 10.1126/sciadv.aax1569. eCollection 2019 Oct.

Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement

Eric L Garland  1   2 , Rachel M Atchley  3 , Adam W Hanley  1   2 , Jon-Kar Zubieta  4 , Brett Froeliger  5
Affiliations

Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement

Eric L Garland et al. Sci Adv. .

Abstract

Addiction neuroscience models posit that recurrent drug use increases reactivity to drug-related cues and blunts responsiveness to natural rewards, propelling a cycle of hedonic dysregulation that drives addictive behavior. Here, we assessed whether a cognitive intervention for addiction, Mindfulness-Oriented Recovery Enhancement (MORE), could restructure reward responsiveness from valuation of drug-related reward back to valuation of natural reward. Before and after 8 weeks of MORE or a support group control, prescription opioid users (N = 135) viewed opioid and natural reward cues while an electroencephalogram biomarker of target engagement was assessed. MORE was associated with decreased opioid cue-reactivity and enhanced capacity to regulate responses to opioid and natural reward cues. Increased positive affective responses to natural reward cues were associated with decreased craving and mediated MORE's therapeutic effects on opioid misuse. This series of randomized experiments provide the first neurophysiological evidence that an integrative behavioral treatment can remediate hedonic dysregulation among chronic opioid users.

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Figures

Fig. 1
Fig. 1. Experiment 1: Treatment effects on centroparietal LPP during opioid cue-reactivity.
(A) Experiment 1: Treatment by time effects on centroparietal LPP during opioid cue-reactivity. (B) Experiment 1: Change in centroparietal LPP (in μV) index of opioid cue-reactivity (opioid cue − neutral cue) from pretreatment to posttreatment (n = 40).
Fig. 2
Fig. 2. Experiment 2: Treatment effects on centroparietal LPP during down-regulation of opioid cue-reactivity.
(A) Experiment 2: Treatment by time effects on centroparietal LPP during down-regulation of opioid cue-reactivity. (B) Experiment 2: Change in centroparietal LPP (in μV) index of regulation of opioid cue-reactivity (regulate-view) from pretreatment to posttreatment (n = 24).
Fig. 3
Fig. 3. Experiment 3: Treatment effects on centroparietal LPP during up-regulation of natural reward.
(A) Experiment 3. Treatment by time effects on centroparietal LPP during up-regulation of natural reward. (B) Experiment 3: Change in LPP (in μV) index of regulation of natural reward cue-reactivity (regulate − view) from pretreatment to posttreatment (n = 29).
Fig. 4
Fig. 4. Experiment 4: Treatment effects on positive affect and craving ratings across view and regulate conditions of the natural reward cue-reactivity task.
(A) Experiment 4: Change in positive affect ratings (log transformed) across view and regulate conditions of the natural reward cue-reactivity task from pretreatment to posttreatment (n = 64). (B) Experiment 4: Change in craving ratings (log-transformed) during up-regulation of natural reward cue-reactivity (regulate − view) from pretreatment to posttreatment (n = 64). (C) Experiment 4: Associations between treatment-related changes in positive affect reactivity and decreases in craving during up-regulation of responding to natural reward (n = 64). Note that several cases had identical change scores and are therefore represented by a single data point in the scatterplot.
Fig. 5
Fig. 5. Path analysis demonstrating that the effect of MORE on reducing opioid misuse by 3-month follow-up is mediated by increased positive affective reactivity to natural reward cues.
See this image and copyright information in PMC

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