Posted 12.18.2019 | by AMRA

Over 15 million Americans report having an opioid use disorder, and opioid-related deaths currently exceed 45,000 per year. As people become addicted to opioids, they become more emotionally responsive to drug-related cues and less emotionally responsive to cues signaling the availability of naturally occurring rewards. Naturally occurring rewards include those that come from relationships, accomplishments, and aesthetic appreciation.

It is possible to measure this shift in cue responsiveness using an electroencephalogram (EEG). The Late Positive Potential (LPP) is an EEG wave that arises 400-800 milliseconds after a stimulus is presented. LPPs originate in the emotional processing centers of the brain and are down-regulated by the cognitive processing centers.

Opiate users show larger LPPs to drug-related cues than to natural reward cues. Moreover, larger LPPs in response to drug-related cues are associated with stronger drug-related cravings and an increased likelihood of opioid misuse. Interventions that reduce the salience of drug-related cues and restore the salience of natural reward cues can help in opioid abuse recovery.

Garland et al. [Science Advances] conducted four experiments to assess whether Mindfulness-Oriented Recovery Enhancement (MORE) could help opioid users reduce their emotional responsiveness to drug-related images (e.g., pills and pill bottles) and restore their responsiveness to images of naturally occurring rewards (e.g., social affiliation, natural beauty, sports victories). Emotional responsiveness was assessed using LPP magnitudes and participants’ subjective ratings of craving and positive affect.

The researchers randomly assigned three samples of middle-aged chronic prescription opioid users (total number of participants = 135; average opioid use duration = 10 years; 51% female; 84% Caucasian) to an 8-week Mindfulness-Oriented Recovery Enhancement (MORE) program or an 8-week support group control. The MORE program included training in mindfulness, savoring, and reappraisal skills to help shift attention from drug-related to natural reward cues and to interrupt the automaticity of the craving-drug misuse cycle. The support group was based on Rogerian non-directive empathic listening.

Participants were shown images on a computer screen of drug-related and neutral cues (experiments 1 and 2) or natural reward cues (experiments 3 and 4) before and after intervention. In experiments 1-3, EEGs were recorded while images were presented. EEGs were not recorded in experiment 4.

Participants were first asked to view the images passively. Then, in experiments 1 and 2, they were asked to try to decrease their reactivity to drug-related cues using mindfulness (non-reactive metacognitive awareness of thoughts, feelings, and sensations). In experiments 3 and 4, participants were asked to try to increase their responsiveness to natural reward cues by savoring pleasant aspects of the presented images.

In experiment 1, MORE participants decreased LPP reactivity to drug-related cues to a significantly greater degree than controls (ηpartial2=0.12) under passive and mindful viewing conditions. Mindful viewing did not enhance this effect. In experiment 2, MORE participants were more effective in using mindfulness to down-regulate their LPPs to drug-related cues than were controls (ηpartial2=0.26).

In experiment 3, MORE participants showed larger LPP increases to natural reward cues than controls (ηpartial2=0.16). In experiment 4, MORE participants reported a greater decrease in cravings in response to drug-related cues (ηpartial2=0.15) and greater positive affect in response to natural reward cues (ηpartial2=0.09) than controls.

Decreased craving to drug cues was significantly associated with increased positive affect in response to natural reward cues (r=-.41) for all participants. There were significant correlations between the amount of time participants spent practicing mindfulness skills and decreased LPP opioid cue reactivity (r=-.73), the capacity to increase LPPs to natural reward cues through mindfulness (r-.63), and reduced cravings while savoring natural reward cues (r=-.49).

The results show that MORE decreases responsiveness to drug-related stimuli while restoring responsiveness to natural rewards. This shift in cue responsiveness reduces cravings and has the potential to decrease opioid misuse. The study’s limitations include small sample sizes and a limited number of stimulus block presentations.


Garland, E. L., Atchley, R. M., Hanley, A. W., Zubieta, J. -K., & Froeliger, B. (2019). Mindfulness-Oriented recovery enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement. Science Advances.

[Link to study]