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Autonomic activity while meditating linked to less opioid use

Posted 10.28.2020 | by AMRA

The over-prescription of opioids for chronic pain is a significant risk factor for drug abuse and addiction. About one-fifth of chronic pain patients double their opioid dosage over the course of two years, and so primary care psychological interventions are needed to reduce the risk of eventual misuse and dependence.

In a previous clinical trial, a mindfulness training program for opioid users reduced pain and opioid dosage in chronic pain patients. Garland et al. [American Psychologist] conducted a secondary analysis of that clinical trial, now examining whether physiological changes in heart rate variability (HRV) predict opioid dose reduction. HRV is the variation of time between each heartbeat and serves as a biomarker for increased autonomic nervous system self-regulation. Greater HRV is associated with relaxation and greater emotional and behavioral self-control.

The researchers randomly assigned 95 primary care patients who were prescribed opioids for the management of chronic musculoskeletal pain (66% female; 90% Caucasian; average age = 57 years) to Mindfulness-Oriented Recovery Enhancement (MORE) or a support group. Both MORE and support groups were delivered once weekly for 2 hours across 8 weeks.

MORE included didactics and practice in mindfulness, cognitive reappraisal, and savoring naturally occurring rewards that included 15 minutes a day of home practice in these skills. Emphasis was placed on making the skills relevant to substance abuse, pain, stress reduction and self-regulation. The support group included nondirective counseling, social support, home journaling, and discussions of chronic pain, stigma, and stress.

Daily opioid dosage before and after intervention was assessed using retrospective self-report and prescription data from the medical record. After intervention, HRV was measured via electrocardiogram during a 5-minute baseline recording and a […]

October 28th, 2020|News|

Opioid users reduce emotional cling to drug images after MBI

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 […]

November 18th, 2019|News|

Mindfulness program prevents dropout from addictions treatment

Posted 08.19.2019 | by AMRA

Many women attending residential substance use disorder treatment fail to successfully complete their program. These women often have complex social histories, multiple psychiatric and medical diagnoses, and histories of incarceration. They may also have trouble adjusting to the programs due to conflicts with staff and peers, substance withdrawal and cravings, and difficulty abiding by program rules and structure. Mindfulness may help women negotiate these difficulties by reducing their automatic reactivity to cravings, interpersonal conflicts, and other emotional triggers.

Black et al. [Behaviour Research and Therapy] studied whether a mindfulness-based intervention specifically designed for women in residential substance use disorder treatment settings could reduce the likelihood of prematurely leaving the program in unimproved condition.

The researchers randomly assigned 200 women in residential substance use disorder treatment (average age = 33 years; 58% Hispanic; 62% with incarceration history; 76% with amphetamine/methamphetamine abuse) to either the Moment-by-Moment Women’s Recovery (MMWR) program or a time-matched psycho-educational control.

Both were add-on interventions with participants continuing to receive all of the services ordinarily provided by the residential treatment program. In both of the interventions, the participants met twice weekly for 80-minute group sessions over the course of six weeks.

The MMWR program was based on Mindfulness-Based Stress Reduction, but specifically designed for ethnoracially diverse women in residential substance use treatment. The program addressed the role of mindfulness in dealing with cravings and relapse, trauma, parenting, conflicts with staff and peers, and other issues likely to arise in treatment.

The psycho-educational control consisted of didactic material regarding brain structure, function, and biochemical changes pertaining to substance abuse. Attendance in both groups averaged 9 out of 12 classes, and participants rated both groups highly in […]

August 19th, 2019|News|

MBSR changes brain networks of opiate dependent patients

Posted 03.14.2018 | by AMRA

The United States is in the midst of an opioid epidemic, with over 42,000 opioid overdose related deaths in 2016. There is a clear need for innovative approaches to help deal with the problems of substance dependency and misuse. Mindfulness-based interventions are sometimes used as adjunctive treatments for substance use disorders, but little is known about how these interventions affect the brains of substance users.

Fahmy et al. [Addictive Behaviors] used structural magnetic resonance imaging (MRI) to investigate brain changes in opiate dependent patients undergoing either treatment-as-usual (TAU), or treatment-as-usual plus Mindfulness-Based Stress Reduction (MBSR).

MRI data were analyzed to identify structural changes in the cellular networks connecting brain regions. The researchers limited their investigation to regions previously shown to be of interest in addiction and mindfulness research. They also looked at whether structural brain network changes were accompanied by meaningful changes in personality traits relevant to recovery and relapse.

The study followed 28 opiate dependent patients (average age = 30 years; 89% male) in a four-week inpatient substance treatment program in Cairo, Egypt. Half the participants were assigned to treatment as usual (TAU) and half to MBSR. Assignment was based on order of enrollment in the study and was not strictly random.

Nineteen participants completed their treatments and post-treatment evaluations. There was no difference in treatment dropout rates. TAU included medication and group cognitive behavioral therapy. The MBSR program was a culturally adopted Arabic-language version of MBSR. Participants completed the Freiburg Mindfulness Inventory (FMI), self-reported measures of distress tolerance, sensation seeking, impulsivity, and addiction severity, and underwent MRI scanning before and after treatment.

MBSR participants showed significant strengthening in the brain networks connecting the prefrontal cortex […]

March 14th, 2018|News|

MBRP practice loosens grip of craving on substance use

Posted 10.19.2017 | by AMRA

Roughly half of all substance use program graduates relapse within six months. This has led researchers to seek better ways of reducing the frequency and severity of relapses after treatment. Mindfulness-Based Relapse Prevention (MBRP) is a program offered after residential or intensive outpatient treatment to prevent relapse.

MBRP teaches mindfulness skills to help substance users cope more effectively with their cravings. Rather than treating cravings as a danger to be avoided, MBRP approaches cravings as transient mental states that can be investigated and tolerated without triggering relapse.

Using data from a previously published MBRP trial, Enkema & Bowen [Drug and Alcohol Dependence] investigated whether MBRP actually weakened the association between craving and substance use. They reasoned that if it did, the link between craving and subsequent use would be weakest for those who practiced mindfulness meditation the most.

The 57 study participants (77% male, 63% Caucasian, average age = 38 years) had been randomly assigned to the MBRP arm of a parent study comparing MBRP to other aftercare programs. The participants had completed either an inpatient or intensive outpatient substance use program before starting MBRP.

In the previously published parent study, MBRP participants showed a 54% reduced risk of drug use and a 59% decreased risk of heavy drinking compared with the participants in comparison treatments.

The present study made use of MBRP participants’ reports of the quantity and frequency of their substance use (if any) during the six-month period following their completion of the program. The participants also indicated the intensity of their cravings and the extent of their formal (e.g. seated meditation) and informal (e.g., using mindfulness to “urge surf” cravings) mindfulness practice within the […]

October 19th, 2017|News|

Eating for pleasure: Biomarker identified for mindful eating

Posted 06.15.2015 | by AMRA

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Eating is often an enjoyable experience, and at times we eat more for pleasure (“hedonic eating”) than to provide nutrition or reduce hunger. Since pleasure occurs in response to the brain’s release of endogenous opioids (morphine-like neurotransmitters manufactured in the brain), the opioid system plays an important role in hedonic eating. This activity can be measured indirectly by administering naltrexone, an opioid-blocking drug that triggers cortisol secretion and sensations of nausea.

Prior research has shown that overweight women with larger cortisol or nausea responses to naltrexone are more prone to binge and emotional eating and less likely to gain weight during a mindfulness-based overeating intervention. Mason et al. [Appetite] sought to replicate and extend these findings in a large-scale randomized, controlled study of weight-loss programs with and without a mindfulness component.

Eighty-eight obese women (mean age = 47, mean BMI = 36 kg/m2) were randomly assigned to five-month diet-and-exercise-based weight-loss programs which included either a mindfulness component (based on MBSR and MB-EAT) or an active control component that included cognitive-behavioral techniques and progressive muscle relaxation.

Both programs involved sixteen 2 to 2.5 hour-long group sessions and one all-day session. Prior to randomization, participants were assessed for their naltrexone-induced salivary cortisol and nausea responses. Participants self-rated their food addiction, binge-eating, and reward-based, mindful, and emotional eating before and after treatment.

Participants’ naltrexone-induced cortisol responses were significantly correlated positively with reward-based eating and food addiction, and negatively with mindful eating. Participants with the largest cortisol responses in the mindfulness group showed significantly greater reduction in food addiction symptoms than participants with the largest cortisol responses in the control group.

Women who experienced naltrexone-induced nausea reported a statistically greater […]

June 15th, 2015|News|

MBRP-W for culturally diverse underserved women

Posted: 04.25.2014 | by AMRA

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An estimated 40% to 60% of substance abusers relapse following treatment, emphasizing the need for the development of more effective relapse prevention and harm reduction approaches. While mindfulness-based relapse prevention approaches may have considerable theoretical appeal, traditional mindfulness programs may not be completely suitable for underserved populations who have their own unique needs, and may need to be modified accordingly.

Amaro et al. [Subst Use Misuse.] studied the feasibility and benefits of incorporating “Moment-by-Moment in Women’s Recovery: A Mindfulness-Based Approach to Relapse Prevention” (MBRP-W) into existing substance use programs serving a culturally diverse, low-income cohort of women with trauma exposure histories. The 9-week program used a modified MBSR format designed to increase its relevance to women with issues of addiction, relapse, mental illness, low literacy levels, and trauma.

Three hundred and eighteen low-income ethnically-diverse women who were actively attending publicly-funded substance use programs were enrolled additionally in the MBRP-W program. The cohort was 45.3% Hispanic, 34.6% non-Hispanic Black, and 20.1% non-Hispanic White, with 45.6% having been court-mandated to treatment. Based on the difficulties of meeting the logistical demands of residential treatment, 44.3% of the women attended no sessions, 19.8% attended 1-4 sessions, and 35.8% attended 5-9 sessions. Scheduling conflicts with courts, medical providers, child protective services, and dropout from their primary clinic all contributed to attrition and lowered attendance.

Average satisfaction ratings from those who attended the final MBRP-W session were “very good to excellent” on program usefulness, quality, and importance. Participants who attended 5 or more sessions showed significantly greater rates of decline in alcohol addiction over 12 months, and greater declines in drug addiction at 6 and 12 months, than those who never […]

April 25th, 2014|News|