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Mindfulness-Oriented Recovery Enhancement (MORE), a behavioral therapy used alongside medication treatment, may help people with opioid use disorder respond differently to drug-related cues and natural rewards, according to a randomized clinical trial led by researchers at the Icahn School of Medicine at Mount Sinai. The findings offer insight into how MORE may reduce opioid craving and support recovery.

Published in JAMA Psychiatry, the study used brain imaging to examine how MORE affects the prefrontal cortex, which helps regulate behavior, make decisions and evaluate rewards. After eight weeks, participants who received MORE showed changes in brain activity while regulating their responses to drug-related images. These changes were associated with greater reductions in craving.

At a follow-up visit approximately four months after treatment, participants receiving MORE also had greater increases in the duration of abstinence than those receiving a comparison therapy.

"Opioid use disorder is a chronic condition that can involve persistent cravings and a risk of relapse, even among people receiving medications such as methadone or buprenorphine," says Rita Z. Goldstein, Mount Sinai professor in neuroimaging of addiction at the Icahn School of Medicine at Mount Sinai and senior author of the paper. "While these medications are established treatments, additional approaches that help people manage cravings and engage with rewarding experiences beyond drug use could further support recovery."

"The prefrontal cortex sits at the top of the brain's hierarchy for self-control and for assigning value to our experiences, and in addiction these functions are hijacked by drug cues at the expense of other rewards," Goldstein continues.

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