Opioid addiction represents a growing public health challenge worldwide, often beginning insidiously through the use of medications prescribed to alleviate chronic pain – a condition affecting millions of people. This problem transcends mere physical dependence; it deeply delves into the neurobiological mechanisms of the brain, hijacking an individual's ability to experience joy and pleasure in everyday, natural experiences. As addiction progresses, the brain becomes less sensitive to natural rewards, creating a state known as anhedonia – the loss of the ability to enjoy. This internal feeling of emptiness and emotional numbness often drives individuals to take increasing doses of opioids in search of a fleeting sense of relief or normality, thereby closing the vicious cycle of addiction.

In light of this complex problem, scientists and clinicians are constantly searching for more effective therapeutic approaches. One approach showing exceptionally promising results is Mindfulness-Oriented Recovery Enhancement (MORE), an innovative evidence-based therapy. Developed by Dr. Eric Garland, a distinguished professor of psychiatry at the University of California San Diego School of Medicine and holder of an endowed chair at the Sanford Institute for Empathy and Compassion, MORE represents an integrative treatment model. This approach uniquely combines mindfulness training, cognitive-behavioral therapy (CBT) techniques, and principles of positive psychology to simultaneously address key aspects of the problem: the addiction itself, accompanying emotional distress, and often present chronic pain.

New research confirms MORE therapy's ability to "reshape" the brain

The latest study, whose results were published on April 30, 2025, in the prestigious scientific journal Journal of the American Medical Association (JAMA), provides strong evidence of the neurobiological effects of MORE therapy. Researchers at UC San Diego discovered that MORE can help literally "reshape" brain responses to natural, healthy sources of pleasure. This finding suggests that the therapy not only works on a symptomatic level but also promotes fundamental changes in brain functioning in individuals addicted to opioids.

The study involved 160 individuals suffering from chronic pain, with some participants diagnosed with opioid use disorder (OUD), while others were not. Participants were recruited from primary health care facilities and pain clinics. All completed specific questionnaires and underwent a positive emotion regulation task (ER task). A key part of the study involved a subgroup of participants at risk of opioid misuse who were randomly assigned to two groups: one received individual MORE therapy over eight weeks, while the other participated in standard supportive group therapy. After the therapeutic cycle, participants underwent the ER task again, and follow-up via questionnaires continued for three months.

The results were strikingly clear: participants with OUD showed significant difficulties in enhancing positive emotions. This manifested through weakened brain responses (measured by electroencephalogram, specifically the late positive potential - LPP) when they attempted to consciously savor and deepen the experience of images representing naturally rewarding objects and experiences – such as smiling babies, puppies, or a beautiful sunset. This numbness or inability to fully experience positive emotions was directly linked to stronger opioid cravings. However, MORE therapy demonstrated the ability to heal this inability to enjoy. Participants who underwent MORE therapy showed a significant increase in brain responses to positive stimuli. Most importantly, this improvement in the neurophysiological capacity for enjoyment was associated with a 50% lower level of opioid craving compared to participants in the supportive group.

"Opioid addiction diminishes the brain's ability to experience natural, healthy pleasure, which in turn drives increased drug craving," explained Dr. Garland, the study's lead author. "Our research shows that MORE helps restore that capacity, reducing craving and potentially preventing opioid misuse." These findings suggest that MORE can play a crucial role in helping individuals with OUD regain control over their emotions and cravings, paving the way towards reducing or ceasing opioid misuse.

Mechanisms of action: More than mindfulness

The success of MORE therapy lies in its sophisticated synthesis of various therapeutic techniques targeting the fundamental mechanisms of addiction and pain. The therapy teaches specific mindfulness skills that help individuals recognize and regulate automatic reactions to craving and pain. Instead of being overwhelmed by unpleasant sensations or thoughts, they learn to observe them from a distance, without judgment and impulsive reaction. This "interruption" of the automatic chain leading from a trigger (e.g., stress, pain) to craving and potential opioid use is a key element of recovery.

Furthermore, MORE incorporates elements of cognitive therapy, particularly techniques of reappraisal or cognitive restructuring. Participants learn to identify and change negative or catastrophizing thoughts associated with pain, stress, or life adversities, seeking meaning and perspective even in difficult circumstances instead. This helps reduce the emotional distress that often fuels the desire to escape through opioids.

The third pillar of MORE therapy involves techniques from positive psychology, with an emphasis on the skill of "savoring" – consciously enjoying and deepening positive experiences. Through guided exercises, participants learn to direct attention to pleasant sensations, emotions, and moments in daily life – whether it's the taste of food, the beauty of nature, a feeling of connection with others, or a simple sense of peace. The goal is to reawaken the dormant reward system in the brain, making natural sources of pleasure attractive and fulfilling again. This process is believed to help restore balance in the brain's dopaminergic and endogenous opioid systems, which are dysregulated by chronic opioid use. Some research also suggests an influence on brain waves, particularly an increase in theta activity in the frontal lobes, which is associated with deep concentration, reduced self-focus, and experiences of self-transcendence, potentially further reducing addictive behavior.

Confirmed effectiveness through clinical trials

The results of the latest JAMA study build upon an already impressive body of evidence confirming the effectiveness of MORE therapy. To date, MORE has been tested in more than 13 randomized clinical trials involving over 1,300 participants with various issues, including chronic pain, prescription opioid addiction, heroin addiction, and comorbid psychological problems like PTSD.

One of the largest trials, published in early 2022 in the journal JAMA Internal Medicine, included 250 patients. The results showed that MORE therapy reduced opioid misuse by as much as 45% over a nine-month follow-up period. This effect was nearly three times stronger than the effect of standard supportive group therapy, which served as the control. Additionally, an impressive 50% of patients treated with MORE therapy reported a clinically significant reduction in chronic pain intensity, indicating a dual benefit of the intervention.

Another significant study, published in 2023 in JAMA Psychiatry, investigated the effectiveness of adding MORE therapy to standard addiction care, which often includes medication-assisted treatment like methadone or buprenorphine (MOUD - Medications for Opioid Use Disorder). The results showed that the combination of MORE therapy and standard care led to 42% fewer relapses (return to drug use) and as much as 59% fewer treatment dropouts compared to standard care alone. This suggests that MORE can significantly improve outcomes and patient retention within the addiction treatment system.

A unique approach for pain and addiction

One of the key advantages of MORE therapy is its ability to simultaneously target two often intertwined problems: chronic pain and opioid addiction. Many patients start using opioids precisely because of a legitimate need for pain relief, only to later develop tolerance, dependence, and paradoxically, sometimes even increased sensitivity to pain (opioid-induced hyperalgesia). Traditional approaches often treat pain and addiction separately, which can be less effective. MORE, on the other hand, through its integrated techniques of mindfulness, cognitive restructuring, and savoring, helps patients change their relationship with pain, reduce pain-related catastrophizing, regulate emotional reactions to pain, and simultaneously reduce craving and reliance on opioids. The ability to achieve clinically significant pain reduction in half of the patients in the large trial further confirms this unique dual effect.

Tremendous value for society

Besides clinical effectiveness, research also points to the exceptional cost-effectiveness of MORE therapy. It is estimated that every dollar invested in implementing MORE therapy yields a return of as much as $798 in terms of societal savings. These savings stem from a range of factors: prevention of fatal overdoses, reduced healthcare costs (fewer hospitalizations, emergency room visits), decreased involvement in the criminal justice system, and increased work productivity of individuals successfully recovering. The total estimated lifetime economic impact of MORE therapy per person undergoing treatment amounts to an impressive $320,216. These data clearly show that investing in expanding the availability of such therapies is not only an ethical imperative but also a smart economic strategy for a society facing the devastating consequences of the opioid crisis.

Need for wider application and further research

Although the results to date are extremely encouraging, experts emphasize the need for further research, particularly studies that will track the long-term effects of MORE therapy and explore its applicability in different populations and settings. "This study is a crucial step, but we need more large, long-term studies to fully understand how treatments like MORE can help heal the brain and improve recovery from opioid addiction," noted Dr. Garland.

Given the strong evidence from multiple rigorous, well-controlled clinical trials confirming the effectiveness of MORE therapy, Dr. Garland believes that now is the right time to act. He calls for collaboration with policymakers, healthcare organizations, and administrators of funds from opioid-related legal settlements to expand this evidence-based therapeutic approach nationwide and make it more accessible to those who need it most. Innovations such as the development of MORE therapy in a virtual reality format (MORE-VR), which are also being explored, could further enhance accessibility and reach an even larger number of people struggling with addiction and chronic pain, offering them a new path toward healing and a more fulfilling life.

Source: University of California