Mindfulness-Based Interventions for Opioid Use

Mindfulness-based interventions for substance use, such as Mindfulness-Based Relapse Prevention (MBRP) and Mindfulness-Oriented Recovery Enhancement (MORE), teach mindfulness-based skills for recognizing and resisting the urge to respond to triggers for substance use, including guided meditations, daily mindfulness-building activities, and relapse prevention skills.

Evidence for the intervention

Evidence for mindfulness-based interventions for persons with substance use disorders comes from multiple randomized control trials, which have been summarized in systematic reviews and meta-analyses; in these trials, the interventions are typically delivered by highly trained research staff. The evidence for mindfulness-based interventions for persons with opioid use disorder primarily comes from studies testing it as an adjunctive intervention, as delivered by highly trained clinicians. Studies consistently find that mindfulness-based interventions help reduce alcohol, nicotine, cocaine, and opioid use when delivered by highly trained clinicians and when delivered in combination with medication for opioid use disorder. There is limited evidence for its use when delivered by front-line clinicians in busy clinical settings, and no data supporting its use as a stand-alone treatment for opioid use disorder.

Evidence-based Scale

Mindfulness-based interventions for substance use help people manage complicated feelings and sensations that lead to alcohol or drug use by focusing on the present moment with openness and curiosity. The underlying theory of mindfulness-based interventions for substance use is that addiction reflects an underlying tendency towards reacting habitually to stressors in the present moment without thinking of the long-term consequences, resulting in an “automatic” response to engage in addictive behaviors or use drugs. Mindfulness cultivates greater awareness of the present moment and can help patients improve their ability to self-regulate and reduce their habitual addictive behaviors.

Two common mindfulness-based approaches for substance use include Mindfulness-Based Relapse Prevention (MBRP) and Mindfulness-Oriented Recovery Enhancement (MORE), which are both rooted in principles of cognitive-behavioral therapy. MBRP was developed specifically for patients with substance use disorders, whereas MORE was developed for patients with co-occurring substance use and chronic pain.

Mindfulness-based interventions typically start with learning about warning signs and triggers for relapse. Then, the interventions use mindfulness to recognize warning signs and resist the urge to respond to triggers. Patients are encouraged to practice mindfulness skills both during and outside of sessions to cultivate the skills in daily life. Common activities include guided meditations (e.g., mindfulness of breath and body scan), activities to build mindfulness in daily life (e.g., mindful movement) and relapse prevention skills (e.g., urge surfing). Both MBRP and MORE have demonstrated effectiveness in reducing alcohol, nicotine, cocaine, and opioid use, with benefits including reduced days of use, reduced symptoms of depression and anxiety, and increased treatment retention. For persons with opioid use disorder, mindfulness-based interventions have been well-studied in combination with medications for OUD like methadone and buprenorphine and are less well studied as a standalone treatment.

The theory underlying mindfulness-based interventions and data supporting these interventions as a treatment for chronic pain can be found in a separate evidence-based guide here.