A research team at the Icahn School of Medicine at Mount Sinai in the United States reported results from a randomized clinical trial in which adults with opioid use disorder receiving medication treatment also took part in an eight-week Mindfulness-Oriented Recovery Enhancement (MORE) program. The program changed activity in the prefrontal cortex in response to drug cues and reduced cravings. The study was published October 28 in the psychiatric journal JAMA Psychiatry.
Opioids are narcotic substances that include heroin, fentanyl and some pain medications. Medication treatments such as methadone and buprenorphine have been used in the United States for decades, but the research team noted in the paper that overdose deaths remain high and that more approaches targeting the brain mechanisms of addiction are needed. This study tested mindfulness as one such approach: adding mindfulness to medication treatment rather than asking patients to stop taking medication.
Participants Saw Scenes From Trainspotting in the First Randomized Trial to Use Brain Imaging
The study was conducted at Samaritan Daytop Village, a long-term residential treatment facility in New York. According to a Mount Sinai news release, 86 adults with opioid use disorder took part, all of whom were taking methadone or buprenorphine. Participants were randomly assigned to receive either MORE or the comparison treatment, supportive psychotherapy with psychoeducation, for eight weeks. The comparison treatment was also delivered over the same period in a group format to help isolate the effects of mindfulness. The trial ran from November 2020 to September 2024.
The research team used functional magnetic resonance imaging (fMRI) before and after treatment. Participants completed a task requiring them to regulate their responses as they viewed images related to drugs and images of natural, everyday rewards such as food. They also watched drug-related scenes from Trainspotting, a film about drug addiction. The goal was to see how the brain responded to stimuli closer to real life than laboratory images. The team said this was the first randomized trial to use fMRI to examine how mindfulness-based treatment changes brain function in addiction.
Two Hours a Week for Eight Weeks: Mindfulness, Reappraisal and Savoring
MORE is a group program developed by Eric Garland, a professor at the University of California San Diego (UCSD), who also co-authored the study. According to the paper, participants met once a week for two hours, for eight sessions.
The program combines three practices. The first is mindfulness training to notice what is happening in the body and mind in the present moment. The second is cognitive reappraisal: looking at situations that trigger thoughts of drug use from a different perspective. The third is savoring, the practice of deliberately lingering on positive everyday moments, such as sunshine or a warm cup of tea. As addiction deepens, people may find little pleasure in anything but drugs; savoring is intended to help them reconnect with the muted pleasures of daily life.
The More the Brain Turned Toward Everyday Pleasures, the More Cravings Fell
The findings fell into three areas. First, during a task requiring participants to try to reduce their responses to drug-related images, the MORE group showed a greater reduction than the comparison group in activity in the lateral prefrontal cortex associated with drug cues. The prefrontal cortex is involved in controlling impulses and evaluating what is valuable.
Within the MORE group, cravings fell more among participants whose prefrontal response to drug cues changed more, and among those who showed greater activity in the ventromedial prefrontal cortex while savoring food images. In other words, the extent to which the brain’s focus shifted from drugs toward natural, everyday rewards tracked with the decline in cravings. The paper said this association appeared only in the MORE group.
There was also a difference when participants watched the film scenes. In the MORE group, medial prefrontal cortex activity was less synchronized with the drug-related scenes than in the comparison group, and participants with the greatest decrease in this synchronization also had the greatest reduction in cravings triggered by the scenes. At a follow-up about four months after treatment ended, the MORE group had a longer period of abstinence than the comparison group.
Senior author Professor Rita Goldstein said in a news release, “Prefrontal function in addiction is not fixed, and recovery of brain function is possible.” First author Dr. Yifeng Huang said that although medications for opioid use disorder save lives, they are not designed to retrain the brain’s response to cues that trigger cravings. The changes observed in this study, Huang said, may be part of what recovery in the brain looks like.
It Does Not Replace Medication; Only Dozens Were Included in the Final Analyses
The first point to keep in mind is that MORE does not replace medication treatment. Every participant was receiving methadone or buprenorphine, with mindfulness added to their care. The research team also positioned MORE as an adjunct to medication treatment. The findings should not be interpreted to mean that mindfulness alone can overcome opioid addiction.
The numbers also warrant caution. The news release said 86 people took part, but according to the paper’s abstract, 59 participants were included in the analysis of responses to drug cues (24 in the MORE group and 35 in the comparison group), 37 in the film-viewing analysis, and 38 in the four-month follow-up analysis (13 in the MORE group and 25 in the comparison group). The difference in abstinence duration was statistically significant, but the reported effect size was small. Of the participants in the drug-cue analysis, 13 were women, about 22%. The research team said larger and more diverse groups are needed to test whether the findings hold in other treatment settings, and that it plans to recruit more women to examine how sex and hormones affect treatment response.
This is not the first time MORE has been tested in opioid recovery settings. In another clinical trial published online in the same journal in December 2023, researchers added eight weeks of MORE by video to usual care for 154 patients with chronic pain at five methadone treatment clinics in New Jersey. Compared with the group receiving usual care alone, the MORE group had lower risks of drug reuse and treatment discontinuation. The Mount Sinai study is an attempt to examine what brain changes may accompany such effects.
Not Meditation in Stillness, but Practice in Reappraisal and Savoring
When people hear the word meditation, they may first picture someone sitting cross-legged for a long time, trying to empty their mind. The MORE program in this study takes a somewhat different approach. Participants met in a group to notice present-moment sensations, see situations that trigger cravings from a different perspective, and practice savoring small pleasures in everyday life—all alongside medical treatment. In an age overflowing with information and stimulation, noticing what captures our attention and what we miss is not a challenge unique to people with addiction. For people who give their days over to smartphones and short videos, savoring can also be an accessible place to start.
In addiction recovery, meditation’s role is less about replacing medication and clinicians than about helping people build skills for working with their minds alongside that care. This study offers one piece of evidence for that possibility. This reporting did not establish how widely mindfulness programs are used in addiction treatment settings in South Korea. We hope this growing body of research from abroad will also be discussed among local recovery providers and meditation instructors. If you are receiving treatment for addiction, it is best to consult your treating clinician before beginning meditation.
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