The ancient practice of mindfulness can be a powerful tool in the fight against modern days. opioid dependence epidemic, suggest further research.
In a series of studies, an eight-week course in mindfulness techniques seemed to loosen grip of addiction in people who took prescription painkillers for years and experienced powerful cravings for medications.
Compared to the research subjects who discussed their pain and opioid use in group sessions for eight weeks, those who focused on their breathing, sensations, and body emotions showed evidence of reduced drug craving and greater control over these powerful impulses.
The brains of individuals who have received mindfulness training have also evidenced a renewal of pleasure in the people, places, and things that usually disappear as addiction sets in. The brain activity of those who attended the group sessions showed no evidence of regaining a sense of joy in the positive offerings of life.
O results were published this week in Science Advances magazine.
If confirmed in further research, the findings could open a new front in a battle against an epidemic that killed 400,000 lives and detains about 2 million Americans. The study suggests that mindfulness training may help reverse the process by which opioid drugs hijack the brain's pleasure-seeking and reward networks, making drug use the central focus of a person's life.
Doing so can become a powerful adjunct to – or, for some patients, a substitute for drug – assisted treatment. This approach uses drugs such as methadone, buprenorphine, and extended-release naltrexone to wean people with addiction back to a lower, safer opioid dose, or to completely turn off painkillers.
These medications are considered the most effective addiction treatments available. But one report issued in March by the National Academies of Science, Engineering and Medicine concluded that they are not yet widely available for most of those who need them. The report also noted that many patients would need to take these drugs throughout their lives as a treatment for chronic brain disease.
These disadvantages have made urgent the search for better or complementary treatments.
"This is another potential toolbox tool" for addiction treatments, said Dr. Cecilia Westbrook, researcher and resident physician at the University of Pittsburgh Western Psychiatric Hospital who was not involved in the new study. Not all patients will be open to it or have the mental powers to practice these techniques, and making them widely available to people with addiction can be challenging, she said.
But for many, mindfulness training can be part of a powerful cocktail to combat addiction, said Westbrook, whose work found that mindfulness can help Quit smoking. Just as treating depression seems most effective when medication and psychotherapy are used together, mindfulness can help increase the impact of treating drug-assisted addiction.
Those who study the effects of substance abuse have observed for over a decade that, as addiction occurs, the human brain experiences profound changes. The brain regions that lead us to pleasurable activities — eating, playing, socializing, having sex — begin to disregard these normally healthy behaviors as the bounty-seeking network increases the volume of addictive suggestions.
Scientists call the result "hedonic deregulation". Addicts call him Jones.
Evolved to ensure species survival, these impulses to identify and advance toward rewards are powerful drivers of behavior. When they are hijacked by harmful activities or substances, the new normal can be a loss of spiraling pleasure and self-reinforced by healthy activities.
Eric L. Garland, director of Center for Full Attention and Integrated Development of Health Intervention At the University of Utah, he wondered if mental training could help reverse this relentless dynamic. He then recruited 135 patients with chronic pain with opioid use disorder and performed some experiments.
Study participants were white men in their 50s on average who had been using opioids for about a decade. Many did not consider themselves addicted to painkillers, but most acknowledged that opioid use had become problematic.
University of Utah researchers are preparing for an electroencephalogram test to see if mindfulness techniques have helped people overcome their opioid addiction.
(Spencer Bott / University of Utah School of Social Work)
Garland and his team measured the subjects' level of hedonic dysregulation with an electroencephalogram, a device that can capture distinct electrical signals from the brain through the scalp.
At times when a person is seeing, pondering, or reacting to a suggestion that provokes strong emotions, the brain's electrical activity offers an indication: There is a peak in the amplitude of an electrical signal called late positive potential, or LPP. This distinctive signal usually reflects broad activation in deeper brain regions, essential for the processing of emotions.
In his first experiment using 40 subjects, Garland stated that when opioid subjects were shown pictures of opioid pills or vials, their brains responded with much higher LPP amplitudes than when looking at pictures of unrelated household objects. medication.
In two subsequent experiments, 95 veterans with problematic long-term opioid use were divided into two groups. One group attended eight weekly meetings in which a social worker asked participants to express their emotions and discuss topics pertaining to chronic pain and opioid use (or misuse).
The other group received eight weeks of mindfulness training for two hours a week, and was asked to practice meditative techniques for 15 minutes a day. Subjects learned to control and focus on breathing, to progressively relax their bodies, and to note their emotions and sensory experiences as if they were at a distance. They have learned to recognize the craving, nervousness, tension and tingling of a craving for drugs. In a process sometimes called "impulse surfing," they practiced breaking desires into their component parts and realizing how those feelings changed when they focused their attention on them instead of acting on them.
Mindfulness training also contained a cognitive behavioral component. While individuals practiced conscious control of their breathing and attention to sensation, they were instructed to contemplate the consequences of satisfying desire and remaining abstinent.
Finally, they took an intensive course to savor the pleasures and meaning of beautiful or moving things – first a rose and then an object, place or experience of their choice. They practiced diverting attention from drug cravings to those powerful objects.
After eight weeks, the researchers attached a series of electrodes to the participants' scalp and measured their brain responses to tablet images and pill bottles.
The researchers collected data on how the body automatically responds to emotional images and drug-related stimuli. They measured where a person's eyes looked, moment-to-moment variations in heart rate, smiles and frowns, and blink responses.
(Spencer Bott / University of Utah School of Social Work)
Brain signals from those who participated in group therapy suggested that their emotional response to desires had increased by eight weeks. But those who received mindfulness training exhibited a significant downward change in LPP response to opioid images. By visualizing clues that would normally induce desires, they showed an enhanced ability to handle these powerful action requests.
In a third experiment, participants received photos that trigger happy emotions in healthy people: friends laughing and socializing, scenes of natural beauty, and moments of athletic triumph. They were invited to imagine themselves in the image and relish the feeling.
Those who received mindfulness training had significantly higher LPP responses than pre-treatment scores, a sign that their brains had shifted to give more meaning and positive emotion to these happy scenes. Participants attending group therapy sessions, on the other hand, saw their LPP responses decline.
In a final test, Garland and her team asked participants to rate their feelings of drug craving or happiness as they saw those pictures of happy, beautiful, or inspiring scenes. Graduates in mindfulness training – and especially those who were most successful in "enjoying" these happy moments – rated their opioid cravings much less urgent than their peers who received group therapy.
Individuals who spent most of their time practicing mindfulness techniques outside the classroom were more in tune with positive photos and less triggered by opioid photos. In other words, the dose mattered.
"The idea that … with care and effort, you can start undoing the rewiring that comes with addiction – that's significant," said Westbrook.
The research team is now extending these studies under grants from the Department of Defense and National Institutes of Health. For Garland, treating addiction with mindfulness training has the promise of making recovery stronger, more durable, and more meaningful.
"Recovery is much more than relapse prevention," he said. “Recovery is a holistic process, and part of it is for a patient to regain a meaningful life in the face of all the difficulties he or she has gone through. It is important to give patients a specific set of tools to cultivate meaning in life. "