Mindfulness does matter

Technology | Melissa Healy 5 Nov 2019

The ancient practice of mindfulness may be a powerful tool in fighting the modern-day epidemic of opioid addiction.

In a series of studies, an eight-week course in mindfulness techniques appeared to loosen the grip of addiction in people who had been taking prescription painkillers for years and experienced powerful cravings for drugs.

Compared to research subjects who discussed their pain and opioid use in group sessions for eight weeks, those who focused on their breathing, bodily sensations and emotions showed evidence of reduced drug cravings and greater control over those powerful impulses.

The brains of subjects who got mindfulness training also evinced a renewal of pleasure in people, places and things that typically falls away as addiction takes hold. The brain activity of those who attended group sessions showed no evidence of having recaptured a sense of joy in life's positive offerings.

The results were published recently in the journal Science Advances.

If borne out in further research, the findings may open a new front in a battle against an epidemic that has claimed over 400,000 lives in the US. The study suggests mindfulness training can help reverse the process by which opioid drugs hijack the brain's reward and pleasure-seeking networks.

In so doing, it could become a powerful addition to - or a replacement for - medication-assisted treatment. That approach uses drugs such as methadone, buprenorphine and extended-release naltrexone to wean people with addiction back to a lower and safer opioid dose, or off the painkillers altogether.

These medications are considered the most effective addiction treatments available.

But a report issued in March by the US National Academies of Sciences, Engineering and Medicine concluded that they are not yet widely available to most who need them. The report also noted that many patients would need to take these medications over a lifetime, as treatment for a chronic brain disease.

"This is another potential tool in the toolbox" of treatments, said Cecilia Westbrook, a doctor at the University of Pittsburgh's Western Psychiatric Hospital, who was not involved in the study.

Not every patient will be open to it, or have the mental powers to practice these techniques, and making it widely available to people with addiction could be a challenge. But for many, mindfulness training might be part of a powerful cocktail to fight addiction, said Westbrook, whose own work found that mindfulness can aid in smoking cessation.

Just as depression treatment appears more effective when medication and psychotherapy are used together, mindfulness might help boost the impact of medication-assisted addiction treatment.

Those who study the effects of substance abuse have observed for more than a decade that as addiction takes hold, the brain undergoes profound changes. Regions that drive us toward pleasurable activities begin to discount those normally healthy behaviors as the reward-seeking network turns up the volume on cues linked to the addictive substance.

Scientists call the result "hedonic dysregulation", addicts call it "jones-ing".

Evolved to ensure the survival of species, these impulses to identify and move toward rewards are powerful drivers of behavior. When they're hijacked by unhealthy substances or activities, the new normal can be a spiraling, and self-reinforcing, loss of pleasure from healthy activities.

Eric Garland, director of the Center on Mindfulness and Integrative Health Intervention Development at the University of Utah, wondered whether mental training could help reverse this.

So he recruited 135 chronic pain patients with opioid use disorder and ran some experiments.

The study participants were white men in their mid-50s on average who had taken opioid medications for about a decade. Garland and his team gauged the subjects' level of hedonic dysregulation with an electroencephalogram, a device that can capture the brain's distinct electrical signals through the scalp.

At moments when a person is viewing, pondering or reacting to a cue that elicits strong emotions, the brain's electrical activity offers up a tell: there's a spike in the amplitude of an electrical signal called the late positive potential, or LPP. That signal typically reflects broad activation in deeper regions of the brain that are key to the processing of emotions.

In his first experiment, using 40 subjects, Garland established that when opioid-using subjects were shown pictures of opioid pills or pill bottles, their brains responded with much higher LPP amplitudes than when they looked at pictures of household objects unrelated to their medication.

In two subsequent experiments, 95 veterans with long-term, problematic opioid use were divided into two groups. One attended eight weekly meetings where a social worker prompted participants to express their emotions and discuss topics pertinent to chronic pain and opioid use (or misuse).

The second group recieved eight weeks of mindfulness training for two hours a week, and were asked to practice meditative techniques for 15 minutes a day. Subjects learned to control and focus on their breathing, progressively relax their bodies, and take note of their emotions and sensory experiences as if from a distance. They learned to recognize the longing, jitters, tightness and tingling of a drug craving.

After the eight weeks were up, researchers attached an array of electrodes to the participants' scalps and measured their brains' responses to images of pills and pill bottles.

The brain signals of those who attended group therapy suggested their response to cravings had increased over eight weeks. But those who got the mindfulness training exhibited a significant decrease in their LPP response to pictures of opioids. When viewing cues that would ordinarily induce cravings, they showed a marked ability to manage those powerful prompts to action.

In a third experiment, participants were shown photos that elicit happy emotions in healthy people. Then they were asked to imagine themselves being in the picture and savoring the feeling.

Those who got the mindfulness training had LPP responses that were higher than their pre-treatment scores - a sign that their brains had shifted to attach more meaning and positive emotion to these happy scenes. Participants who attended group therapy sessions, by contrast, saw their LPP responses decline.

In a final test, Garland and his team asked participants to rate their feelings of drug craving or happiness as they viewed those pictures of happy, beautiful or inspiring scenes. The graduates of mindfulness training assessed their opioid cravings as much less urgent than their group-therapy counterparts.

Subjects who spent the most time spent practicing mindfulness techniques outside of class were more keenly attuned to positive pictures and less triggered by pictures of opioids.

In other words, dose mattered.

"The idea that with care and effort you can begin to undo that rewiring that comes with addiction - that is significant," Westbrook said.

Los Angeles Times

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