Healing Brain Reward Circuits in Addiction With Mindfulness

Addiction decreases the brain’s ability to experience natural, healthy pleasure, driving increased cravings and compulsive substance use. But can this brain deficit be healed? New research from my lab shows that brain recovery from addiction is possible through mindfulness-based therapy.

In a new study published in the medical journal JAMA Psychiatry, my colleagues and I found that Mindfulness-Oriented Recovery Enhancement (MORE) can help rewire the brain’s response to natural healthy pleasure in individuals with opioid use disorder (OUD), leading to improved mood, greater attention to positive experiences, and reduced opioid cravings. The findings add to the body of evidence demonstrating that MORE is an effective tool to help people heal from addiction.

Participants savored positive images while brain activity was measured

Source: Eric Garland

OUD can develop when individuals misuse opioids originally prescribed for chronic pain, a condition affecting 50 million Americans each year. As people become increasingly dependent on opioids, they begin to lose the ability to feel joy and pleasure in everyday life, driving them to seek higher doses to maintain a fleeting sense of well-being—a downward spiral that often leads to opioid addiction. In the study, participants with OUD showed difficulty enhancing positive emotions, as seen in weakened brain responses when they tried to savor images representing naturally rewarding objects and experiences, such as smiling babies, puppies, or a beautiful sunset. The responses were measured through electroencephalogram (EEG) scans.

This positive emotional blunting or numbing was directly linked to higher opioid cravings. However, the MORE therapy helped to heal this inability to savor by increasing brain responses to positive stimuli, which correlated with lower cravings and improved emotional well-being. The findings suggest that MORE can play a vital role in helping people with OUD increase their well-being and regain control over their cravings, thereby reducing opioid misuse.

OUD is associated with emotional blunting in the brain

Source: Eric Garland

MORE is an evidence-based therapy developed and tested over the past two decades that integrates mindfulness training, cognitive behavioral therapy, and principles from positive psychology into a treatment that can simultaneously address addiction, emotional distress, and chronic pain. MORE teaches mindfulness skills to regulate craving, relieve pain, and recover the ability to savor natural, healthy pleasure, joy, and meaning in life.

To date, MORE has been tested in over 16 randomized clinical trials involving more than 2,000 people. In the largest clinical trial of MORE involving 250 patients, published in JAMA Internal Medicine in early 2022, MORE decreased opioid misuse by 45 percent at a 9-month follow-up, nearly tripling the effect of standard group therapy. In addition, 50 percent of patients treated with MORE reported clinically significant decreases in chronic pain. In a 2024 study published in JAMA Psychiatry, my colleagues and I showed that adding MORE to standard addiction care resulted in 42 percent less relapse and 59 percent less dropout from treatment when compared to standard addiction care alone.

Multiple rigorous, well-controlled clinical trials have demonstrated the efficacy of the MORE therapy. I’m now seeking support from policymakers and healthcare organizations and the national opioids settlement to disseminate this evidence-based treatment widely throughout the United States to help alleviate the opioid crisis.