Effects of Mindfulness-Oriented Recovery Enhancement on reward responsiveness and opioid cue-reactivity

RationaleDysregulated reward processing is a hallmark feature of drug addiction; however, scant research has evaluated restructuring reward processing in the context of addiction treatment.ObjectivesWe examined effects of Mindfulness-Oriented Recovery Enhancement (MORE) on reward responsiveness (RR) and opioid cue-reactivity in a sample of chronic pain patients with opioid use problems. We previously reported that MORE decreased pain, opioid misuse, and craving relative to a social support control group (SG). Here, we examined whether these outcomes were linked to changes in RR in a subset of participants.MethodsParticipants were chronic pain patients (71 % women, age 46.6 ± 13.9) who received MORE (n = 20) or SG (n = 29). RR was measured before and after 8 weeks of treatment via heart rate (HR) and heart rate variability (HRV) responses during a dot probe task that included opioid-related, pain-related, and natural reward stimuli, as well as craving ratings.ResultsThe MORE group, who reported decreased opioid misuse and opioid craving during treatment, evidenced less subjective opioid cue-reactivity, greater HR decelerations, and greater increases in HRV to all cues after treatment compared to the SG; HR and HRV effects were most pronounced for natural reward cues. Within the MORE group, HR deceleration to natural reward cues was correlated with increased subjective arousal to the cues, whereas HR deceleration to opioid cues was correlated with decreased subjective arousal. Effects of MORE on craving were mediated by enhanced RR.ConclusionsResults suggest that during treatment with MORE, cardiac-autonomic responsiveness to non-drug reward increases, while reactivity to opioid reward decreases. Studies are needed to discern whether changes in RR were a result or a determinant of reductions in opioid misuse and craving. RR may play a role in addiction treatment.

[1]  J. Deakin,et al.  Electrophysiological evidence of the motivational salience of drug cues in opiate addiction , 2007, Psychological Medicine.

[2]  B. Carter,et al.  Meta-analysis of cue-reactivity in addiction research. , 1999, Addiction.

[3]  M. Sayette,et al.  Peak-provoked craving deserves a seat at the research table. , 2013, Addiction.

[4]  Joshua M. Carlson,et al.  Smoker–nonsmoker differences in neural response to smoking-related and affective cues: An fMRI investigation , 2013, Psychiatry Research: Neuroimaging.

[5]  E. Garland,et al.  Mindfulness Training Targets Neurocognitive Mechanisms of Addiction at the Attention-Appraisal-Emotion Interface , 2014, Front. Psychiatry.

[6]  J. Greeson,et al.  Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. , 2010, Journal of psychosomatic research.

[7]  Mathias Schreckenberger,et al.  Correlation between dopamine D(2) receptors in the ventral striatum and central processing of alcohol cues and craving. , 2004, The American journal of psychiatry.

[8]  C. Boettiger,et al.  Mindfulness Training Modifies Cognitive, Affective, and Physiological Mechanisms Implicated in Alcohol Dependence: Results of a Randomized Controlled Pilot Trial , 2010, Journal of psychoactive drugs.

[9]  E. Garland,et al.  Cue-elicited heart rate variability and attentional bias predict alcohol relapse following treatment , 2011, Psychopharmacology.

[10]  J. Deakin,et al.  Electrophysiological evidence that drug cues have greater salience than other affective stimuli in opiate addiction , 2008, Journal of psychopharmacology.

[11]  Jay L. Memmott.  Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain by Eric L. Garland , 2013 .

[12]  H. Nagaraja,et al.  Heart rate variability: origins, methods, and interpretive caveats. , 1997, Psychophysiology.

[13]  Masayoshi Kuwahara,et al.  Changes in autonomic control of heart associated with classical appetitive conditioning in rats. , 2005, Experimental animals.

[14]  Peter J. Lang,et al.  Attention and Orienting : Sensory and Motivational Processes , 1997 .

[15]  Edythe D. London,et al.  Methamphetamine craving induced in an online virtual reality environment , 2010, Pharmacology Biochemistry and Behavior.

[16]  E. Carmines,et al.  Analyzing models with unobserved variables: analysis of covariance structures , 1981 .

[17]  S. Tiffany,et al.  The clinical significance of drug craving , 2012, Annals of the New York Academy of Sciences.

[18]  P. Lang.  International Affective Picture System (IAPS) : Technical Manual and Affective Ratings , 1995 .

[19]  R. Lane,et al.  Claude Bernard and the heart–brain connection: Further elaboration of a model of neurovisceral integration , 2009, Neuroscience & Biobehavioral Reviews.

[20]  M. Le Moal,et al.  Neurobiological mechanisms for opponent motivational processes in addiction , 2008, Philosophical Transactions of the Royal Society B: Biological Sciences.

[21]  M. Bradley,et al.  Motivated attention: Affect, activation, and action. , 1997 .

[22]  N. Volkow,et al.  Addiction: Decreased reward sensitivity and increased expectation sensitivity conspire to overwhelm the brain's control circuit , 2010, BioEssays : news and reviews in molecular, cellular and developmental biology.

[23]  F. Smulders,et al.  Cephalic phase responses, craving and food intake in normal subjects , 2000, Appetite.

[24]  G. Pasternak,et al.  Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. , 2009, The journal of pain : official journal of the American Pain Society.

[25]  J. Thayer,et al.  Heart Rate Variability, Prefrontal Neural Function, and Cognitive Performance: The Neurovisceral Integration Perspective on Self-regulation, Adaptation, and Health , 2009, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[26]  M. Yücel,et al.  Responsiveness to drug cues and natural rewards in opiate addiction: associations with later heroin use. , 2009, Archives of general psychiatry.

[27]  S. Butler,et al.  Development and validation of the Current Opioid Misuse Measure , 2007, PAIN.

[28]  J. Gross,et al.  The cognitive control of emotion , 2005, Trends in Cognitive Sciences.

[29]  T. Hergueta,et al.  The mini international neuropsychiatric interview , 1998, European Psychiatry.

[30]  Kewei Chen,et al.  Neural correlates of heart rate variability during emotion , 2009, NeuroImage.

[31]  R. Sloan,et al.  Exposure to smoking cues: cardiovascular and autonomic effects. , 2011, Addictive behaviors.

[32]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[33]  M. Sayette,et al.  Peak provoked craving: an alternative to smoking cue-reactivity. , 2013, Addiction.

[34]  S. Segerstrom,et al.  Heart Rate Variability Reflects Self-Regulatory Strength, Effort, and Fatigue , 2007, Psychological science.

[35]  J. Kabat-Zinn,et al.  An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. , 1982, General hospital psychiatry.

[36]  K. Brownell,et al.  Heightened vagal activity during high-calorie food presentation in obese compared with non-obese individuals--results of a pilot study. , 2014, Obesity research & clinical practice.

[37]  Marieke Wichers,et al.  Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: a randomized controlled trial. , 2011, Journal of consulting and clinical psychology.

[38]  C. Kirstein,et al.  Motivational and Addictive States , 2007 .

[39]  P. Kalivas,et al.  Reinstatement of nicotine seeking is mediated by glutamatergic plasticity , 2013, Proceedings of the National Academy of Sciences.

[40]  Rex B. Kline,et al.  Principles and Practice of Structural Equation Modeling , 1998 .

[41]  N. Volkow,et al.  The neural basis of addiction: a pathology of motivation and choice. , 2005, The American journal of psychiatry.

[42]  J. Panksepp,et al.  The SEEKING mind: Primal neuro-affective substrates for appetitive incentive states and their pathological dynamics in addictions and depression , 2011, Neuroscience & Biobehavioral Reviews.

[43]  E. Garland,et al.  Attentional bias for prescription opioid cues among opioid dependent chronic pain patients , 2013, Journal of Behavioral Medicine.

[44]  Jaclyn M. Williams,et al.  Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial. , 2014, Journal of consulting and clinical psychology.

[45]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[46]  M. Bradley,et al.  Emotion and motivation I: defensive and appetitive reactions in picture processing. , 2001, Emotion.

[47]  A. Lintas,et al.  Inputs from the basolateral amygdala to the nucleus accumbens shell control opiate reward magnitude via differential dopamine D1 or D2 receptor transmission , 2012, The European journal of neuroscience.

[48]  M. Alexander,et al.  Principles of Neural Science , 1981 .

[49]  Magnus Dahlbom,et al.  Striatal Dopamine D2/D3 Receptor Availability Is Reduced in Methamphetamine Dependence and Is Linked to Impulsivity , 2009, The Journal of Neuroscience.

[50]  B. Fredrickson,et al.  Clinical Psychology Review , 2022 .

[51]  L. Davidson,et al.  The Concept of Recovery as an Organizing Principle for Integrating Mental Health and Addiction Services , 2007, The Journal of Behavioral Health Services & Research.

[52]  H. de Wit.  Impulsivity as a determinant and consequence of drug use: a review of underlying processes , 2009, Addiction biology.

[53]  J. Weber,et al.  Prefrontal–striatal pathway underlies cognitive regulation of craving , 2010, Proceedings of the National Academy of Sciences.

[54]  G. Koob,et al.  Drug Addiction, Dysregulation of Reward, and Allostasis , 2001, Neuropsychopharmacology.

[55]  E. Garland,et al.  Author's Personal Copy Neuroscience and Biobehavioral Reviews the Downward Spiral of Chronic Pain, Prescription Opioid Misuse, and Addiction: Cognitive, Affective, and Neuropsychopharmacologic Pathways , 2022 .

[56]  Nora D. Volkow,et al.  The addicted human brain viewed in the light of imaging studies: brain circuits and treatment strategies , 2004, Neuropharmacology.

[57]  M. Browne,et al.  Alternative Ways of Assessing Model Fit , 1992 .