In a new study, researchers found that people with opioid use disorder had weaker brain responses to positive emotional experiences. A mindfulness-based therapy appeared to strengthen these responses and reduce opioid craving.

The investigators studied 160 adults with chronic pain who had used opioids for an average of nearly 10 years. Among them, 98 met the criteria for opioid use disorder (OUD). Participants completed an emotion regulation task while undergoing parietal electroencephalogram (EEG) recording. The investigators measured two markers—late positive potential (LPP) and P300—that reflect how the brain processes emotional and rewarding stimuli.

Compared with those without OUD, participants with OUD showed reduced LPP and P300 signals when asked to upregulate their emotional responses to positive images. These differences remained even after adjusting for age, opioid dose, pain severity, and depression.

Weaker LPP responses were linked to greater opioid craving. LPP blunting during positive emotion regulation mediated the association between OUD status and elevated opioid craving, the researchers noted.

For a subsample analysis of those who were at risk for opioid misuse, 62 participants were randomly assigned to either Mindfulness-Oriented Recovery Enhancement (MORE)—which teaches mindfulness, cognitive reappraisal, and savoring—or a supportive group therapy control.

After 8 weeks, participants in the MORE group showed increased LPP signals during the emotional regulation task, which indicated improved brain responses to positive stimuli. This group also reported better mood, increased attention to positive information, and reduced symptoms of anhedonia—the inability to feel pleasure.

Craving scores dropped more significantly in the mindfulness group than in the control group. At 3-month follow-up, stronger LPP responses continued to predict lower craving scores.

“Training in mindfulness and savoring via MORE enhanced positive emotion regulation (ER), which in turn reduced craving, indicating that interventions that normalize reward system function may remediate OUD,” wrote lead study author Eric L. Garland, PhD, of the University of California, with colleagues.

The study authors described that people with OUD may struggle not only with resisting drug cues but also with experiencing pleasure from natural rewards. The mindfulness-based therapy aimed to shift this imbalance by helping participants amplify positive emotional experiences.

Participants were predominantly female, White, and middle-aged, with chronic pain conditions such as low back pain, joint pain, or fibromyalgia. Commonly used opioids include oxycodone, hydrocodone, and tramadol.

The investigators concluded that EEG markers such as LPP could help identify emotion regulation deficits in OUD, and that mindfulness-based therapies may offer a strategy to improve brain responses to natural, healthy rewards.

Full author disclosures are available in the published study.

Source: JAMA Psychiatry