Summary: Yes, mindfulness can help decrease loneliness during treatment for opioid addiction. However, the way it works may not be the way most people might guess.
Key Points:
- Mindfulness and related techniques are common in opioid addiction treatment.
- Mindfulness helps people in treatment develop stress management skills and emotion regulation skills that help reduce risk of relapse
- Studies on people in opioid addiction treatment with co-occurring disorders show mindfulness reduces severity of symptoms of anxiety and depression
- People in opioid addiction treatment with less severe symptoms of anxiety and depression report less loneliness, which improve overall treatment outcomes
Which Life Factors Increase Risk of Opioid Use Disorder?
Previous research shows the following social and community factors – known as the social determinants of health (SDOH) – can increase risk of opioid misuse, disordered use, addiction, and overdose:
- Poverty
- Isolation
- Limited access to:
- General health care
- Mental health care
- Addiction treatment
- Transportation
- Limited social support
- Homelessness
- Unemployment
- Hunger/food instability
While loneliness is not on that list it’s clear to us that factors like poverty, isolation, lack of social support, unemployment, and hunger may all contribute to a sense of loneliness. In addition, we know loneliness itself can contribute to emotional issues associated with substance use disorder, such as anxiety and depression. Studies show that mindfulness training can decrease risk of relapse, reduce drug-related cravings, and mitigate symptoms of anxiety and depression that often increase risk of relapse.
That’s why two studies published recently caught our attention:
First Study:
The publication “Testing Mindfulness-Based Relapse Prevention Among Adults in OUD Therapy: A Quasi-experimental Study” offers valuable evidence on the positive impact of a specific approach to mindfulness training during treatment for opioid use disorder called mindfulness-based relapse prevention, or MBRP.
Second Study:
The publication “Assessing Loneliness among Adults Receiving Treatment for Opioid Use Disorder (OUD)” is a supplemental study to the initial study we describe above. Researchers simply added one more metric – loneliness – to the comprehensive metrics used to measure the impact of MBRP on individuals in treatment for OUD.
Note: while this study was conducted on patients in outpatient treatment with medications for opioid use disorder (MOUD), the role of mindfulness in addiction treatment is broadly supported by evidence showing its effectiveness in various contexts – outpatient treatment, partial hospitalization treatment, intensive outpatient treatment, and residential treatment – for various drugs, including alcohol, methamphetamine, cocaine, and cannabis, with or without the use of medication-assisted treatment.
Therefore, we can use data from both these studies to inform our support for patients with opioid addiction, which may include medication for opioid use disorder in the early stages of our residential treatment programs for addiction.
We’ll start this discussion by focusing on the first study, the one on mindfulness. Then we’ll shift focus the second study, the one on loneliness.
The Effect of Mindfulness-Based Relapse Prevention (MBRP) during Treatment for OUD
Randomized controlled trials (RCTs) on the effectiveness of behavioral support – meaning counseling, therapy, and other complementary treatment modalities such as mindfulness – during treatment for OUD show mixed results. Patients for whom therapy helped reported that contingency management – i.e., strategies to avoid or rebound from relapse – had the most beneficial effect on their recovery journey.
However, the phenomenon of co-occurring disorders confounds these results. Evidence shows that more than 1/3rd of people diagnosed with SUD also meet clinical criteria for a mental health disorder, a.k.a. a co-occurring disorder. To address the dual challenge of treating individuals with SUD and a co-occurring mental health disorder, one approach researchers and clinicians explore is mindfulness. Since mindfulness-based therapeutic techniques are known to improve mental health outcomes, researchers theorize that supporting patients in SUD treatment with complementary mindfulness interventions will improve outcomes.
Two primary approaches to using mindfulness in SUD treatment show promise:
- Mindfulness-oriented Recovery Enhancement (MORE)
- Mindfulness-based Relapse Prevention (MBRP)
The latter approach – MBRP – has an extensive, robust evidence base. Therefore, a group of researchers based in West Virginia – a mountainous, rural state located entirely in Appalachia – conducted a study on the impact of MBRP on a group of individuals diagnosed with opioid use disorder (OUD) who engage in evidence-based treatment for opioid addiction.
To learn more about mindfulness in addiction and mental health treatment, please visit the blog section of our website and read this article:
Can Mindfulness Help Addiction Recovery?
Which Mindfulness Techniques Help Mental Health Treatment?
That article will give you general idea of how mindfulness can help decrease loneliness during treatment for opioid addiction. The studies we discuss in this article are focused specifically on people with OUD who participate in evidence-based treatment for opioid use disorder (OUD).
First Study: Outcomes and Metrics
In this study on the impact of mindfulness training on recovery, researchers collected data related to the following four outcomes:
- Treatment retention.
- Relapse to any substance use.
- Psychological risk-factors for relapse:
- Researchers assessed five self-reported mindfulness skills:
- Observing
- Describing
- Acting with awareness
- Non-judgment of inner experience
- Non-reactivity to inner experience
Those are the four outcomes they designed the study to measure. Now let’s look at their study design and participants.
First Study: Mindfulness-Based Relapse Prevention (MBRP) or Treatment As Usual (TAU): Was There a Difference?
We’ll report these results one metric at a time, in the order we introduce them above, starting with treatment retention.
Here’s what the researchers found.
Retention: Did MBRP Affect Treatment Retention?
- 12 weeks:
- MBRP group: 91%
- TAU group: 91%
- 24 weeks:
- MBRP group: 80%
- TAU group: 76%
- 36 weeks:
- MBRP group: 74%
- TAU group: 71%
There was no statistically significant difference in retention between the MBRP group and the TAU group.
Relapse: Did MBRP Affect Relapse Rates?
45% of participants relapsed at least once during the 36-week study. The MBRP group showed lower relapse rates than the TAU group.
Here’s the detailed breakdown by time point and experimental group.
- 12 weeks:
- MBRP group: n/a
- TAU group: n/a
- 24 weeks:
- MBRP group: 31%
- TAU group: 40%
- 36 weeks:
- MBRP group: 43%
- TAU group: 47%
Of note from this data set is the fact that only 4% – a total of 4 participants – relapsed to opioid use. The majority of relapse events involved methamphetamine, alcohol, and benzodiazepines. Relapse rates were higher, overall, in the TAU group.
Cravings: Did MBRP Reduce Cravings?
Higher scores indicate higher frequency and intensity of drug cravings.
Here’s the data by assessment time point and experimental group.
- Baseline:
- MBRP group: 22.3
- TAU group: 23.1
- 12 weeks:
- MBRP group: 20.9
- TAU group: 22.3
- 24 weeks:
- MBRP group: 20.1
- TAU group: 20.3
- 36 weeks:
- MBRP group: 19.5
- TAU group: 19.3
It’s important to recognize that while there was no statistically significant difference in cravings between the MBRP group and TAU group, both groups reported significant reduction in cravings. This emphasizes the crucial role of behavioral therapy in reducing cravings for individuals in addiction treatment.
Depression: Did MBRP Reduce Depressive Symptoms?
Higher scores indicate higher frequency and intensity of depressive symptoms.
Here’s the data by assessment time point and experimental group.
- Baseline:
- MBRP group: 7.1
- TAU group: 5.1
- 12 weeks:
- MBRP group: 4.3
- TAU group: 5.2
- 24 weeks:
- MBRP group: 4.2
- TAU group: 5
- 36 weeks:
- MBRP group: 3.6
- TAU group: 3.9
This data set shows that the MBRP group experienced statistically greater reductions in depressive symptoms, compared to the TAU group.
Anxiety: Did MBRP Reduce Anxiety?
Higher scores indicate higher frequency and intensity of symptoms associated with anxiety.
Here’s the data by assessment time point and experimental group.
- Baseline:
- MBRP group: 9
- TAU group: 6.5
- 12 weeks:
- MBRP group: 6.6
- TAU group: 6.5
- 24 weeks:
- MBRP group: 6.1
- TAU group: 6
- 36 weeks:
- MBRP group: 5.5
- TAU group: 5.7
This data set is somewhat misleading. The leveling off – meaning almost identical scores – recorded at 12 and 24 weeks mask the statistically greater overall reduction reported by the MBRP group compared to the TAU group. Overall, the MBRP group showed a 40% decrease in symptoms related to anxiety, while the TAU group showed a 12% decrease in symptoms related to anxiety.
Mindfulness: Did MBRP Increase Mindfulness?
Higher scores indicate a higher level of self-reported mindfulness, as determined by the five components of mindfulness addressed in the mindfulness assessment.
Here’s the data breakdown by time point and experimental group.
- Baseline:
- MBRP group: 3
- TAU group: 3.1
- 12 weeks:
- MBRP group: 3.4
- TAU group: 3.3
- 24 weeks:
- MBRP group: 3.4
- TAU group: 3.3
- 36 weeks:
- MBRP group: 3.5
- TAU group: 3.3
Like the data on anxiety, this data set may also be a challenge to interpret. What this data shows is that participants in the MBRP group showed a 17% increase in mindfulness overall, compared to a 6% increase for the TAU group. In addition, the MBRP group showed statistically higher levels of self-reported mindfulness at 12, 24, and 36 weeks, despite showing lower levels of self-reported mindfulness at baseline.
When we consider this data set as a whole, we see robust evidence for the use of MBRP in treatment for people with OUD. This data teaches us at least two things: both treatment-as-usual (TAU) with therapy/counseling and mindfulness (MBRP) effectively reduce rates of relapse and increase treatment retention. Treatment adherence and relapse rates – in the absence of any behavioral treatment at all – are far higher than those reported in this study. The second thing we learn from this data is that, compared to treatment as usual, MBRP:
- Reduces cravings more effectively
- Decreases anxiety more effectively
- Reduces depressive symptoms more effectively
In addition – and this comes as no surprise – individuals who engaged in MBRP reported increased mindfulness, which experts recognize improves outcomes for people in recovery.
Now we have one more metric to discuss: loneliness.
Second Study: The Impact of Mindfulness on Loneliness
Remember: the study on loneliness is the same study as the one we describe in detail above. The only difference is that in the second study, researchers added one more metric: loneliness. They hypothesized that the mindfulness group would report less loneliness over time than the treatment-as-usual group.
Were they right?
Let’s take a look.
Loneliness: Compared to Treatment-as-Usual (TAU) Did MBRP Decrease Loneliness?
Researchers measured loneliness with the 20-item Revised-UCLA Loneliness Scale (R-UCLA). Higher scores indicate higher levels of loneliness.
Here are the results, offered by time point and experimental group.
- Baseline:
- MBRP group: 45.4
- TAU group: 43.2
- 12 weeks:
- MBRP group: 41.2
- TAU group: 6
- 24 weeks:
- MBRP group: 40.2
- TAU group: 42.0
- 36 weeks:
- MBRP group: 40
- TAU group: 41
There are two important takeaways from this set of data.
First, we note that in both groups, rates of loneliness decreased over time: since loneliness is a risk factor for addiction and overdose, this confirms the validity of behavioral interventions during opioid addiction treatment.
Second, we note that although there was no significant difference in reported loneliness, on average, over the 36-week study, the MBRP group reported a 10 percent reduction in loneliness, compared to the 5 percent reduction reported by the TAU group.
How this Data Helps Us Help People With Opioid Addiction
One way this research helps is by adding to the evidence base that supports the use of behavioral interventions – e.g. therapy, counseling, mindfulness techniques – in treatment programs for people diagnosed with opioid use disorder.
That tells us that at Honu House, we’re on the right track: we include behavioral counseling in all our addiction treatment programs.
Evidence from the first study shows that MBRP is more effective than standard counseling in reducing cravings, depression, and anxiety: that’s critical information for us, since it’s common for patients with OUD to have a co-occurring mental health disorder.
We know that when we treat the whole person – meaning treating addiction as well as any mental health disorder – outcomes improve, and individuals have a greater chance at achieving sustainable, lifelong recovery.
Finally, this data teaches us that behavioral interventions decrease loneliness in people with OUD in treatment programs. When individuals with OUD in treatment programs engage in therapy, counseling, and/or mindfulness training, their levels of loneliness decrease. That decrease has a mirror: decreased loneliness means an increased sense of social connection. Combined, those two developments – a decrease in loneliness and an increase in social connection – can increase the likelihood of a full and successful recovery from opioid use disorder, a.k.a. opioid addiction.
