Mindfulness-Oriented Recovery Enhancement, or MORE, combines attention to cravings with practice noticing everyday pleasures. A new study examined these skills alongside medication for opioid use disorder.
In a MORE session, a bouquet of flowers can become something to practice with: notice the colors and scent, let the pleasant feeling register, and return attention when it wanders. That example comes from a researcher studying how a structured therapy might help people respond differently to reminders of drug use.[1]
The new trial, published October 28 in JAMA Psychiatry, examined Mindfulness-Oriented Recovery Enhancement in an inpatient setting. Participants received methadone or buprenorphine as well as group therapy. MORE was studied as an addition to medication, not a replacement.[2][3]
Fast Facts About the MORE Study
- MORE participants practiced mindful awareness, reappraisal and savoring, with daily practice between sessions.[1]
- Both study groups had eight weekly, two-hour sessions. The comparison group received supportive therapy rather than MORE training.[2]
- Brain imaging was the primary outcome. Craving and length of abstinence were secondary outcomes, so a change on a scan should not be read as a personal recovery forecast.[2]
What Participants Practiced in MORE
MORE brings together three kinds of practice: noticing craving, reconsidering a drug-related cue and giving attention to pleasant experiences. Rita Z. Goldstein, PhD, Mount Sinai Professor in Neuroimaging of Addiction, Icahn School of Medicine at Mount Sinai, described the sessions in written answers to AddictionHelp.com. She is the study’s senior author.[1][3]
Goldstein’s flowers example illustrates savoring. Participants hold their attention on a pleasant sensory experience, notice its details and allow themselves to register the feeling. When attention drifts, they bring it back. The exercise gives a concrete meaning to the phrase “natural rewards”: experiences that can feel good without a drug.[1]
Participants also practice mindful awareness of craving. Reappraisal, another part of MORE, means stepping back from a reminder of drug use and reconsidering what it means. Goldstein said participants were asked to practice for 15 minutes each day outside the sessions.[1]
These are deliberate, repeated activities within a therapy program. The flowers are one example of the training, not an exercise this trial tested on its own. Someone trying a brief savoring exercise would not be receiving the full intervention studied here.[2][1]
How MORE Compared With Supportive Group Therapy
The comparison group also had regular time with a facilitator and other participants. Goldstein said they met equally often, for equally long sessions, discussed addiction-related topics and journaled daily. They did not train the MORE skills.[1]
That makes the comparison more informative than simply asking whether people who attended a group changed over time. Both groups had scheduled support. The study asked what differed when one group received the structured MORE program. Because the skills were delivered together, the results cannot identify the effect of savoring, reappraisal or mindful awareness alone.[2][1]
What the MORE Study Found About Brain Responses and Craving
The researchers reported differences in how the groups’ brains responded during imaging tasks after treatment. The drug-cue analysis included 59 people: 24 who received MORE and 35 who received supportive therapy.[2]
Within the MORE group, participants whose prefrontal responses shifted further away from drug cues and toward ordinary rewards reported larger reductions in craving, Goldstein explained. The prefrontal cortex is involved in self-control and assigning value to experiences. This was an association between changes, not proof that a particular brain change caused craving to fall.[1]
A separate movie-watching analysis involved 37 people, including 18 in MORE and 19 in supportive therapy.[2] During drug-related scenes, prefrontal activity was less synchronized across people in the MORE group. In plain language, their brain responses were less alike.[2]
These findings concern responses under study conditions. As Goldstein put it, “The brain findings are group effects, and individual responses vary.” They cannot tell a particular person how their recovery will unfold.[1]
What the Smaller MORE Follow-Up Can Tell Us
The researchers reported longer abstinence in the MORE group at follow-up, about four months after treatment. That analysis included 38 people: 13 in MORE and 25 in supportive therapy.[2]
Goldstein emphasized that not everyone returned. She described the finding as encouraging but preliminary, needing replication in larger studies. People missing from follow-up leave an important unanswered question: would the pattern look the same if their outcomes were known? The finding is a reason for further study, not a reliable estimate of how much longer someone receiving MORE will remain abstinent.[1]
The 59-person imaging analysis, 37-person movie analysis and 38-person follow-up answer different questions. Their totals should not be treated as interchangeable or used to calculate how many people dropped out of treatment.[2]
Discussing MORE Alongside Medication
For someone interested in mindfulness for addiction, this study offers a clearer picture of what one structured program involves. It also gives a useful starting point for a conversation with a treatment team: “Could structured skills such as MORE fit alongside my medication and the support I already receive?”
Follow-up questions can make that conversation practical: Who would lead the sessions? What would practice between appointments involve? How would the team check whether the approach is helping with the difficulties that matter to you?
Goldstein’s message about the study’s medication context was direct: “stay on your medication.” The question this research explores is what additional skills might contribute within ongoing care.[1]
For broader background on the different approaches, read about mindfulness for addiction. Bring questions about cravings and daily practice to the clinician who knows your treatment plan, so the discussion starts with the support you need.
People We Spoke With
Rita Z. Goldstein, PhD, Mount Sinai Professor in Neuroimaging of Addiction, Icahn School of Medicine at Mount Sinai, provided written answers about MORE practices, the comparison group and the limits of the follow-up results. She is the senior study author. Official Mount Sinai profile.[1][3][4]
MORE Study Background and Funding
Study coauthor Eric L. Garland developed MORE. Mount Sinai reports support from the National Center for Complementary and Integrative Health, with additional support from the National Institute on Drug Abuse, National Institute of Mental Health and National Center for Advancing Translational Sciences.[3]
Goldstein said Garland receives payments for training clinicians in MORE and royalties from books about the program. She also described his roles as founder of the MORE Science Institute and director of ONEMIND at the University of California San Diego, and his reported personal fees from BehaVR outside this study. These disclosures also appear in the public PubMed record.[2][5]
Goldstein reported NCCIH grant support during the study.[2][5] She said the funders had no role in its design or conduct, data collection or analysis, preparation or approval of the manuscript, or the decision to submit it for publication.[5]
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