Mindfulness-Oriented Recovery Enhancement: An Evidence-Based Social Work Intervention for Addiction, Stress, and Chronic Pain.

Abstract

The purpose of this commentary is to update social workers about the evolution of Mindfulness-Oriented Recovery Enhancement (MORE) since the publication of the book Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain (Garland, 2013, reviewed in Martin, 2022) and to provide a succinct overview of MORE’s clinical outcomes and mechanisms. MORE is an evidence-based social work intervention that unites mindfulness training, cognitive–behavioral therapy (CBT), and positive psychology into an integrative treatment for addiction, stress, and chronic pain. Across weekly MORE sessions, participants learn mindfulness, reappraisal, and savoring techniques to alleviate symptoms, enhance well-being, and strengthen their recovery. MORE draws on principles from social–behavioral learning theory to enhance motivation to practice, maximize therapeutic expectancy, and positively reinforce success experiences to increase participant engagement. Since 2013, MORE has been tested in 11 clinical trials, demonstrating efficacy for clients struggling with addiction and related issues (e.g., psychiatric disorders, chronic pain). The first Stage 1 randomized controlled trial (RCT) of MORE was conducted in a sample of people with alcohol use disorder (many of whom had co-occurring cocaine use disorder) residing in a long-term therapeutic community. This pilot (N = 53) provided an initial indication of MORE’s potential treatment value, demonstrating effects on addiction risk mechanisms including alcohol attentional bias and autonomic recovery from alcohol cue exposure—indicators of the extent to which a patient was “triggered” by addiction cues (Garland et al., 2010). Subsequently, my colleagues and I launched a five-year Stage 3 RCT (N = 180) of MORE at the same therapeutic community in a sample of formerly homeless men with co-occurring substance use disorders, trauma, and psychiatric disorders. MORE outperformed both trauma-focused CBT (a program based on Seeking Safety) and usual care in reducing drug craving and PTSD symptoms (Garland et al., 2016). For these first two trials of MORE, the treatment was targeted for clients in the “action” and “maintenance” stages of change (Prochaska et al., 1992).