Mindfulness approaches show potential in retraining addiction-related brain dysfunction

Mindfulness-based treatments for substance dependence appear to lead to functional brain changes, particularly in areas related to reward processing and cognitive control, according to a new paper published in BMC Psychiatry. But the research review suggests that more high-quality studies using functional magnetic resonance imaging (fMRI) are needed to better understand the neurobiological mechanisms underlying the effects of these therapies.

Mindfulness is a mental state characterized by present-moment awareness and non-judgmental attention to one’s thoughts, feelings, and sensations. It involves intentionally paying attention to the present moment, without getting caught up in judgments or becoming overly reactive to experiences.

Mindfulness-based interventions are therapeutic approaches that incorporate mindfulness practices into various aspects of treatment. These interventions aim to cultivate mindfulness skills in individuals and apply them to promote well-being and address a range of psychological and physical health conditions.

Substance use disorders have a significant impact on individuals and society, affecting millions of people worldwide and costing billions of dollars annually. Substance use disorders are associated with negative neurobiological and psychosocial outcomes, including brain dysfunction, intense cravings, hazardous behaviors, and mental health problems. The high relapse rates within the first year of treatment further highlight the need for effective therapies.

Mindfulness-based interventions have shown promise in addressing mental health problems and have been incorporated into psychological therapies in recent years. However, it is important to understand the neurobiological changes associated with mindfulness-based interventions in substance use disorders and their potential effects on substance use and related behaviors.

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“I was interested in the topic as substance use disorders can be difficult to treat and isolating; and mindfulness based interventions can provide accessible and useful tools for people to manage substance use related problems also from their homes,” said study author Valentina Lorenzetti, an associate professor at the Australian Catholic University and deputy director of the Healthy Brain and Mind Research Centre.

“Also, this topic aligns well with my team’s efforts to unpack how to mitigate brain dysfunction in substance use disorders. Our PhD student and co-author, Emillie Beyer, worked with people with substance use disorders and she has seen first hand the devastating impact it has on people and their families.”

The researchers conducted a systematic review to integrate the available evidence from multiple studies that examined the effects of mindfulness-based interventions on brain function in individuals with substance use disorders. They performed a comprehensive literature search in multiple databases and selected relevant 7 studies for their analysis based on specific criteria.

The evidence from the review suggests that mindfulness-based interventions can lead to changes in the brain function of individuals with substance use disorders. Specifically, the areas of the brain most consistently affected by mindfulness-based interventions were the anterior cingulate cortex (ACC) and the striatum, which are important for reward processing and mindfulness.

The researchers also noted changes in other brain regions involved in cognitive processes related to reward dysregulation and mindfulness. These regions included the insula, cerebellum, precuneus, inferior frontal gyrus, and posterior cingulate cortex (PCC). The insula, in particular, is known to play a role in addiction and has been targeted in interventions to reduce cravings.

“The emerging evidence using neuroimaging shows that mindfulness based interventions can reduce dysfunction in the addiction neurocircuitry in some people with substance use disorders. The samples include people with tobacco use disorders and opioid use disorder,” Lorenzetti told PsyPost.

But, based on their review, the researchers emphasized the need for further research and the establishment of minimum methodological standards for fMRI studies in this field.

“The literature has major caveats and the results need to be replicated in more studies with stronger methodologies,” Lorenzetti explained. “To mention some limitations: (i) only 7 studies have examined how mindfulness based interventions affect brain function in substance use disorder, we need more evidence to understand with precision the underlying mechanisms; (ii) most studies do not have any control group, and it is unclear if the effects are specific to mindfulness or to the fact people received any intervention; (iii) the number of participants included was small, we need larger samples to understand who benefits the most from the interventions; (iv) the interventions were quite different, we need more studies to understand which interventions are most effective; (v) few studies explored how changes in brain function relate to change in dosage”

By understanding the neural mechanisms underlying the effects of mindfulness-based interventions on substance use disorders, researchers can identify potential neurobiological targets for interventions aimed at reducing problematic substance use.

“Mindfulness based interventions can be beneficial for some people to retrain brain dysfunction and reduce craving, dosage and stress, it is worth considering these interventions with appropriate professional support,” Lorenzetti said.

The study, “Do mindfulness-based interventions change brain function in people with substance dependence? A systematic review of the fMRI evidence,” was authored by Valentina Lorenzetti, Alexandra Gaillard, Emillie Beyer, Magdalena Kowalczyk, Sunjeev K. Kamboj, Victoria Manning, and John Gleeson.