New Research Study Accepted for Publication! “Attentional bias for prescription opioid cues among opioid-dependent chronic pain patients”

I am excited to announce that a scientific article I wrote with my colleagues Brett Froeliger (Duke University), Steven Passik (Vanderbilt University), and Matthew Howard (University of North Carolina at Chapel Hill) was recently accepted for publication in the Journal of Behavioral Medicine. This article details the first evidence of an attentional bias toward prescription opioid cues ever documented in the scientific literature! We found that among a sample of people with chronic pain who were prescribed opioid painkillers, those individuals who met diagnostic criteria for opioid dependence paid significantly more attention to opioid-related images than opioid-users in chronic pain who were not dependent on opioids. To measure attention to opioids, we used a neurocognitive task that looked something like this:

Participants were shown two pictures (displayed either for 200 ms, or 2000 ms), side by side, on a computer screen, and were asked to “choose the side with the dot” by clicking a button on a keypad. The computer recorded their reaction times down to the millisecond. We found that, compared to non-dependent opioid users, opioid dependent people were significantly faster to choose the side with the dot when the dot replaced an opioid photo than when it replaced a neutral photo.¬† This reaction time difference indicated that their attention was captivated by opioids. Also, the more they reported craving their opioid medication, the more their attention was biased towards the opioid photos. This effect was evident for cues presented for 200 ms (that’s one-fifth of a second!), suggesting that this attentional bias occurred automatically, unconsciously, and before participants even had time to think about what they were doing.

So what does this research mean in terms of helping people with addiction and chronic pain? The study findings suggest that people who take opioids for chronic pain may develop an automatic tendency to be fixated on their medication, even when they don’t want to be. This tendency might make it difficult to stop thinking about opioids, causing craving, distraction, or other kinds of disruption in life. It might even lead to taking more medication than is necessary, although the current research study cannot answer that question.

If future studies replicate these findings, the opioid attentional bias may be an important treatment target for people struggling with prescription opioid misuse and addiction. Mindfulness-Oriented Recovery Enhancement (MORE) is designed to address attentional bias and may be particularly helpful in that regard. My preliminary research on MORE as a treatment for alcoholism found that MORE had a significant effect on attentional bias for alcohol cues. Research is currently underway to determine if MORE can have a similar effect on the opioid attentional bias.

Recovery from Addiction, Stress, and Pain through Mindfulness and Social Support

I am honored to have the opportunity to discover new ways of helping people heal and recover from the challenges in their lives. For the past several years, I have been busily engaged in developing a new therapy for people struggling with chronic pain and problems with prescription opioid painkillers through a study funded by the National Institute on Drug Abuse. I first developed this new therapeutic approach, which I call Mindfulness-Oriented Recovery Enhancement, for an earlier study I conducted on alcoholism that was funded by a Francisco Varela Award from Mind and Life Institute. Mindfulness is an expansive and fundamental concept that has been pursued for millennia as a means of ameliorating suffering – look for more posts here soon about it. I am studying how this new treatment compares to a conventional support group. Support groups are a widely-used form of psychological support for people dealing with health and mental health issues that can be extremely helpful.

My approach to helping people is focused on promoting the basic goodness and inherent capacity for growth that lies within each person. I have a lot to say on this topic, but my latest thoughts can be summed up with an image:

In a way, this upward spiral of mindfulness, meaning, and positive emotion may be viewed as the converse of the downward spirals of addiction, stress, and pain that have become a modern day epidemic.

Downward Spiral of Pain and Prescription Opioid Misuse, Abuse, Dependence, and Addiction