1st Edition

Mindfulness-Oriented Recovery Enhancement An Evidence-Based Treatment for Chronic Pain and Opioid Use

By Eric L. Garland Copyright 2024

    The opioid crisis arose in part due to the attempt to relieve chronic pain. Meeting a huge need, this is the authoritative presentation of Mindfulness-Oriented Recovery Enhancement (MORE) for chronic pain and opioid use. MORE is one of the few evidence-based treatments shown to simultaneously reduce opioid use and/or addiction, pain, and co-occurring emotional distress. MORE integrates mindfulness training with principles of cognitive-behavioral therapy and positive psychology. In a convenient large-size format, the book provides everything needed to set up and run MORE groups. Treatment developer Eric L. Garland supplies session-by-session guidelines, sample scripts, clinical pointers, guided practices, and psychoeducational resources, including 16 reproducible handouts that can be photocopied or downloaded.

    1. Introduction
    2. The Downward Spiral from Chronic Pain to Addiction
    3. What Is MORE and How Can It Help?
    4. Anatomy of Mindfulness Meditation
    5. Processing Mindfulness in a PURER Way
    6. Notes on Delivering the Sessions
    The MORE Sessions
    - Session 1. Mindfulness of Physical and Emotional Pain
    - Session 2. Mindfulness and Automatic Pilot
    - Session 3. Reappraising Adversity as a Source of Growth
    - Session 4. Savoring Healthy Pleasure, Joy, and Meaning in Life
    - Session 5. Mindfulness as Freedom from Craving
    - Session 6. Breaking the Chain between Emotional Pain and Craving
    - Session 7. Mindfulness to Meaning through Interdependence
    - Session 8. Maintaining Mindful Recovery
    7. Supplemental Session on Self-Transcendence in Recovery
    Appendix. Resources for Learning MORE


    Eric L. Garland, PhD, LCSW, is Distinguished Endowed Chair in Research, Distinguished Professor, and Associate Dean for Research at the University of Utah College of Social Work, where he is also Director of the Center on Mindfulness and Integrative Health Intervention Development. Dr. Garland is the developer of Mindfulness-Oriented Recovery Enhancement. He has published more than 250 scientific papers and has conducted extensive clinical trials of mindfulness for addiction and chronic pain. Dr. Garland is an appointed member of the Multi-Disciplinary Working Group that assists the Helping to End Addiction Long-term Initiative of the National Institutes of Health (NIH HEAL Initiative). In 2021, a bibliometric analysis of mindfulness research published over the past 55 years found Dr. Garland to be the most prolific author of mindfulness research in the world.

    “MORE makes use of a highly nuanced and skillful combination of script-guided formal and informal mindfulness meditation practices, cognitive reappraisal, and strategies for nurturing intimacy with--that is, learning to savor--drug-free moments. MORE’s clinical effectiveness has been rigorously established through sophisticated outcome studies. Given the enormity of the opioid epidemic and the huge number of casualties from the widespread misuse and abuse of such drugs, MORE will be a welcome antidote for decades to come. It offers a portal into a new way of inhabiting one’s moments that can optimize well-being and meaning and minimize dysphoria, addictions of all kinds, harm, and suffering. Of great potential secondary benefit to the reader/therapist are the undoubted health-enhancing and mind-opening effects of practicing regularly with the scripts of the guided meditation practices, and, as discussed in the closing chapter, glimpsing the wisdom dimension of meditative practice as a way of being that transcends imprisoning dualisms."--Jon Kabat-Zinn, PhD, founder of Mindfulness-Based Stress Reduction; author of Mindfulness Meditation for Pain Relief

    "Research supporting MORE shows its effectiveness, especially for those who may not have achieved treatment goals with other therapy. As a physician whose clinical practice and research focus on helping people with chronic pain and opioid-related issues, I recommend MORE as an intervention; it offers my patients a pathway to safely improve health and quality of life, and take control over their lives."--Aleksandra Zgierska, MD, PhD, Professor of Family and Community Medicine, Anesthesiology and Perioperative Medicine, and Public Health Sciences, The Pennsylvania State University

    “Guided by neuroscience and rooted in contemplative science, Garland’s analysis of the common mechanisms underlying opioid use and chronic pain is incisive and generative. MORE opens doors to recovery for sufferers whose clinical care has been fragmented and siloed. This accessible treatment manual is backed by 15 years of validation and never takes its focus off the people it is intended to serve. MORE is destined to become the new standard of care for a largely underserved population."--Zindel Segal, PhD, Distinguished Professor of Psychology in Mood Disorders, University of Toronto–Scarborough, Canada

    "This book will appeal to pain specialists, because Garland--a pioneer in mindfulness-based treatments for pain--is both a scientist and a practitioner. He provides novel scientific insights into how MORE works for patients taking opioids in the context of persistent pain. The book will be of particular interest to clinicians struggling to engage chronic pain patients in meditation or other nonpharmacologic treatments. It is loaded with clinical tips on how to tailor treatment rationales and procedures for patients who vary with regard to their current opioid use, risk factors, or active misuse or addiction. This book is a remarkable resource for any clinician who works with patients suffering from persistent pain or wishes to learn more about the scientific basis of mindfulness-based pain relief."--Francis J. Keefe, PhD, Department of Psychiatry and Behavioral Sciences, Duke Pain Prevention and Treatment Research Program, Duke University School of Medicine-