Addiction arises from an imbalance between bottom-up reward-learning processes and top-down executive control in the brain, with drug use weakening prefrontal cognitive control networks and hijacking striatal circuits meant for natural rewards. Mindfulness-based interventions (MBIs) can be seen as mental training that exercises and strengthens these brain networks. This review proposes that MBIs remediate addiction by regulating frontostriatal circuits, restoring balance between top-down and bottom-up processes. Evidence indicates MBIs improve cognitive control over drug-related automaticity, attentional bias, and cue reactivity, while increasing responsiveness to natural rewards. An integrative account of neural mechanisms is offered to inform addiction therapy.
A mindfulness-based intervention, Mindfulness-Oriented Recovery Enhancement (MORE), improved the ability to inhibit responses when exposed to pain-related emotional distractors in adults with chronic pain and long-term prescription opioid use. In a controlled trial, participants in MORE showed greater reductions in errors of commission on an Emotional Go/NoGo Task with pain-related stimuli compared with a support group. More mindfulness practice and increased nonreactivity predicted better emotional response inhibition. Improvements in emotional response inhibition were linked to later reductions in pain severity at 3-month follow-up. The results provide preliminary evidence that MORE enhances inhibitory control under negative emotional interference.