Low Dispositional Mindfulness Predicts Self-medication of Negative Emotion With Prescription Opioids

Abstract

Objectives Although evidence is mounting that opioids are abused to self-medicate negative emotions, little is known about the traits and factors linked to opioid self-medication. One potentially crucial psychological correlate is dispositional mindfulness. Thus, the purpose of this study was to describe the prevalence of opioid self-medication among a treatment-seeking sample of prescription opioid dependent individuals, and to specifically examine the relationship between dispositional mindfulness and opioid self-medication. Methods Participants in acute detoxification or intensive outpatient treatment for prescription opioid dependence (n = 79) were recruited from a regional hospital’s addictions treatment unit for this cross-sectional study. Sociodemographic data were collected along with surveys of opioid self-medication, pain level, and dispositional mindfulness. Results Self-medication of negative affective states with opioids was quite common - with 94.9% of individuals sampled reporting self-medication behaviors. In adjusted analyses, individuals engaging in more frequent opioid use tended to self-medicate negative emotions with opioids more often (β = −.33, p < .05). Importantly, irrespective of opioid use frequency and other clinical and sociodemographic covariates, dispositional mindfulness was inversely associated with opioid self-medication (β = −.42, p < .001), such that less mindful individuals reported using opioids more frequently to self-medicate negative emotions. Conclusions Self-medication of negative emotions with opioids was prevalent in this sample and related to low dispositional mindfulness. Plausibly, increasing mindfulness may decrease opioid self-medication. Addictive automaticity and emotion regulation are discussed as potential mechanisms linking low dispositional mindfulness and self-medication.

Deficits in autonomic indices of emotion regulation and reward processing associated with prescription opioid use and misuse

“…From this perspective, emotional distress from comorbid chronic pain and affective dysregulation might impel self-medication motives and thereby increase vulnerability to prescription opioid misuse. Indeed, epidemiological studies indicate that mood and anxiety disorders are often antecedent to the onset of opioid misuse and dependence (Green et al 2011; Martins et al 2012), and in a sample of prescription opioid dependent individuals in acute detoxification and long-term outpatient treatment, 94% reported frequent misuse of opioids to self-medicate negative affect (Garland et al 2014c). Given the common occurrence of prescription opioid misuse as a means of self-medicating negative emotions, it is possible that some participants in the study who were classified as opioid misusers may have suffered from preexisting emotion dysregulation (perhaps due to untreated pain) prior to the onset of opioid use.…”

“…Approximately 21% to 29% of chronic pain patients receiving long-term opioid analgesic pharmacotherapy exhibit opioid misuse behaviors including unauthorized dose escalation or attempts to self-medicate negative affect with opioids (Vowles et al 2015). A recent investigation of treatment-seeking opioid dependent individuals found that 95% reported using opioids to alleviate negative affective states (Garland et al 2015b). Thus, misuse of opioids to regulate emotional well-being may be prevalent in some populations.…”

An Ultra-Brief Mindfulness-Based Intervention for Patients in Treatment for Opioid Addiction with Buprenorphine: A Primary Care Feasibility Pilot Study

“…6,7,20,22 Recent data showing that low dispositional mindfulness correlates with self-medication of negative emotion with opioids further suggest that mindfulness training may attenuate self-medication. 23 Unfortunately, standard MBSRbased mindfulness training requires extensive time commitment and cost and is not available in most rural primary care settings.…”

Adverse childhood experiences predict autonomic indices of emotion dysregulation and negative emotional cue-elicited craving among female opioid-treated chronic pain patients

“…In that regard, chronic pain patients with extensive histories of ACEs may suffer from emotion dysregulation, and turn to opioids as a means of coping with poorly managed affective distress. Such opioid self-medication of negative affect may be quite common among individuals with OUD; for example, in a sample of inpatients with OUD, 95% reported they had used opioids to relieve negative affective states (Garland, Hanley, Thomas, Knoll, & Ferraro, 2015).…”