Picture a man eight weeks into residential treatment for opioid use disorder. He takes his methadone every morning and he has not used. Then a counselor mentions a street corner he used to know, and his chest tightens, his mouth floods, and the craving arrives as if the medication were not there at all. I have watched this happen to patients for thirty years, and for most of that time the only answer we had for it was to tell them to push through.
A trial reported this week in JAMA Psychiatry suggests there is a better answer, and that you can see it working in the brain.
What the Mount Sinai trial tested
Yuefeng Huang, PhD, and Rita Z. Goldstein, PhD, at the Icahn School of Medicine at Mount Sinai, working with Eric L. Garland, PhD, of the University of California San Diego, randomized 86 adults with opioid use disorder to one of two eight-week group treatments. All of them lived at a long-term inpatient facility run by Samaritan Daytop Village in New York City, and all were taking methadone or buprenorphine.
One group received Mindfulness-Oriented Recovery Enhancement, or MORE, which Garland developed. MORE combines three skills: mindfulness training, cognitive reappraisal of drug triggers, and savoring ordinary positive experiences such as a meal or a conversation. The other group received psychoeducational supportive therapy, matched for duration and group format, so any difference could not be explained by simply having more attention from clinicians.
Before and after treatment, every participant went through functional MRI. They reappraised drug-related images, looked at pictures of food as a natural reward, and watched drug scenes from the film Trainspotting.
What changed in the scanner
The MORE group showed less drug-related activity in the lateral prefrontal cortex while reinterpreting drug images than the comparison group did. That region helps regulate craving, so the finding says the brain was doing the regulating with less effort spent on the cue itself.
Within the MORE group, larger shifts in prefrontal response to drug cues were linked to larger drops in craving. The same was true for ventromedial prefrontal activity while savoring food images. That area assigns value to rewards, and I find this result the most interesting in the paper. Patients who learned to feel an ordinary pleasure more fully were the ones whose cravings fell furthest. This fits what we have understood about reward deficiency for years: the brain in recovery is short on ordinary reward, and drug cues fill the gap.
During the movie task, MORE participants showed less synchronized medial prefrontal activity while watching drug scenes. Across all participants, bigger drops in that synchrony went along with bigger reductions in scene-triggered craving.
At a follow-up about four months after treatment, the MORE group had gained more abstinence time than the comparison group. The press coverage does not report effect sizes or exact craving and abstinence figures, so I would want to read the full paper before putting numbers on the benefit.
What this does and does not show
The trial drew from one inpatient facility, and the investigators say larger and more diverse samples are needed. They also plan to recruit more women to study sex-related and hormonal influences on response. MORE was tested on top of medication, never in place of it. Huang put it well: medications for opioid use disorder save lives, but they were not designed to retrain how the brain responds to the cues that trigger craving.
I want that last point to land with families, because I still hear the claim that people on methadone or buprenorphine are not truly in recovery. The data point the other way. Medication stabilizes the brain enough for learning to happen, and a skills-based treatment like MORE then changes how the brain handles the triggers medication leaves untouched. Nobody in this trial was asked to choose.
What this means for recovery
If you or someone you love is in treatment for opioid use disorder, ask the program whether it offers anything that trains reappraisal and savoring, not only education about relapse. Ask whether it measures craving over time. A program that tracks how a patient's brain responds to cues will adjust faster than one that waits for a relapse to find out.
This is also where precision matters. At The Neurogenesis Project, our Rescue From Rehab track pairs medication-friendly addiction care with brain-level assessment, because two patients with the same diagnosis can have very different reward circuitry. Nutrition matters here too, since a brain rebuilding its reward system needs raw materials, and the brain nutrition work we do with Action Potential Supplements is built around that need. For a broader look at how addiction changes the brain across a lifespan, see our earlier post on how substance use looks different in the brain at 20, 35, and 55.
Craving is a brain process, and brain processes can be retrained. That is a more hopeful message than willpower ever offered, and it removes the shame from the patient who felt that corner pull at him despite doing everything right.
Hero image: illustration created with AI image tools.
This article was drafted with the assistance of AI writing tools, then reviewed, edited, and approved by Dr. Drew W. Edwards, Ed.D., who holds full editorial responsibility for its content.
Sources: Huang Y, Goldstein RZ, Garland EL. Prefrontal Cortical Changes With Mindfulness-Oriented Recovery Enhancement in Opioid Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry. DOI 10.1001/jamapsychiatry.2026.3388. Coverage: News-Medical, October 28, 2026.