About 20 years ago I developed Mindfulness-Oriented Recovery Enhancement (MORE), an evidence-based, neuroscience-informed therapy that integrates the most powerful techniques from three great traditions in behavioral treatment: mindfulness training, cognitive-behavioral therapy, and positive psychology. All of the components in MORE were selected based on fundamental discoveries from addiction neuroscience.

MORE uses a unique and targeted treatment sequence to simultaneously address addiction, emotional distress, and chronic pain. The nice thing about MORE is that you don't need a separate therapy to address addiction, emotional distress, and pain -- you have one therapeutic approach that targets all of these problems in a unified treatment protocol. Traditional approaches address one or another of these problems, but if you don't address them simultaneously, you're leaving the risk factors that cause relapse unaddressed.

The three core techniques in MORE are mindfulness, reappraisal, and savoring.

Mindfulness: MORE teaches specific mindfulness techniques to help patients strengthen self-regulation, deal with craving, relieve physical pain, and produce feelings of well-being. One of the key things mindfulness does is train metacognitive attentional control over automatic habits. In addiction, there's a hyper-fixation of attention on drug cues that automatically triggers the addictive habit. Mindfulness trains people to interrupt that automatic process. Multiple studies show that MORE decreases the extent to which the brain is triggered by addiction-related cues.

Reappraisal: This is a core technique from CBT -- the practice of challenging and changing negative thoughts into more helpful ways of viewing oneself and the world. In MORE, we integrate mindfulness with reappraisal so they synergize each other. Mindfulness disrupts negative habits of thinking and broadens attention, which allows people to reappraise and reframe negative thought patterns more effectively. We have new data from a NIH-funded RCT showing MORE outperforms CBT in negative emotion regulation, both in self-reports and in brain activity.

Savoring: Learning to focus mindfully on pleasant, good, or meaningful everyday events, so as to deeply take in the good from those experiences. When we savor, we appreciate and amplify positive emotions and the pleasurable sensations that arise from naturally occurring positive experiences. This technique is specifically designed to reverse the blunting of the brain's reward system that addiction causes. Through savoring, patients learn how to make themselves feel good naturally, rather than depending on the drug as a source of wellbeing.

About one out of every two patients with OUD has chronic pain, and a lot of people were driven into opioid addiction due to originally having a prescription for opioids for pain. Chronic pain is also very common among people with other substance use disorders, alcohol use disorder, and nicotine addiction.

MORE decreases chronic pain symptoms by about 25%, and those effects last nine months after the end of this eight-session therapy -- that's about as much pain relief as you get from 10 milligrams of oxycontin. But here we're getting this pain relief just by training people to use their minds.

Unrelieved pain is also a big driver of relapse, whether its physical pain or emotional pain, like depression, shame, and trauma. When people are hurting inside they seek any means they can find to produce relief. The mindfulness, reappraisal, and savoring skills in MORE are powerful means of alleviating emotional pain and distress as well as relieving physical pain.

We have shown in multiple studies that MORE actually helps normalize the brain's reward system following addiction. In a study of patients with OUD published in JAMA Psychiatry in 2025, we found that the brains of people treated with MORE look more like the brains of people who never had OUD in the first place in terms of their neural reward response during savoring, and the greater the increase in savoring, the greater the reduction in craving for opioids.

We've used EEGs, functional MRIs, and structural MRIs to show how MORE changes the brain. A key study published in Science Advances showed that MORE massively decreases EEG markers of drug cue-reactivity in people with opioid misuse. After 8 weeks of MORE, patients brains were less triggered by opioid-related cues -- the first data in the scientific literature from a randomized trial showing that a mindfulness-based intervention could reduce drug cue-reactivity in the brain.

We now have a study with Rita Goldstein at Mount Sinai showing MORE rebalances neural activity in the prefrontal cortex by shifting responses away from drug-related cues and towards natural healthy pleasure. Following treatment with MORE the brain is less triggered by images of needles, pipes, and bags of dope.

We also show MORE leads to significantly greater increases in the thickness of the prefrontal cortex than CBT. MORE is actually growing the prefrontal cortex over the 8-session treatment, and that increase in cortical thickness predicts the ability to regulate craving.

We show people images on a computer screen -- smiling babies, cute puppies, beautiful mountains, beautiful sunsets -- and then we measure the EEG, heart rate variability, and fMRI response to those images. We show that when patients go through the MORE program, their brains and bodies actually become more sensitive to those rewarding stimuli. And the more sensitive the brain and body become to the positive image, that actually predicts decreases in craving and substance misuse. MORE is powerfully treating anhedonia and teaching people how to feel good again, naturally.

MORE is an eight-session protocol. It can be delivered once a week over eight weeks, or twice a week over four weeks, so you can double it up if you're working in a traditional 30-day recovery program or a residential treatment center. MORE is typically delivered as group therapy, but it can also be delivered as individual therapy. Most of the research has been on group-based MORE, which I think is a really powerful format for learning and feeling a sense of community.

The counselor guides the group through each session using a structured, moment-to-moment processing approach called PURER -- a framework for tuning into subtle shifts in attention, emotion, and body sensations as they unfold, and reinforcing therapeutic moments as they arise. When a client experiences even a brief sense of relief, clarity, or connection during practice, the counselor highlights it to strengthen motivation and build self-efficacy.

The group dynamic amplifies this process: when one person is struggling and another is finding traction with a given skill, the encouragement comes from peers rather than from a lecture. That social learning element -- seeing someone like me succeed -- often becomes a turning point in the room.

MORE is a manualized treatment protocol. Once certified, counselors have the evidence-based treatment manual, handouts ready to print, audio recordings to guide the mind-body practices, and access to all the material through the learning management system, which walks a therapist through all eight sessions with the script of what the therapist says and the questions to ask the group. All spelled out, very step by step.

We have two tracks: addiction and stress, and pain and opioid use. The manualized structure is a big advantage for medical systems because they know they're going to get fidelity and efficacy -- the treatment manual is exactly the same protocol used in our NIH- and DOD-funded RCTs.

Absolutely. The MORE therapy program is really ideal for telehealth. It can be delivered face-to-face, but we've also tested it pretty extensively as a telehealth therapy. MORE is effective in both face-to-face and telehealth formats.

In our 2024 JAMA Psychiatry trial, we gave telehealth-enabled tablets to patients and they did MORE online in groups with the therapist. We found powerful effects including a 42% decrease in drug relapse and 59% decrease in addiction treatment dropout. That same year in the American Journal of Psychiatry we did a study in veterans and found a similar pattern: MORE decreased opioid use, reduced pain, dropped craving, reduced anhedonia, and improved well-being, with effects lasting through an 8-month follow-up.

MORE is unique because it's a next-generation behavioral treatment built directly from the science of how addiction, emotion dysregulation, and chronic pain actually work in the brain and body. Every technique in the protocol was selected because it maps onto a specific process that needs to change, which is why the intervention is both highly structured and strongly evidence-based.

A core issue cutting across many mental health and addiction problems is impaired cognitive control. In addiction, drug cues automatically grab attention, trigger craving, and drive the habitual urge to seek and use the substance. That's exactly what mindfulness trains. Mindfulness also cultivates meta-awareness -- the capacity to observe thoughts, feelings, and sensations as events in the mind rather than as defining features of the self. This creates space for choice, flexibility, and healthier responding.

Reappraisal -- the core CBT strategy for cognitive restructuring -- is integrated with mindfulness in MORE to create a more powerful approach to regulating negative emotions. That expanded awareness makes it easier for clients to generate and focus on more adaptive interpretations of their challenging life experiences.

And savoring was included because addiction blunts the brain's ability to experience natural healthy pleasure. As addiction progresses, the reward system becomes less responsive, creating a sense of emptiness and despair. A similar loss of pleasure -- anhedonia -- is common in chronic pain, depression, and PTSD. Savoring helps reverse this process by training people to notice and fully engage with small positive experiences in daily life.

General mindfulness programs are often open-ended and focus on nonspecific themes like relaxation and acceptance. MORE is very different. It is a structured, mechanism-driven treatment built specifically to target the processes that keep addiction, emotional distress, and chronic pain going. Every technique in MORE was chosen because it maps onto a well-defined psychological or neurobiological mechanism.

MORE is also highly experiential. Clients do not simply talk about their problems. They engage in mind-body practices that allow them to directly experience moments of relief, clarity, or well-being during the session itself. That immediate experience of feeling better is reinforcing, and it increases motivation to keep practicing. In MORE, clients often leave the session feeling good, more grounded and more empowered -- which likely contributes to the 59% decrease in treatment dropout compared to standard care.

I used to do a live two-day training course. As we started to scale up, we realized that's tough for people to take two whole days off of work. So we've now developed an asynchronous on-demand training -- pre-recorded clinical demonstrations, didactic discussion, animations and illustrations, case examples, all built into an online learning management system. It takes about 10 hours to complete on their own schedule.

Once they complete that, they're fully trained and certified to deliver MORE. They then have access to the evidence-based treatment manual, the handouts, audio recordings, and all the material. We also have a dashboard that shows us how people progress through the training.

Annual membership includes ongoing continuing education in MORE to help you maintain your certification. It also provides access to an open consultation hour -- a live online group meeting that I lead each month. During this consultation, clinicians from around the world can ask questions about implementing MORE in their setting. I review clinical cases, demonstrate techniques, and offer guidance on best practices.

Membership also includes access to a growing library of PURER practice demonstrations. We are continually expanding this library and updating the educational content. Becoming a MORE therapist involves a long-term commitment to skill development, and membership ensures ongoing access to training resources and the latest science.

$895 per counselor for the complete training that gets you MORE-certified. We offer discounts for larger systems -- typically 25% or greater for 25 or more counselors, and we can work with you to negotiate bigger discounts for larger, longer engagements. Then $295 a year thereafter for the annual membership that includes ongoing consultation and continuing education.

The app is $12.99 a month for the patient, or $100 a year if purchased annually -- about $8 a month, the price of a Starbucks latte with an extra shot. Some organizations pay for the app through opioid grant funding; at others, the patient pays.

There is no charge to deliver the therapy. There is no per-patient charge beyond the optional app fee.

Yes. The clinician training and the patient app are completely separable. The app was designed as an optional educational companion. Everything required to deliver MORE is already included in the core training -- the treatment manual, the guided recordings, and the handouts. You do not need the app to implement the protocol with fidelity.

The MORE app simply extends and strengthens the work you are already doing in session. It makes adherence to MORE easy and effective. Patients can access practices, explanations, and reminders between sessions, which helps reinforce learning and support daily engagement. For larger systems with their own app, we are able to integrate into that app for a per patient licensing fee.

We have a really nice app to educate the patient that has audio recordings of all of the MORE mind-body skills and mindfulness practices, as well as all the educational material. It has two tracks: 1) addiction and stress, and 2) pain and opioid use. Within each track, the app mirrors content in each of the MORE sessions, in the correct treatment sequence. Each session starts with a check-in where the patient reports how he or she is feeling, then provides mind-body practice skill recordings and educational materials that parallel what the therapist described in the session. Patients just have to hit play.

The app removes the burden of having to provide daily meditations from the clinician to the patient. The app can be delivered by cell phone or loaded onto a tablet or iPad for facilities where phone access is restricted. The app can also be integrated into an organization's own digital ecosystem if they have one.

That's the right question to ask. The short answer is that MORE fills a mechanistic gap that CBT, MI, DBT, and ACT don't directly address, and the data show it.

MORE is not a repackaging of existing therapies. It was built from addiction neuroscience to target the specific mechanisms that drive relapse and chronic dysregulation: the automatic, unconscious habit loop; the hijacked reward system; the collapse of natural pleasure; and the way physical pain amplifies craving. These are processes that traditional CBT- or MI-based approaches do not explicitly address.

Across multiple randomized trials, MORE has produced three times the effect size of standard therapy and has dramatically reduced treatment dropout. In two separate RCTs, MORE outperformed CBT in reducing craving. We now have new evidence that MORE also outperforms CBT in negative emotion regulation, both on a performance-based behavioral task and in neural activation patterns during fMRI.

So the rationale isn't one more therapy. It's adding a mechanistically precise intervention that complements your existing approaches and improves outcomes where standard treatments plateau.

One of the advantages of MORE is that with this evidence-based approach you don't need separate treatments for addiction, mental health symptoms, and physical pain. MORE is designed as a single, unified intervention that simultaneously reduces addictive behavior, improves mood and emotion regulation, and relieves pain.

In an integrated care environment where patients often present with overlapping medical, psychological, and behavioral challenges, having one treatment that addresses all three domains is a major asset. So instead of referring a patient to three different services, MORE allows an integrated care team to deliver one evidence-based protocol that moves multiple outcomes at once.

There are multiple opioid treatment programs (OTPs) in Massachusetts, New Jersey, and Utah that are actively delivering MORE. We've also trained clinicians at large HMOs like Essentia Health and Kaiser to deliver MORE, and academic systems like Harvard, NYU Langone, Mount Sinai, and UCSD. We've done large MORE trainings at the Arkansas Department of Health and Human Services, Ventura County Behavioral Health, and Hampshire County jails. MORE is being used broadly throughout the U.S. and internationally.

To date, MORE has been tested in 16 randomized controlled trials with more than 2,500 participants. These studies span a wide range of clinical populations and settings -- people with opioid use disorder and other substance use disorders, individuals with chronic pain on long-term opioid therapy, patients undergoing orthopedic surgery, and people receiving cancer treatment.

MORE has been implemented with civilians, veterans, and active-duty service members. Across these trials, many participants also had co-occurring mental health diagnoses such as major depression, PTSD, and generalized anxiety disorder.

Importantly, MORE is not a therapy limited to high-functioning or highly motivated patients. It has been delivered successfully to individuals with low income, low educational attainment, and across all stages of change. The evidence shows that MORE is feasible, acceptable, and effective across diverse demographic, clinical, and motivational profiles.

We've conducted one study of the core MORE skills -- mindfulness, reappraisal, and savoring -- in high school classrooms. Classrooms that received these core MORE components showed significantly lower rates of cannabis use and vaping compared to classrooms that did not receive the training. That suggests the MORE skill set can function as an effective prevention strategy for youth.

It's also worth noting that MORE has demonstrated efficacy for digital addictions -- big problems among youth. In a randomized trial with college students, MORE significantly reduced video game addiction and craving. So the model generalizes beyond substance use to other forms of compulsive behavior.

MORE doesn't require perfect clarity of mind or full abstinence to be effective. In fact, many of our studies have involved patients with chronic pain who were actively taking, and in many cases misusing, prescription opioids during treatment. Even with opioids on board, people were able to engage with the mind-body skill practices and benefit greatly from the therapy.

So yes, MORE can be delivered early in the recovery process. It's also clearly useful for patients who are in medium- and longer-term recovery, to strengthen their commitment and prevent relapse. The bottom line is that MORE is effective across a wide range of recovery stages.

We've trained social workers, psychologists, counselors, marriage and family therapists, nurses, and physicians. We've also trained certified drug and alcohol counselors, peer support workers, physical therapists, and chaplains. So a Master's or PhD in behavioral health is not required. That said, I think MORE is probably most effective in the hands of a skilled and experienced clinician.

If you're doing group-based MORE, sessions take about 1.5 to 2 hours to complete. An hour and a half works, and two hours gives you plenty of time to deliver all of the content and allow a lot of opportunity to engage in therapeutic processing.

Sessions are highly experiential. Patients go through mind-body techniques in session, so they can have a direct experience of well-being. They leave the session feeling good, empowered, and wanting to engage with the material. That's different from a lot of traditional therapies where patients rehash their life problems and traumas and leave the session feeling emotionally drained. With MORE, patients leave wanting to come back. We've held more than ten independent focus groups and uniformly, patients tell us that they like MORE so much that they don't want the groups to end.

In a recent economic analysis, we found that for every $1 spent on MORE, there are over $700 in cost savings. The lifetime economic impact of MORE is estimated to be greater than $300,000 saved per patient. We also have new data showing that MORE significantly reduces emergency room visits across the board, but especially for pain, addiction, and mental health-related ER visits. The cost savings to organizations are profound, not just from dropout and relapse reduction, but from reduced ER utilization as well.

As an evidence-based psychotherapy, MORE is billable using standard group psychotherapy CPT codes or individual psychotherapy CPT codes for reimbursement. Physicians leading MORE have also successfully obtained reimbursement for MORE by billing it as a medical group visit. So MORE is very easy to integrate into existing systems.

Institutional discounts are available for organizations who want to train multiple counselors. For instance, there is a 25% discount for training 25 or more counselors. If the engagement is going to be bigger and longer term, we can work with your organization. We're very creative and entrepreneurial about this because we want to make it feasible and accessible. We want to change addiction treatment for the better. That's why we're doing this work.

Dr. Eric Garland is Endowed Professor in Health Sciences at the Sanford Institute, Professor of Psychiatry at UC San Diego, and Director of UCSD ONEMIND (Optimized Neuroscience-Enhanced Mindfulness Intervention Design). He holds a PhD and LCSW, and has spent 20 years developing and testing MORE through $90 million in federal research grants across 16 RCTs.

His work has been published in JAMA Psychiatry, JAMA Internal Medicine, the American Journal of Psychiatry, Nature Mental Health, Science Advances, and other leading peer-reviewed journals. With over 290 peer-reviewed publications, Dr. Garland is the most prolific author of mindfulness research in the world. He has trained over 1,000 clinicians worldwide and collaborated with Harvard, NYU Langone, Mount Sinai, Johns Hopkins, Kaiser Permanente, Essentia Health, and the VA.

He has given briefings on MORE to the U.S. Congress, the Director of the Office on National Drug Control Policy (ONDCP), administrators at SAMHSA, and multiple directors at the National Institutes of Health (NIH), including Dr. Nora Volkow (NIDA).