Exploring the Role of Mindfulness and Metacognition in Opioid Recovery among Indian adult Men: Implications for Global Addiction Rehabilitation

Abstract

Purpose: Mindfulness and metacognition, two higher-order cognitive capacities central to emotion regulation and relapse prevention, are often impaired in individuals with opioid use disorder (OUD). Despite their conceptual overlap, few studies have examined their combined relationship, particularly in non-Western contexts. This study assessed mindfulness and metacognitive functioning among Indian men with OUD, compared these abilities with healthy controls, and explored their interrelationship within a culturally grounded framework. Methods: A total of 200 adult men aged 25–45 years participated. The clinical group (n = 100) met ICD-11 diagnostic criteria for OUD, while the control group (n = 100) comprised age-matched psychologically healthy men. Participants completed standardized measures of mindfulness, metacognitive awareness, and general health. Independent-sample t-tests examined group differences, and Pearson’s correlations assessed associations between mindfulness and metacognitive regulation, with statistical adjustments for multiple comparisons. Results: Men with OUD demonstrated significantly lower levels of mindfulness and metacognitive awareness than controls (p < .05). A strong positive correlation (r = .92) was observed between mindfulness and metacognitive regulation, suggesting a reciprocal relationship in which enhancement of one process may facilitate the other. Conclusions: This study provides the first integrated empirical analysis of mindfulness and metacognition among opioid-dependent men in India. Findings reveal a shared cognitive vulnerability underlying OUD and underscore the need for culturally adapted mindfulness-based interventions that target metacognitive regulation. Such approaches may enhance relapse prevention, promote sustained recovery, and strengthen the cross-cultural validity of global addiction treatment models.