Cognitive Behavioral Therapy Improves Treatment Outcomes for Prescription Opioid Users in Primary Care Buprenorphine Treatment

Abstract

To determine whether treatment outcomes differed for prescription opioid and heroin use disorder patients, we conducted a secondary analysis of a 24-week (N = 140) randomized trial of Physician Management (PM) or PM plus Cognitive Behavioral Therapy (CBT) in primary care buprenorphine/naloxone treatment. Self-reported opioid use and urine toxicology analyses were obtained weekly. We examined baseline demographic differences between primary prescription opioid use patients (n = 49) and primary heroin use patients (n = 91) and evaluated whether treatment response differed by assigned condition. Compared to primary heroin use patients, primary prescription opioid use patients had marginally fewer years of opioid use, were less likely to have had a previous drug treatment or detoxification, and were less likely to report injection drug use. Although opioid abstinence only, and treatment retention did not differ by opioid use group, opioid category moderated the effect of CBT on urine samples negative for all drugs. Primary prescription opioid use patients assigned to PM-CBT had more than twice the mean number of weeks of abstinence for all drugs (7.6) than those assigned to PM only (3.6; p=.02), while primary heroin use patients did not differ by treatment. Findings suggest that examination of other factors that may predict response to behavioral interventions is warranted.

Trends and mental health correlates of nonmedical opioid use among criminal justice-involved African American men

“…This may include incorporating religion and spirituality, family therapy, case management, collaboration with probation and parole, and vocational training. Cognitive behavioral therapy (Kumari et al, 2016; Moore et al, 2016) and contingency management (Ling et al, 2013) have previously shown effectiveness with community-based samples and may have potential – if culturally adapted to address the specific substance use and mental health needs of criminal justice-involved African American men. Finally, while medication-based interventions have shown some efficacy (Carroll & Weiss, 2017) and effectiveness (Damian et al, 2017), compared to Whites, African Americans are disproportionately underrepresented in pharmacotherapy studies (Hansen et al, 2016; Mitchell et al, 2016).…”

Low theoretical fidelity hinders the research on health coaching for opioid reduction: A systematic review of randomized controlled trials

“…While brief motivational interviewing was not found to be superior to other interventions for reduction of opioid usage, previous studies have investigated the effectiveness of other behavioral interventions, such as cognitive behavioral therapy (CBT), on the reduction of opioid usage. CBT has been shown to increase abstinence from drugs in those addicted to prescription opioids [ 40 ] and to be superior to methadone drug counseling at increasing abstinence from non-prescription opioids [ 41 ]. These results, while promising, are in contrast to our results.…”

A Systematic, Intensive Statistical Investigation of Data from the Comprehensive Analysis of Reported Drugs (CARD) for Compliance and Illicit Opioid Abstinence in Substance Addiction Treatment with Buprenorphine/naloxone

“…Previous studies have used biological markers to determine compliance to known dosages of treatment medications or measure nonabstinence during treatment Baros, Latham, Moak, Voronin, & Anton, 2007;Gerra, Fantoma, & Zaimovic, 2006;Kumari et al, 2016;McDermott et al, 2015;Moore et al, 2016;Pal Singh Balhara & Jain, 2012). Other studies have focused on meaningful comparisons regarding treatment modalities, efficacy methadone vs. bup/nal, and determination of risk factors for compliance and treatment success.…”

“…Other studies have focused on meaningful comparisons regarding treatment modalities, efficacy methadone vs. bup/nal, and determination of risk factors for compliance and treatment success. Many of these studies have used short follow-up periods, and researchers have focused largely on retention rates, chart reviews, instances of buprenorphine administration, interviews, self-report of heroin use and criminal activity, and telephone or internet communication, to measure adherence and abstinence (Fareed et al, 2014;Maas, Barton, Maskrey, Pinto, & Holland, 2013;Mattick et al, 2014;Moore et al, 2016;Parran et al, 2010;Tkacz, Severt, Cacciola, & Ruetsch, 2012).…”