Systematic content analysis of patient evaluations of START NOW psychotherapy reveals practical strategies for improving the treatment of opioid use disorder

Abstract

Background Clinical trials provide consistent evidence for buprenorphine’s efficacy in treating opioid use disorder (OUD). While the Drug Addiction Treatment Act of 2000 requires physicians to combine medication-assisted treatment (MAT) with behavioral intervention, there is no clear evidence for what form or elements of psychotherapy are most effective when coupled with MAT to treat OUD. This investigation involves focus groups designed to collect patient opinions about a specific psychotherapy, called START NOW, as well as general beliefs about various elements of psychotherapy for treating OUD. Our analysis reveals trends about patient preferences and strategies for improving OUD treatment. Methods Subjects included patients enrolled in buprenorphine/naloxone MAT at our institution’s office-based opioid treatment program. All subjects participated in a single START NOW group session, which was led by a provider (physician or nurse practitioner trained and standardized in delivering START NOW). Consented subjects participated in satisfaction surveys and audio-recorded focus groups assessing individual beliefs about various elements of psychotherapy for treating OUD. Results Overall, 38 different focus groups, 92 participation events, and 44 unique subjects participated in 1-to-6 different START NOW session/audio-recorded focus group sessions led by a certified moderator. Demographic data from 36/44 subjects was collected. Seventy-five percent (33/44) completed the START NOW Assessment Protocol, which revealed self-reported behavioral trends. Analysis of all 92 START NOW Satisfaction Questionnaire results suggests that subjects’ opinions about START NOW improved with increased participation. Our analysis of audio-recorded focus groups is divided into three subsections: content strategies for new psychotherapies, implementation strategies, and other observations. For example, participants request psychotherapies to target impulsivity and to teach future planning and build positive relationships. Conclusions The results of this study may guide implementation of psychotherapy and improve the treatment of OUD, especially as it relates to improving the modified START NOW program for treating OUD. Our study also reveals a favorable outlook of START NOW with increased participation, suggesting that any initial reticence to this program can be overcome to allow for effective implementation.

Noninferiority Clinical Trial of Adapted START NOW Psychotherapy for Outpatient Opioid Treatment

“…Participants in this sample were mostly female (59.1%), white (92.0%), and non-Hispanic (97.1%), with a mean age of 38.0 years (SD: 10.9). These results are consistent with the participant population in a pilot study (Truong et al, 2021). There was no statistically signi cant differences in race (p = 0.3992) and ethnicity (p = 0.4808) between the START NOW and TAU groups.…”

“…Because START NOW is always free, it may be especially useful in low-resource settings, which have limited access to OUD treatment ( 29 – 31 ). Furthermore, a preliminary pilot study of START NOW for OUD conducted at our institution suggested that patients favorably view the skills-based training aspects START NOW and the diversity of the skills-training provided ( 14 ). This is important because patients need confidence in their treatment program which includes not only the clinician but also the psychotherapy provided.…”

“…We propose that such a comprehensive intervention is START NOW, a psychotherapy that was originally implemented and validated in the Connecticut Correctional Health Research Program with support from a National Institute of Justice grant (NIJ 2002-IJ-CX-K009) ( 13 ). For the purposes of treating substance use disorders (SUD), START NOW has since been modified and validated in a pilot study so that it is more appropriate and applicable for the OUD patient population ( 14 ).…”

START NOW WebApp—promoting emotion regulation and resilience in residential youth care and correctional institutions: study protocol for a cluster randomized controlled trial

“…There is accumulated support for the use of the START NOW intervention with adult forensic and correctional populations, institutionalized AYA as well as student populations. Indeed, studies have shown START NOW’s effectiveness in terms of reduced behavioral problems [ 13 ], reduced hospitalization rates [ 14 ], improved mental health functioning [ 15 ] and high satisfaction rates [ 16 ]. In addition, Stadler et al [ 17 ] adapted START NOW for AYA and investigated its implementation and efficacy within an international randomized trial.…”

START NOW: a cognitive behavioral skills training for adolescent girls with conduct or oppositional defiant disorder – a randomized clinical trial

“…Another integrative approach that has accumulated support for use within correctional (Kersten, Cislo, Lynch, Shea, & Trestman, 2016) and outpatient (Truong et al., 2021) adult populations is START NOW, which was developed from dialectical behavioral therapy – corrections modified (DBT‐CM; Sampl, Wakai, & Trestman, 2010). The program is an evidence‐based, manual‐guided, gender‐specific, strengths‐based skills training incorporating methods of cognitive behavioral therapy (CBT) and DBT, motivational interviewing (MI), and trauma‐informed care.…”