A preliminary randomized controlled trial of a distress tolerance treatment for opioid dependent persons initiating buprenorphine

Abstract

Background Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency but early relapse rates are high and are often associated with withdrawal-related or emotional distress. Methods To determine whether a novel distress tolerance (DT) intervention during buprenorphine initiation decreases opioid relapse, we conducted a preliminary randomized controlled trial with opioid-dependent outpatients. Participants received buprenorphine-naloxone induction and 3-months of maintenance buprenorphine plus seven, 50-minute manualized, individual sessions (DT vs. Health Education (HE) control) over a 28-day period, linked to clinician medication dosing visits, and beginning 2 days prior to buprenorphine induction. Primary outcomes included use of illicit opioids (positive defined as any self-reported use in the prior 28 days or detected by urine toxicology) and treatment drop out. Results Among 49 participants, the mean age was 41 years, 65.3% were male. Persons randomized to DT had lower rates of opioid use at all three monthly assessments, and at 3-months, 72% of HE participants were opioid positive compared with 62.5% of DT participants. Rates of dropout were 24% and 25% in the HE and DT arms, respectively. Conclusions This distress tolerance treatment produced a small, but not statistically significant reduction in opioid use during the first three months of treatment although no differences were found in drop-out rates between conditions. If replicated in a larger study, DT could offer clinicians a useful behavioral treatment to complement the effects of buprenorphine. Trial registered at clinicaltrials.org. Trial number NCT01556087.

Initiating buprenorphine treatment for opioid use disorder during short‐term in‐patient ‘detoxification’: a randomized clinical trial

“…We documented considerable drop-off in prescribed buprenorphine use between the 1-and 3-month assessments. High rates of attrition have been noted among many large buprenorphine trials [17,34,35] and has been one reason that methadone, which has shown better retention, is sometimes recommended [36]. As noted, in this study the LINK participants were able to bypass the bureaucratic and practical barriers necessary to begin out-patient buprenorphine treatment.…”

Component Model of Addiction Treatment: A Pragmatic Transdiagnostic Treatment Model of Behavioral and Substance Addictions

“…Furthermore, among smokers with a history of early relapses, people who were randomly assigned to a distress tolerance treatment were over six times more likely to be abstinent compared to a standard smoking cessation treatment, with the effects being maintained, albeit diminishing overtime ( 92 ). More recently, Stein et al ( 93 ) assessed the effects of including a distress tolerance intervention to buprenorphine in the treatment of opioid dependence. At 3 months, 36.5% of people randomly assigned to the distress tolerance program were opioid negative compared to 28% of people who were randomly assigned to the health education program.…”

A developmental‐based motivational intervention to reduce alcohol and marijuana use among non‐treatment‐seeking young adults: a randomized controlled trial

“…A Health Education intervention served as the control condition . The duration and timing of these five sessions was identical to the EA condition.…”