A Review of Behavioral Therapies in Adolescents with Opioid Use Disorder

Abstract

A growing evidence base supports the use of medication to treat opioid use disorder (OUD) in adolescents, but little is known about behavioral therapies for adolescents with OUD. A systematic review using PRISMA methodology was conducted on behavioral therapy for adolescent OUD. Only three studies were identified. Combined evidence from two studies indicates initial efficacy of the Adolescent–Community Reinforcement Approach, motivational enhancement therapy, and cognitive-behavioral therapy for reducing opioid use. The only group therapy identified, which involved adolescents and their parents, demonstrated improvement in participants’ knowledge of relapse-prevention strategies, drug-refusal skills, and overall psychosocial functioning. Additional studies that included behavioral therapy but that did not specifically test its efficacy are also highlighted to expand the understanding of the small literature base. This review highlights the sparse evidence base for these therapies in this population. In addition, we highlight promising areas for future research and include evidence from the adult literature that may inform that research. Studies on behavioral therapies that utilize randomized, controlled trials for this population are imperative.

Prescribed opioid use is associated with increased all-purpose emergency department visits and hospitalizations in community-dwelling older adults in the United States

“…In summary, in this nationally representative sample of community-dwelling older adults, prescribed opioid use, advanced age, male gender, unemployment/retirement, African Americans, living alone, fair or poor general health status, and history of depression were positively associated with all-purpose ED visits and/or hospitalizations. Clinicians should identify older adults at high risk for ED visits and hospitalizations and encourage them to use evidence-based interventions, such as non-pharmacological pain management interventions ( 51 ), behavioral therapies ( 52 ), and counseling ( 53 , 54 ) to treat chronic pain in this population. This may decrease chronic pain, opioid use, opioid-related adverse health outcomes, ED visits, and hospitalizations in this vulnerable population.…”

Factors associated with counselling adherence in opioid treatment programs

“…Motivational enhancement therapy emphasises a patient's ability to motivate themselves to change for the better (Welsh et al, 2020). CBT identifies ways for limiting trigger exposure and creates new abilities to modulate trigger reactions (Davis et al, 2019; Welsh et al, 2020). Greater collaboration between the self‐help community and professional service organisations can assist in achieving the needs of OUD patients (Mowbray et al, 2010).…”

“…It will be important for counsellors and social workers to address these for engagement improvements in treatment outcomes. Motivational enhancement therapy emphasises a patient's ability to motivate themselves to change for the better (Welsh et al, 2020). CBT identifies ways for limiting trigger exposure and creates new abilities to modulate trigger reactions (Davis et al, 2019; Welsh et al, 2020).…”

“…Mowbray et al (2010) note barriers such as structural and cognitive, which are specific to patients whose primary heroin use patients. TA B L E 2 (Continued) (Welsh et al, 2020). CBT identifies ways for limiting trigger exposure and creates new abilities to modulate trigger reactions (Davis et al, 2019;Welsh et al, 2020).…”

Commentary on Monico et al.: The urgent need for developmental competency and effective policy to prevent youth opioid overdose

“…Compared to older adults, youth with OUD are prone to dropping out of treatment and having inferior MOUD outcomes [10]; are more influenced by peer environments, yet are less well‐resourced with peer recovery supports [11]; and lack mature impulse control and executive functioning, rendering adult SUD treatment models less effective for this age group [12]. Behavioral treatment of adolescents with OUD is understudied, but preliminary data support the applications of the adolescent‐community reinforcement approach, motivational enhancement therapy, and cognitive–behavioral therapy for reducing opioid use [13]. Monico et al .’s results suggest that such treatment platforms include specific elements to address: (1) heterogeneity of OUD presentations and individualized treatment planning, (2) improved knowledge about overdose and skills for risk reduction, (3) reduction of psychological distress (significantly increased during the coronavirus pandemic, with youth representing the highest increase among all age groups [14]) and suicide risk and (4) incentivizing treatment entry through peer influence and peer attachment.…”