A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction

Dugosh, Karen L.; Abraham, Amanda J.; Seymour, Brittany L.; McLoyd, Keli; Chalk, Mady; Festinger, David S.

doi:10.1097/adm.0000000000000193

Cited by 267 publications

(187 citation statements)

References 35 publications

(70 reference statements)

Supporting

Mentioning

179

Contrasting

Unclassified

Order By: Relevance

“…Our findings suggest that discounting can be strongly influenced by the current environment. Thus, the possibility that delay discounting behavior could be susceptible to change through therapeutic interventions (e.g., contingency management) that enhance the relative value of delayed non-drug reinforcers (Dugosh et al 2016; Holtyn et al 2014; Lussier et al 2006) is important for future study at the behavioral and neurobiological levels.…”

Section: Discussionmentioning

confidence: 99%

Choice between delayed food and immediate opioids in rats: treatment effects and individual differences

et al. 2017

View full text Add to dashboard Cite

Rationale Addiction involves maladaptive choice behavior in which immediate drug effects are valued more than delayed nondrug rewards. Objectives and Methods To model this behavior and extend our earlier work with the prescription opioid oxycodone, we allowed rats to choose between immediate intravenous delivery of the short-acting opioid remifentanil and delayed delivery of highly palatable food pellets. Treatment drugs were tested on a baseline where remifentanil was preferred over food. Results Treatment with a high dose of the opioid antagonist naltrexone decreased but did not reverse the preference for remifentanil. Treatment with the serotonin 5-HT2C agonist lorcaserin decreased remifentanil and food self-administration nonselectively. Across conditions in which the alternative to delayed food was either a moderate dose of oxycodone, a moderate or high dose of remifentanil, a smaller more immediate delivery of food, or timeout with no primary reinforcement, choice was determined by both the length of the delay and the nature of the alternative option. Delayed food was discounted most steeply when the alternative was a high dose of remifentanil, which was preferred over food when food was delayed by 30 s or more. Within-subject comparisons showed no evidence for trait-like impulsivity or sensitivity to delay across these conditions. Conclusions Choice was determined more by the current contingencies of reinforcement than by innate individual differences. This finding suggests that people might develop steep delay-discounting functions because of the contingencies in their environment, and it supports the use of contingency management to enhance the relative value of delayed non-drug reinforcers.

show abstract

Section: Discussionmentioning

confidence: 99%

Choice between delayed food and immediate opioids in rats: treatment effects and individual differences

et al. 2017

View full text Add to dashboard Cite

show abstract

“…This opioid tapering strategy is intended to reduce or altogether stop opioid use, but can result in withdrawal symptoms that curtail further dose reduction or cause relapse. For a more comprehensive review of therapeutic approaches, including nonopioid adjuvant strategies for managing opioid withdrawal, the reader is referred to other articles on this topic [2,5]. …”

mentioning

confidence: 99%

Therapies and Mechanisms of Opioid Withdrawal

2017

View full text Add to dashboard Cite

Opioids are revered as potent analgesics, yet their clinical utility for managing pain is shrouded by concerns over the high abuse potential. With skyrocketing numbers of opioid prescriptions and off-label use, and a striking number of accidental opioid-related deaths and emergency room visits, North America has declared an 'opioid crisis'. In the USA alone, the number of prescribed opioids has quadrupled since 1999, with enough opioid prescriptions dispensed annually to provide a bottle for every household [1]. The opioid crisis, however, is not an isolated North American problem as virtually all developed countries have reported increased opioid consumption and deaths. The alarming rise in opioid-related deaths has stoked growing concerns about the safety of opioids, and increased reluctance on the part of some physicians to prescribe this class of drugs. This has created a conundrum: on one hand, opioids are essential for managing pain, but an over-reliance on opioids can put patients at risk of serious adverse effects, such as opioid analgesic tolerance (diminished pain-relieving effects), hyperalgesia (paradoxical increase in pain sensitivity) and drug dependence (manifesting as drug craving, seeking and/or physical withdrawal). The problem of opioid withdrawalAlthough adverse effects undermine the long-term clinical utility of opioids for pain management, terminating opioid therapy is also problematic because it can precipitate a debilitating withdrawal syndrome in chronic users. In this respect, opioid withdrawal is a significant challenge in patients where pain has resolved and there is no longer a need for opioid treatment, or those that are on dangerously high doses and a reduction in dose is prudent. Depending on the half-life of the opioid used, withdrawal typically presents between 8 and 48 h after the last opioid dose, with symptoms including gastrointestinal discomfort, anxiety, insomnia, muscle cramps and hyperhidrosis [2]. Individuals are therefore compelled to continue using opioids to avoid these unpleasant somatic, autonomic and emotional symptoms. Thus opioid withdrawal is a key determinant for continued opioid use and a contributing factor for relapse. A potential complication of terminating opioid therapy is the re-emergence of pain or exacerbation of a preexisting pain condition. Although pain is a major concern, patients on opioid therapy report that mitigation of withdrawal is a more important consideration for continued opioid use than pain management [3]. However, discerning between pain from a pre-existing condition and pain arising from opioid withdrawal is difficult. Patients may demand higher doses of opioids to manage a perceived worsening of pain, but the underlying reason may stem from withdrawal rather than a progression of a pre-existing pain condition. Withdrawal is also a key motivating factor for continued opioid use in off-label or nonprescription opioid users, and like prescription opioid users, many of these individuals may be better positioned to stop opioid use if mor...

show abstract

“…Dugosh et al (2016) provided a useful service to readers by structuring their review of psychosocial treatment in conjunction with medication for opioid addiction by medication type (e.g., agonist v. antagonist), duration of medication treatment (maintenance v. detoxification) and types of “psychosocial treatment.” Unfortunately, the review did not specify what patient outcome was the focus of the review, the summary of the articles in the review were less than precise, and the discussion section considered all psychosocial treatments as if they were interchangeable.…”

mentioning

confidence: 99%

When Added to Opioid Agonist Treatment, Psychosocial Interventions do not Further Reduce the Use of Illicit Opioids

Schwartz

2016

Journal of Addiction Medicine

View full text Add to dashboard Cite

A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction

Cited by 267 publications

References 35 publications

Choice between delayed food and immediate opioids in rats: treatment effects and individual differences

Choice between delayed food and immediate opioids in rats: treatment effects and individual differences

Therapies and Mechanisms of Opioid Withdrawal

When Added to Opioid Agonist Treatment, Psychosocial Interventions do not Further Reduce the Use of Illicit Opioids

Contact Info

Product

Resources

About