The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review

Abstract

Objective Although counseling is a required part of office-based buprenorphine treatment of opioid use disorders, the nature of what constitutes appropriate counseling is unclear and controversial. We review the existing literature on the role, nature, and intensity of behavioral interventions in office-based buprenorphine treatment. Method Review of randomized controlled studies testing the efficacy of adding a behavioral intervention to buprenorphine maintenance treatment. Results Four key studies showed no benefit from adding a behavioral intervention to buprenorphine plus medical management, while 4 studies indicated some benefit for specific behavioral interventions, primarily contingency management. We examine the findings from the negative trials in the context of six questions: 1) Is buprenorphine that effective? 2) Is medical management that effective? 3) Are behavioral interventions that ineffective in this population? 4) How has research design affected the results of studies of buprenorphine plus behavioral treatment? 5) What do we know about subgroups of patients who do and do not seem to benefit from behavioral interventions? 6) What should clinicians aim for in terms of treatment outcome in buprenorphine maintenance? Conclusions High-quality medical management may suffice for some patients, but there are few data regarding the types of individuals for whom medical management is sufficient. Physicians should consider a stepped care model in which patients may begin with relatively non-intensive treatment, with increased intensity for patients who struggle early in treatment. Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in buprenorphine treatment.

Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives

“…While the added benefit of behavioral interventions in the delivery of MAT is still in question (e.g., 60), many providers and researchers consider adjunctive psychosocial counseling with MAT as the gold standard (59, 61). Counseling during the early phases of MAT may enhance patients’ motivation while later focus can shift to improving coping and relapse prevention skills (59).…”

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

“…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). More research is needed to assess the acute and long-term effectiveness of buprenorphine, methadone, and potential barriers in accessing related treatments among African American men re-entering the community from prison.…”

The Cholinergic System as a Treatment Target for Opioid Use Disorder

“…The principal limitation of MAT is high drop-out rates and subsequent relapse to opioid use. For buprenorphine and methadone maintenance treatments, retention rates at 1 year are typically less than 50% [7, 8]. Retention rates for injectable sustained-release naltrexone are even lower [27–30].…”