Comparison of behavioral treatment conditions in buprenorphine maintenance
Open accessAbstract
Background and aims: The C ontrolled S ubstances A ct requires physicians in the U nited S tates to provide or refer to behavioral treatment when treating opioid‐dependent individuals with buprenorphine; however, no research has examined the combination of buprenorphine with different types of behavioral treatments. This randomized controlled trial compared the effectiveness of four behavioral treatment conditions provided with buprenorphine and medical management (MM) for the treatment of opioid dependence. Design: After a 2‐week buprenorphine induction/stabilization phase, participants were randomized to one of four behavioral treatment conditions provided for 16 weeks: cognitive behavioral therapy (CBT = 53); contingency management (CM = 49); both CBT and CM (CBT + CM = 49); and no additional behavioral treatment (NT = 51). Setting: Study activities occurred at an out‐patient clinical research center in L os A ngeles, C alifornia, USA. Participants: Included were 202 male and female opioid‐dependent participants. Measurements: Primary outcome was opioid use, measured as a proportion of opioid‐negative urine results over the number of tests possible. Secondary outcomes include retention, withdrawal symptoms, craving, other drug use and adverse events. Findings: N o group differences in opioid use were found for the behavioral treatment phase (χ 2 = 1.25, P = 0.75), for a second medication‐only treatment phase, or at weeks 40 and 52 follow‐ups. Analyses revealed no differences across groups for any secondary outcome. Conclusion: There remains no clear evidence that cognitive behavioural therapy and contingency management reduce opiate use when added to buprenorphine and medical management in opiate users seeking treatment.
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Randomized trials of behavioral interventions such as CBT combined with pharmacotherapy to reduce illicit opioid use have had limited success.
“While multiple RCTs have evaluated the effectiveness of behavioral interventions in reducing illicit opioid use, such as CBT in combination with pharmacological intervention, these studies had limited success (Fiellin et al., 2013; Ling et al., 2013; Weiss et al., 2018).”
From Feasibility and acceptability of mindful recovery opioid use care continuum (M-ROCC): A concurrent mixed methods study (2021) · cites this paper as Ling et al., 2013
Whether cognitive behavioral therapy has a direct benefit on craving is unclear, as results from studies to date have been inconsistent.
“However, whether CBT has a direct benefit on craving is unclear, as results from studies to date have been inconsistent (128, 129).”
From Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice (2019) · cites this paper as [128]
In a study by Ling et al., no significant differences in craving were observed between patients treated with buprenorphine and standard medical management or buprenorphine combined with either cognitive behavioral therapy or contingency management.
“In a study by Ling et al. (128), no significant differences in craving were observed between patients treated with buprenorphine and standard medical management (limited counseling) or buprenorphine combined with either CBT (weekly counseling sessions, exercises, and homework) or contingency management.”
From Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice (2019) · cites this paper as [128]
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- Authors
- Ling, W., Hillhouse, M., Ang, A., Jenkins, J., & Fahey, J.
- Affiliations
- University of California, Los Angeles (US)
- Corresponding author
- Hillhouse, Maureen
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2013-07-12
- Volume
- 108
- Issue
- 10
- Pages
- 1788-1798
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC3866908
- OpenAlex
- W2153599479
- Cited by
- 128
- References
- 50
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 8 · 2023: 5 · 2022: 11 · 2021: 20 · 2020: 16 · 2019: 14 · 2018: 8 · 2017: 8 · 2016: 10 · 2015: 8 · 2014: 9 · 2013: 2
- FWCI
- 9.86
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (DA020210, R01DA020210)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- buprenorphine maintenance, opioid use disorder, behavior therapy, cognitive behavioral therapy, contingency management, medical management, opioid use, treatment retention, Controlled Substances Act
- MeSH terms
- Adult, Analgesics, Opioid, Buprenorphine, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Narcotic Antagonists, Opioid-Related Disorders, Outpatients, Substance Withdrawal Syndrome, Los Angeles, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult, Opiate Substitution Treatment
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