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

Carroll, Kathleen M.; Weiss, Roger D.

doi:10.1176/appi.ajp.2016.16070792

Cited by 211Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesPain Management and Opioid Use

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

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Carroll, Kathleen M., Weiss, Roger D.·2017·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2016.16070792PMC PMC5474206

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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. The authors review the literature on the role, nature, and intensity of behavioral interventions in office-based buprenorphine treatment. METHOD: The authors conducted a 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, and four studies indicated some benefit for specific behavioral interventions, primarily contingency management. The authors examined 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 those who 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 nonintensive 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.

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Studies of traditional evidence-based behavioral interventions with buprenorphine/naloxone have failed to demonstrate significant reductions in opioid use compared to treatment as usual.
“Unfortunately, studies of traditional evidence-based behavioral interventions with buprenorphine/naloxone treatment have failed to demonstrate significant reductions in opioid use compared to treatment as usual (TAU) 7.”
From Effects of a trauma-informed mindful recovery program on comorbid pain, anxiety, and substance use during primary care buprenorphine treatment: A proof-of-concept study (2023) · cites this paper as [7]
The section on four trials showing no benefit reports that adding counseling or other behavioral interventions to buprenorphine plus medical management did not improve opioid-use outcomes in those trials. But the Summary and conclusions says an equal number of trials found behavioral interventions effective, particularly contingency management. The claim omits those positive findings and overgeneralizes the negative trials. (LLM, conf=0.88)
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Behavioral Therapy as an Adjunct to Buprenorphine Treatment for Opioid Use Disorder
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Authors: Carroll, K. M., & Weiss, R. D.
Affiliations: Harvard University (US)
ORCID: Carroll, Kathleen M.
Weiss, Roger D.
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2017-08
Volume: 174
Issue: 8
Pages: 738-747
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2016.16070792
PMC: PMC5474206
OpenAlex: W2566316894
Cited by: 211
References: 67
Citations by year: 2026: 3 · 2025: 15 · 2024: 21 · 2023: 21 · 2022: 33 · 2021: 35 · 2020: 29 · 2019: 29 · 2018: 20 · 2017: 5
FWCI: 17.85
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (UL1TR001863)
National Institute on Drug Abuse (K24DA022288, P50DA009241, UG1DA015831)
National Center for Advancing Translational Sciences
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 treatment, opioid use disorder, behavioral interventions, contingency management, office-based opioid treatment, medical management, stepped care, treatment retention, counseling, treatment discontinuation
MeSH terms: Behavior Therapy, Buprenorphine, Combined Modality Therapy, Heroin Dependence, Humans, Long-Term Care, Methadone, Opioid-Related Disorders, Outcome and Process Assessment, Health Care, Patient Compliance, Randomized Controlled Trials as Topic, Cocaine-Related Disorders, Patient Preference

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

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