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The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review
Open accessAbstract
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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“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]
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“30 Primary studies typically provided data on more than 1 outcome; therefore, data for effect-size estimation were selected based on a decisional hierarchy in the following order: (1) biological assay measures, (2) measures of frequency or quantity in the form of means (SDs), (3) sample proportions, and (4) other outc…”
MethodSelf-citation
Metadata
- Authors
- Carroll, K. M., & Weiss, R. D.
- Affiliations
- Harvard University (US)
- Venue
- American Journal of Psychiatry
- Published
- 2017-08
- Volume
- 174
- Issue
- 8
- Pages
- 738-747
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- 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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