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

In February, the American Society of Addiction Medicine (ASAM) published its meta-analysis review of all existing literature related to the effectiveness of behavioral interventions when combined with medication-assisted therapy (MAT) in the Journal of Addiction Medicine. This research was completed as part of the long process of rolling out updated ASAM guidelines related to use pharmacological agents (buprenorphine, methadone. and naltrexone) in treating opioid use disorder.

The authors looked at a total of 27 articles to use in drawing their conclusions specifically around efficacy and safety of these combination programs. The overall results of their research generally support the use of psychosocial interventions such as cognitive-behavioral therapy (CBT), Contingency Management, and Biofeedback in the treatment of opioid addiction, but the amount and quality of the supporting evidence is lacking and more research needs to be done.

In particular, of the 27 studies used for the analysis, 14 of them related to methadone. Eight of these 14 demonstrated significant benefits from psychosocial interventions most profoundly around reduced illicit drug use and increased program attendance, which for obvious reasons is one of the strongest predictors of long term success in battling addiction.

Interestingly, of the eight studies used to evaluate buprenorphine treatment for opioid use disorder, only three showed significant benefits from the behavioral interventions. Furthermore, only three studies looking at oral naltrexone and psychosocial intervention were available for inclusion but had mixed results. There were no references available for long-acting naltrexone (Vivitrol).

Much more research is needed to better understand the interplay of various factors in predicting outcome for these patients. Given SAMHSA’s recent estimate that there are 4.3 million non-medical users of opioids in the U.S., and the recent rapid expansion of well-funded MAT clinics expanding across the country, clinicians need much better clinical guidance sooner rather than later.








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