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 those 4 negative trials in the context of six questions:
Conclusions: While buprenorphine is far more effective than treatments that do not involve medications for opioid use disorder, retention in buprenorphine treatment appears to be significantly poorer than in methadone maintenance treatment. High-quality medical management may suffice for some patients, but it’s hard to know which patients that might be. Physicians might consider a stepped-care model, starting new patients out with relatively low intensity treatment, adding more care and intervention for patients who appear to struggle early on. Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, innovative strategies for enhancing retention in buprenorphine treatment must be explored.
Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Carroll KM, Weiss RD. The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review. American Journal of Psychiatry 2016 (in press).