Counseling and/or 12-Step Attendance Improves Outcomes for People on Medications for Opioid Use Disorder

CTN Dissemination Library / Northwest ATTC

Sitting in circle counseling session

What’s the Question?

Opioid use continues to cause high rates of overdose and death in the U.S. Though there are several effective medications for the treatment of Opioid Use Disorder (OUD), such as methadone, buprenorphine, and injectable extended-release naltrexone, access to and engagement in treatment remains low. Anything treatment providers can do to improve the chances of someone starting and staying in care can save lives.

Counseling is often suggested as a potentially helpful addition to medication treatment for OUD, one that could help improve retention and outcomes, but research has found conflicting evidence. Also, many of those studies involved methadone treatment only, with fewer looking at the combination of counseling and buprenorphine or naltrexone.

This study aimed to address some of these information gaps by looking at the relationship between psychosocial counseling and 12-Step attendance on subsequent opioid use over several months of Medication for Opioid Use Disorder (MOUD) treatment.
 

How Was This Study Conducted?

Researchers used data from a national multisite randomized clinical trial comparing buprenorphine-naloxone (BUP-NX) to extended release naltrexone (XR-NTX), NIDA Clinical Trials Network study CTN-0051 (X:BOT).  

In the original study, a total of 570 participants were assigned randomly to two treatment groups: one that received XR-NTX (n=283), the other BUP-NX (n=287). 

At each study visit, which occurred weekly the first month, then every 2 weeks, and finally every 4 (weeks 16, 20, and 24), providers focused on medication management, provider-patient rapport, medication adherence and side effects, and promotion of other psychosocial treatment, like counseling or 12-Step involvement.

For the current study, researchers looked at the data from CTN-0051 to see if there were any correlations between opioid use and counseling/12-Step attendance, as well as whether there were any differences by treatment assignment (XR-NTX or BUP-NX).
 

What Did Researchers Find Out?

Analysis revealed that any type of counseling or 12-Step attendance reduced the likelihood a participant would report opioid use at the next study visit. The strength of this association grew over time, suggesting that ongoing attendance in psychosocial treatment continued to reduce the risk of opioid use going forward. 

In the BUP-NX arm, group counseling was associated with a greater reduction in odds of opioid use. For XR-NTX, 12-Step seemed to be more effective. 
 

What are the Implications for the Workforce?

Any type of counseling or 12-Step engagement appears to help people in medication treatment for opioid use disorder remain abstinence from opioid use, and the strength of that association may grow over time. 

It’s important to note here, though, that this association could be explained by the fact that more motivated individuals may both attend more counseling/12-Step sessions AND have better treatment outcomes. More research is needed to investigate the actual connection between these two things.

Nevertheless, organizations and providers who offer MOUD may want to consider adding counseling or other psychosocial support services in-house or referring patients to external services to receive that care. While the results of the present study suggest that when it comes to psychosocial support, “more is better,” the findings also suggest that “any is better than none.” Since no single type of psychosocial care was significantly better than another, providers should encourage patients to attend whatever they think will work best for them. 


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Hefner K, et al. Time-lagged association between counseling and/or 12-Step attendance with subsequent opioid use in a secondary analysis from a randomized, clinical trial of medications for opioid use disorder. Drug and Alcohol Dependence Reports 2022;5:100100.