Cognitive Behavioral Therapy's Impact on Relapse Rates in Opioid Use Disorder Patients Receiving Medication-Assisted Treatment

Opioid use disorder (OUD) sends an estimated 1,000 Americans to the emergency room each day and costs the United States $600 billion each year in healthcare expenses, lost productivity at work, and costs related to the criminal justice system. The U.S. government declared the opioid epidemic a national crisis in 2017 and highlighted the need to provide “appropriate treatment for individuals experiencing OUD,” but the question of what constitutes “appropriate treatment” remains. Medication-assisted treatment (e.g., using methadone or buprenorphine) is an evidence-based approach to helping opioid-dependent individuals reduce their withdrawal symptoms and cravings for opioids; however, relapse or program dropout is still very common among these patients. To produce better outcomes, some researchers suggest employing combination therapy, which incorporates psychotherapy alongside pharmacotherapy. Cognitive behavioral therapy (CBT) is one option for psychotherapy that has proven successful in treating substance use disorders by changing patterns of thinking and thereby prompting behavioral changes.

The purpose of this poster is to present an integrative review of the recent evidence-based literature concerning the research question. The research question investigated is: What are the relapse rates in opioid-dependent patients receiving medication-assisted treatment (MAT) who participate in CBT compared to opioid-dependent patients receiving MAT without CBT?

To identify relevant literature, searches were completed between September 2018 and April 2019, using the following databases: Ovid, PubMed, and CINAHL. The search was limited to articles published in English within the last seven years in peer-reviewed journals. Key search terms included cognitive behavioral therapy and opioid. Many of the initial results focused on independent or dependent variables that were not the focus of this review (e.g., impact of HIV counseling on reducing risky behaviors in OUD patients) and were therefore eliminated.

Research findings suggest a statistically significant reduction in relapse rates among patients enrolled in MAT with CBT, compared to those enrolled in MAT alone. Future studies are needed to replicate results from the studies examined in this integrative review, as well as to: (1) compare the efficacy of group versus individual CBT sessions; (2) evaluate the impact of CBT manuals designed specifically for OUD versus more general CBT; (3) understand any differences in efficacy of CBT for patients medicated with methadone versus buprenorphine; and (4) provide longer-term follow-up to allow for better assessment of CBT’s impact on sustained drug abstinence.

It is hoped that this research can inform the referral and management of patients with OUD, as well as spark more discussion and research on developing evidence-based treatments for OUD.