Therapy ineffective for opioid addiction

Cognitive behavioral therapy (CBT) is not an effective way to treat opioid dependence, according to a study conducted by researchers at the Yale School of Medicine.

In a surprise finding, a team of seven researchers reported that CBT — which typically involves a therapist working directly with a patient to overcome addiction — does not offer significant benefits when administered to patients already on medication. The study, published online in The American Journal of Medicine, evaluated patients being treated with buprenorphine, the drug most often prescribed to treat substance abuse. The findings contrasted with earlier studies showing improved outcomes for patients undergoing treatments that included CBT in addition to medication.

“This study found that CBT did not improve the effectiveness of standard office-based buprenorphine maintenance treatment in a selected population of opioid-dependent patients,” said Yale professor of psychiatry Richard Schottenfeld ’71 GRD ’76, who co-authored the study.

The researchers evaluated the impact of cognitive behavioral therapy by conducting a clinical trial involving 141 opioid-dependent patients. The patients were divided into two groups -— one group received buprenorphine treatment under the care of a physician, while the other received both buprenorphine and therapy. Results showed patients receiving therapy did not show a greater reduction in opioid use than those receiving only medication.

The study’s lead author, Yale School of Medicine professor David Fiellin, said in a January press release that the study could have significant implications for the field of substance abuse treatment. CBT had previously been considered an important element of addiction treatment, but no previous studies had evaluated its impact when paired with buprenorphine.

“This is good news in many ways,” Schottenfeld said in an email to the News. “It means that many patients obtain great benefits of standard, office-based buprenorphine/naloxone maintenance treatment without needing additional CBT counseling, which would be difficult and costly to provide to all patients.”

The study does not suggest that CBT is entirely ineffective, according to Yale associate research scientist in psychiatry Brent Moore, who co-authored the study. Moore said it is possible CBT did offer benefits to some of the opioid-dependent patients, but its impact might have been too statistically small to affect the study findings.

“CBT is certainly better than nothing at all in terms of treatment,” Moore said. “Our study simply shows that it does not have an additive effect for patients on medication.”

Having demonstrated that CBT is not a significantly beneficial additive treatment, the team of researchers said they hope to explore whether other adjunctive treatments can be added to buprenorphine to improve patients’ experiences recovering from addiction. Schottenfeld said that although standard medications are effective, the researchers hope to identify ways that treatments can be improved so that patients recover more quickly.

“There is still considerable room for improvement, even in the population studied, since many patients did remain in treatment,” Schottenfeld said. “Whether other approaches to counseling or psychosocial interventions … can improve the effectiveness of standard treatment or whether CBT improves the effectiveness of the treatment with other patient populations are important areas for further research.”

The study was funded by grants from the National Institute on Drug Abuse.

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