24 Nov Combined Use of Buprenorphine and Behavioral Therapy for Opioid Addiction Treatment
Buprenorphine is a medication commonly used to treat people recovering from addictions to various types of opioid narcotic drugs. In the U.S., federal guidelines mandate that people receiving the medication also have the opportunity to participate in some sort of additional behavioral therapy. In a study published in 2013 in the journal Addiction, researchers from the UCLA compared the effectiveness of two popular forms of behavioral therapy when used in combination with buprenorphine. The researchers also compared the effectiveness of treatment programs that include behavioral therapy to the effectiveness of programs that use only buprenorphine.
Buprenorphine (sold in the U.S. as Subutex) is an opioid narcotic substance. However, when compared to well-known narcotics such as oxycodone or heroin, it produces a relatively modest spike in a person’s levels of the extreme state of pleasure called euphoria. In addition, unlike most commonly abused opioid narcotics, buprenorphine stops producing increasing amounts of euphoria when taken in large or excessive dosages. Because of these qualities, doctors can use the medication to treat people addicted to stronger narcotics. When introduced as a replacement for these drugs, buprenorphine decreases an addict’s overall level of opioid dependence while simultaneously preventing opioid withdrawal, a highly unpleasant phase of addiction recovery that often acts as a deterrent to quitting opioid use.
Despite its role in opioid addiction treatment, buprenorphine is itself potentially subject to abuse and addiction, especially in people with no prior experience with narcotic substances. In addition, when used in high dosages in certain individuals, the medication can actually trigger the onset of opioid withdrawal rather than preventing it. This situation occurs when high blood levels of buprenorphine interfere with the processing of all narcotics in a currently addicted person. Doctors can reduce the risks for buprenorphine abuse by prescribing Suboxone, a medication that combines buprenorphine and naloxone, a substance that negates the effects of narcotic drugs. They can control withdrawal risks by limiting the buprenorphine dosages they prescribe to their patients.
Behavioral Therapy Basics
Behavioral therapy is a general term for non-medication-based treatments designed to modify a person’s habitual actions and reduce the chances that dysfunctional behaviors will appear during moments of extreme or commonplace stress. Forms of this therapy used along with buprenorphine as part of opioid addiction treatment include cognitive behavioral therapy (CBT) and contingency management (CM). During cognitive behavioral therapy (an umbrella term for a range of specific therapeutic practices), participants gain information about how they behave dysfunctionally in stressful situations, then gradually learn to adopt healthier behaviors that ultimately replace any dysfunctional predecessors. Contingency management is a behavioral reinforcement therapy that provides positive or wanted outcomes for appropriate, functional behaviors and negative outcomes or punishments for inappropriate, dysfunctional behaviors.
In the study published in Addiction, the UCLA research team compared the relative effectiveness of four approaches to buprenorphine-based opioid addiction treatment: buprenorphine plus cognitive behavioral therapy, buprenorphine plus contingency management, buprenorphine plus a combination of CBT and CM, and buprenorphine without any additional behavioral therapy. They decided to make these comparisons because no previous research had outlined the relative benefits of these approaches, even though federal guidelines stipulate that buprenorphine use is ideally combined with behavioral therapy during opioid addiction recovery.
The study contained 202 adult men and women, assigned in roughly equal numbers to one of the four treatment approaches. The participants who received behavioral therapy as part of their treatment were given a 16-week course of cognitive behavioral therapy, contingency management or combined CBT and CM after a two-week course of buprenorphine. The researchers primarily relied on level of participation in opioid use as an indication of whether each of the treatment approaches was effective. They also included several secondary measurements of effectiveness, including willingness to continue treatment, level of opioid craving and level of ongoing use/abuse of other substances.
At the end of the study’s main phase, the researchers found that there was no difference in opioid use levels between the participants who received a combination of buprenorphine and behavioral therapy and the participants who only received buprenorphine. They made the same findings after a 40-week treatment follow-up and a one-year treatment follow-up. In addition, the researchers found that the secondary measurements of effectiveness were the same for the participants who received a combination treatment and the participants who received buprenorphine alone. As a result of these conclusions, the researchers determined that participation in behavioral therapy does not improve the outcomes for recovering opioid addicts treated with buprenorphine.
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