Cognitive Behavioral Therapy for Opioid Use Disorder

Cognitive Behavioral Therapy for Opioid Use Disorder helps people learn skills to reduce their opioid use and reduce opioid-related consequences by focusing on the relationships between their thoughts, emotions, and behaviors.

Evidence for the intervention

There is moderate quality and heterogeneous evidence for Cognitive Behavioral Therapy for Substance Use Disorder (CBT-SUD). Effect sizes tend to be higher for individuals receiving CBT-SUD for cannabis than for opioids or stimulants, and there have been mixed results when examining the effects of CBT-SUD as an adjunct to medication for opioid use disorder (OUD). A systematic review and meta-analysis published in 2020 concluded “the evidence cautiously suggests that for OUD, there may be some benefit to adding non-individual CBT to buprenorphine therapy.” We therefore give this a rating of yellow.

Evidence-based Scale

Cognitive Behavioral Therapy for Opioid Use Disorder (CBT-OUD) is a type of therapy that helps patients reduce their opioid use by changing their thoughts and behaviors. CBT has demonstrated effectiveness for a range of substances including alcohol, cocaine, marijuana, and methamphetamine and, to the extent possible, this guide focuses on the data for CBT-OUD. CBT-OUD is different from other behavioral treatments like Contingency Management because it simultaneously addresses both thoughts and behaviors. This guide does not include closely related therapies such as Acceptance and Commitment Therapy or Dialectical Behavior Therapy. These therapies have less evidence to support their use in the treatment of substance use in general and the treatment of OUD in particular.

CBT-OUD often starts with a functional analysis to identify triggers for opioid use. The counselor and their patient use information from the analysis to select behavioral and cognitive skills. The patient practices these skills to achieve their treatment goals (typically abstinence or reduction in use). Several common behavioral skills are taught in CBT-OUD. Patients learn problem-solving skills to reduce life stressors and interrupt patterns that lead to opioid use. For example, a common CBT-OUD skill is avoiding places where the patient has used opioids and other substances. Patients also learn interpersonal skills to reduce conflict and increase their ability to refuse opioids. In addition, emotion regulation skills are taught to help patients cope with challenging emotions that lead to use. There are also several common cognitive skills taught in CBT-OUD. Patients are taught about the role of thoughts and cravings in maintaining opioid use. Patients also learn to identify and alter patterns of thinking that lead to low mood or substance use, such as “I’ve had a hard day, I deserve to use.”