Cognitive Behavioral Therapy for Opioid Use Disorder

Cognitive Behavioral Therapy for Opioid Use Disorder can work for a range of patients with opioid use disorders, either as a standalone treatment or in combination with medications such as methadone and buprenorphine. For patients with opioid use disorder, the results are mixed, with some studies suggesting that it does not offer significant benefits beyond the effects of medication.

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

When delivered as a standalone treatment, the effects of Cognitive Behavioral Therapy for Opioid Use Disorder (CBT-OUD) are modest. The most significant effects for CBT are seen for treatment of adults with cannabis use, followed by treatments for cocaine and opioids, and the most limited effects are seen for treatment of adults with polysubstance use (substance use disorder involving multiple substances).

CBT-OUD is most commonly used in combination with medications like methadone and buprenorphine. Several large studies have found that CBT-OUD does not add benefit beyond medication for opioid use on treatment retention, treatment satisfaction, psychological symptoms, and quality of life. However, in one clinical trial, a subgroup analysis found that when CBT-OUD was added to buprenorphine, patients who primarily used prescription opioids benefited more than patients who primarily used heroin. CBT-OUD may be helpful when used alongside buprenorphine in prescription opioid users, but not in heroin users. A head-to-head comparison of CBT and Contingency Management (CM) targeting stimulant use among patients receiving methadone found that CM was more effective during treatment, but that CBT had comparable long-term effects. Overall, the authors concluded that the trial provided solid evidence of efficacy for both CBT and CM as adjuncts to methadone.