Implementation of Cognitive Behavioral Therapy for Opioid Use Disorders (CBT-OUD) has been studied far less often than implementation of Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD) in general. Implementation of CBT-OUD typically involves some form of competency-based training. In a trial comparing medication for opioid use disorders plus CBT-OUD versus medication for opioid use disorders plus Physician Management, the CBT-OUD clinicians were “trained to competence in delivery of CBT” and given a detailed treatment manual. In the Department of Veterans Affairs CBT-SUD Training Program, competency-based training was offered to all licensed therapists who treated Veterans with problematic substance use. Therapists were eligible to participate if they were licensed VA staff members who deliver psychotherapy to Veterans diagnosed with substance use disorders and function as a psychiatrist, psychologist, social worker, advanced practice mental health nurse, licensed professional mental health counselor, or marriage and family therapist. The training model included a face-to-face training workshop, which introduced foundational information about cognitive-behavioral theory, research support for CBT-SUD, and practice in delivering CBT-SUD skills and interventions.

Ongoing support from a CBT-OUD expert is recommended following competency-based training. In the trial comparing medication for opioid use disorders plus CBT-OUD versus medication for opioid use disorders plus Physician Management, the CBT-OUD clinicians received weekly supervision focused on ensuring fidelity. In the Veterans Affairs CBT-SUD Training Program, therapists were invited to receive weekly 90-minute telephone-based consultation sessions, which were offered over a 17-week period. The consultation sessions consisted of 3–4 therapists and one CBT-SUD consultant. During these calls, the consultant provided feedback and coaching and offered to follow up via individual calls, as needed.

Performance feedback is another recommended component of CBT-OUD implementation, though trials of CBT-OUD have not described this element. In the Veterans Affairs CBT-SUD Training Program, therapists submitted audio recordings of their sessions to their training consultants for rating and feedback. Therapist skill was assessed using the CBT-SUD Rating Scale, which was adapted from the Yale Adherence and Competency Scale and developed through an expert consensus process.