The effectiveness of combining behavioral therapy with medical management and buprenorphine treatment for opioid use disorder (OUD) has been examined in a number of sizable, randomized clinical studies. Overall treatment response rates have been consistently high in these investigations, with no discernible additive benefit from extra behavioral therapy.
Thus, this study was to fill in the knowledge gaps regarding additional behavioral therapy for buprenorphine-using patients. These gaps included whether certain subgroups respond better to additional behavioral therapy and whether additional behavioral therapy is associated with retention and functional outcomes.
This study is a secondary analysis of four randomized clinical trials that were carried out between 2000 and 2011 in ten different US locations, including Southern California and Connecticut. Adults with opioid dependency as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were among the participants.
Standard medical management, standard medical management plus opioid dependence counseling, physician management plus cognitive behavioral therapy, physician management, contingency management plus cognitive behavioral therapy, contingency management, and no additional behavioral treatment are among the behavioral therapy levels that are combined with buprenorphine.
The Addiction Severity Index was used to measure the primary outcomes, which included weeks of buprenorphine retention and functioning in seven domains (medical, employment and financial assistance, social and familial, alcohol, drug, legal, and psychiatric).
A total of 869 adults (mean [SD] age: 34.2 [10.4] years; 287 female [33%]) made up the combined sample. In contrast to medical treatment and buprenorphine (mean [SD] number of opioid-free weeks, 7.00 [4.33]), the results showed that additional behavioral therapy was not linked with opioid-free weeks (mean [SD] number of opioid-free weeks, 7.16 [4.35]) (B = 0.28; 95% CI, -0.33 to 0.89; P =.37).
When compared to medical management and buprenorphine (mean [SD] number of weeks of buprenorphine, 10.21 [3.15]), additional behavioral therapy was not linked to higher buprenorphine retention (mean [SD] number of weeks of buprenorphine, 10.29 [3.21] out of 12) (B = 0.00; 95% CI, −0.43 to 0.43; P =.98).
Functional measures showed little change throughout therapy, and the randomized groups did not vary from one another. Once repeated comparisons were taken into account, there were no discernible moderating effects of subgroups (such as history of heroin use). Overall, when paired with medical therapy for opioid use disorder, the results of these clinical trials demonstrate the effectiveness of buprenorphine treatment.
Reference:
McHugh, R. K., Bailey, A. J., McConaghy, B. A., Weiss, R. D., Fiellin, D. A., Hillhouse, M., Moore, B. A., & Fitzmaurice, G. M. (2025). Behavioral therapy as an adjunct to buprenorphine treatment for opioid use disorder: A secondary analysis of 4 randomized clinical trials. JAMA Network Open, 8(8),. https://doi.org/10.1001/jamanetworkopen.2025.28529
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