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Psychosocial Approaches in the Treatment of Opioid Use Disorders

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Treating Opioid Addiction

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

Treatment admissions for opioid use disorder (OUD) have risen dramatically in the United States, as population exposure to potent opioids, both prescribed and illicit, has increased substantially. Psychosocial approaches are empirically supported and cost-effective interventions in the treatment of substance use disorders (SUD), including alcohol, marijuana, and cocaine use disorders. While many practice guidelines recommend psychosocial approaches in comprehensive treatment protocols for individuals with OUD, key questions exist regarding their nature, scope, and impact in addressing OUD specifically. Given the consensus view that medications such as methadone, buprenorphine/naloxone, and extended-release naltrexone are first-line treatments to decrease opioid use and reduce overdose risk, the utility of psychosocial approaches for individuals with OUD has come under scrutiny. This chapter provides an overview of the application of, and evidence for, psychosocial approaches as independent interventions and as adjuncts to pharmacotherapies in the treatment of OUD. This review further outlines a research agenda to address important but unanswered clinical questions and provides clinical recommendations based on the existing evidence. Given that these recommendations are based on limited OUD-specific empirical support, however, there is a critical need to develop, test, and disseminate psychosocial approaches that can (1) help build on the benefits provided by pharmacotherapies and (2) operate as stand-alone interventions for individuals who prefer not to take OUD medication.

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Abbreviations

AA:

Alcoholics Anonymous

ACT:

Acceptance and commitment therapy

AUD:

Alcohol use disorder

BI:

Brief intervention

CBT:

Cognitive-behavioral therapies

CM:

Contingency management

DSM:

Diagnostic and statistical manual of mental disorders

IOPs:

Intensive outpatient programs

MASH:

Massachusetts Association of Sober Housing

MHOs:

Mutual-help organizations

MI:

Motivational interviewing

MM:

Medication management

NA:

Narcotics Anonymous

NARR:

National Association for Recovery Residences

OUD:

Opioid use disorder

PHPs:

Partial hospital programs

RCTs:

Randomized controlled trials

SAMHSA:

Substance Abuse and Mental Health Services Administration

SBIRT:

Screening, brief intervention, and referral to treatment

SUD:

Substance use disorder

TAU:

Treatment as usual

TES:

Therapeutic Education System

TSF:

Twelve (12)-step facilitation

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Authors and Affiliations

  1. Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA

    Brandon G. Bergman, Lauren A. Hoffman & John F. Kelly

  2. Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA

    Nilofar Fallah-Sohy

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  4. John F. Kelly
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Correspondence to Brandon G. Bergman .

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  1. Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine, Harvard Medical School, Boston, MA, USA

    John F. Kelly

  2. Department of Medicine, Harvard Medical School, Boston, MA, USA

    Sarah E. Wakeman

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Bergman, B.G., Fallah-Sohy, N., Hoffman, L.A., Kelly, J.F. (2019). Psychosocial Approaches in the Treatment of Opioid Use Disorders. In: Kelly, J., Wakeman, S. (eds) Treating Opioid Addiction. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-16257-3_6

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