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Primary care management of opioid dependence: the addition of CBT gives no extra benefit compared to standard physician management alone

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Question: For opioid-dependent patients receiving buprenorphine treatment in primary care, what is the effect of adding cognitive behavioural therapy (CBT) to standard physician management?

Patients: 141 patients with opioid dependence. Exclusions: alcohol, benzodiazepine or cocaine dependence; psychosis; untreated major depression; dangerous to themselves or others; unable to comprehend English; life-threatening medical problems.

Setting: Primary care centre of Yale-New Haven Hospital, USA; 2006–2009.

Intervention: Physician management plus CBT or physician management only. Buprenorphine was provided to all patients in the 2 weeks prior to randomisation (induction and stabilisation period) immediately followed by 16 mg buprenorphine for 24 weeks. Physician management was manually guided and provided by internal medicine physicians with no experience in CBT. Sessions of 15–20 min were offered weekly for first 2 weeks, fortnightly for the next 4 weeks and monthly thereafter. CBT was manually guided and provided by trained clinicians. Up to 12, 50-min CBT sessions were offered during the first 12 weeks of treatment, which focused on coping with drug cravings, enhancing drug refusal and improving decision-making.

Outcomes: …

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