Alternative Treatments for CBT for Opioid Addiction
CBT and Opioid Addiction
Medscape Today recently released an article which states that cognitive-behavioral therapy (CBT) does not offer benefits to patients trying to recover from opioid addiction. “The addition of cognitive-behavioral therapy to medical treatment for opioid dependence does not significantly enhance outcomes compared with medical treatment alone, ” staff writer Pam Harrison wrote. As CBT seems to be historically known for its success in treating mental disorders and substance use disorders, now that it has been dubbed ineffective, what therapies are left—if any? Detoxification alone is not enough to manage patients recovering from opioid addiction.
Alternatives to CBT
Not to worry, there are several alternative therapeutic treatments available to CBT for opioid dependence—treatments that help abusers handle stress, trauma, and anger, through many different channels. One popular psychosocial treatment is contingency management (CM), which uses the operant learning theory to involve offering patients vouchers for following the steps to practice abstinence from substances.2 For example, a patient would be given a voucher (a slip for a certain monetary amount or a small prize) that can add up after a period of time of shown abstinence through drug testing. According to McHugh, Hearon, and Otto, “A large number of clinical trials have supported the efficacy of CM for various substances, such as alcohol, cocaine, and opioids.” Reviews have stated that the effects of CM are in the moderate range, showing greater efficacy for opioids and cocaine rather than tobacco and polydrug use.2
Another therapeutic treatment available to patients overcoming opioid dependence is dynamic psychotherapy. According to Adrien Preda, M.D., “Dynamic psychotherapy is based on the concept that all symptoms arise from underlying unconscious psychological conflicts; therefore, the goal of this therapy is to help the patient become aware of these conflicts and develop more adaptive coping mechanisms and healthier methods of resolving intrapsychic conflict.” Lerner and colleagues state that short-term dynamic psychotherapy is more effective than long-term.
Group therapy is also known to be an effective treatment strategy, as it allows patients to target the social stigma that goes along with losing control of a substance.3 Other group members can provide support and help each other maintain abstinence, as they all understand what each other is going through. A form of group therapy, Narcotics Anonymous (NA) is based on the principals of Alcoholics Anonymous, including 12 steps to recovery.3 Those who do well in group therapy may also benefit from NA. Participation is recommended as a supplement to drug addiction treatments.
Based on principles of basic conditioning, aversion therapy is another approach that may be taken with patients who are dependent upon opioids. “Aversion therapy involves pairing aversive stimuli to cognitive images of opioid use and conversely conjuring images of socially appropriate behaviors such as employment, education, and nondrug behavior.”3 These stimuli end up becoming embedded in the patient’s short- and long-term memory, aiding them in experiencing negative feelings when opioids are mentioned or seen.3
CBT Shows Ineffective Results
Overall, while CBT may continue to show ineffective results, there are other forms of therapy that have been effective in the treatment of opioid dependence when paired with medication management. Although the preference of which therapy does not much matter, some form is always beneficial in treatment plans.3
 Harrison, Pam . “No Additional Benefit of CBT in Opioid Addiction.” Medscape News Today. Medscape News, 10 Jan. 2013. Web. 28 Jan. 2013. <http://www.medscape.com/viewarticle/777451>.
 McHugh, Kathryn, Bridget Hearon, and Michael Otto. “Cognitive-Behavioral Therapy for Substance Use Disorders.” Psychiatr Clin North Am. 33.3 (2010): 511-525. NIH Public Access. Web. 28 Jan. 2013.
 Preda, Adrien. “Opioid Abuse Treatment & Management.” Medscape News Today. Medscape News, n.d. Web. 28 Jan. 2013. <http://emedicine.medscape.com/article/287790-treatment>.
 Lerner, A., M. Sigal, A. Bacalu, and M. Gelkopf. “Short term versus long term psychotherapy in opioid dependence: a pilot study..” Isr J Psychiatry Relat Sci. 29.2 (1992): 114-119. NIH Public Access. Web. 28 Jan. 2013.
 Vederhus, John-Kåre, and Øistein Kristensen. “High Effectiveness of Self-Help Programs After Drug Addiction Therapy.” Medscape News Today. Medscape News, n.d. Web. 28 Jan. 2013. <http://www.medscape.com/viewarticle/547553>. CBT.