Table 1.
Overview of 8 studies evaluating behavioral interventions and buprenorphine maintenance
| Study | N/co nditi ons |
Exclusions | Length of trial | Frequency of medical management |
Behavioral therapy | Frequency of urine monitoring |
6-month retention rate, based on ITT |
% opioid-free urine specimens |
|---|---|---|---|---|---|---|---|---|
| Fiellin et al 2006 | 166/3 | No alcohol benzodiazepine, sedative dependence |
24 weeks | 1–3 times a week | Standard medication management=20 min Enhanced management=45 min. |
1× week | MM+1 =50% MM×3=41% EMM×3=44% *completion confounded w/attendance at counseling |
MM+1=44% MM×3=40% EMM×3=40% |
| Weiss et al 2011 | 653/2 | No heroin injection or history of heroin dependence, pain event within 6 months; no alcohol or other drug dependence requiring immediate medical attention |
24 weeks Phase 1=4-week taper, 8-week follow- up Phase 2=12 week maintenance+4 week taper+8 week follow-up |
Phase 1: 2×/week in week 1, then weeks 2,3,4,6,8 Phase 2: 2× week during week 1, 1× week weeks 2–16 |
Individual manualized drug counseling; In Phase 1, 2×/week in weeks1–4, bi-weekly in weeks 5–8 In Phase 2: Weeks 1–6, 2× week, weeks 7–12 1 visit/week; 0 visits weeks 12–16 |
1× week for weeks 1–16, 2× month weeks 16–24 |
Successful outcome: Composite of retention and abstinence; End of Phase 1 MM=7.4% MM+ODC==5.8% End of Phase 2 MM=46.7% MM+ODC==51.7% |
Not reported by group 42% positive at end of Phase II taper. |
| Ling et al 2013 | 202/4 | No alcohol or other drug dependence requiring immediate medical attention |
32 weeks Phase 1=16 week behavioral Phase 2=16 week medication maintenance only |
2× week for 16 weeks, checklist used |
CM 2× week; CBT 1× week Weeks 1–16 No behavioral therapy weeks 17–32 |
2× week for weeks 1–16, 1× week for weeks 17–24 |
CBT =49% CM=57% CBT+CM=49% NT=43% *32-week retention |
Not reported |
| Fiellin et al 2014 | 141/2 | No alcohol, cocaine, benzodiazepine dependence |
24 weeks 12 weeks with CBT 12 weeks no CBT |
1× week for first 2 weeks, then 2× month |
Clinician delivered CBT 1× week; |
1× week | MM =32/71=45% MM+CBT=27/70=38% Transfer to methadone MM=28/71=39% MM+CBT=19/70=27% |
Not reported |
| Bickel et al., 2008 | 135/3 | None | 23 weeks | Not described | Standard counseling 1× week; Computer CRA: 3× week Clinician CRA: 3× week |
3× week | Standard counseling: 58% Computer CRA: 62% Clinician CRA: 53% |
Standard counseling: 57% Computer CRA: 70% Clinician CRA: 73% |
| Christensen et al 2014 | 170/2 | None | 12 weeks | Not described | Computer CRA 3× week; All get CRA 3× week and 30 minutes counseling every 2 weeks |
3× week | CRA+CM:80% CM only 64% *12 week retention |
Not reported |
| Schottenfeld et al 2005 | 162/4 | No alcohol or sedative dependence |
24 weeks; contingencies change at week 12 |
Not described | Counseling: 2× week weeks 1–12, 1× week weeks 13–24 |
3× week | Meth+CM=60% Meth+PF=75% Bup+CM=45% Bup +PF=22% |
Meth+CM=55% Meth+PF=50% Bup+CM=37% Bup+PF=28% |
| Miotto et al 2012 | 94/3 | No benzodiazepine or other substance dependence |
20 week assessment 52 weeks total |
Flexible | ODC: 1× week weeks 1–6, 1× month weeks 7–52; Primary care: 1× week weeks 1–6, once monthly weeks 7–52 Matrix model, weekly groups |
1× weekly weeks 1–9, 1× monthly through week 52 |
20 week retention ODC: 21.4% Primary care: 33.3% Matrix model: 51.5% |
Not reported |
a
. Indicates study-specific exclusions, in addition to pregnancy as well standard medical or psychiatric exclusions
b
. MM=Medical management, EMM=Enhanced medical management, ODC=Outpatient drug counseling, CM=contingency management, CBT=cognitive behavioral therapy, NT=No treatment, CRA=Community Reinforcement Approach, PF=Performance feedback; Meth=methadone maintenance treatment