Opioid use disorder (OUD) is the dependence on or addiction to opioids to the point of significantly impairing one’s quality of life. Examples of opioids are morphine, fentanyl, and heroin. OUD symptoms include increased opioid tolerance, overpowering desire to use, and withdrawal symptoms when one stops using.
Up to 2.1 million Americans have OUD. OUD can be treated with medication, such as methadone, which lessens the “lows” associated with withdrawal and reduces euphoric “highs.” Medications are only one part of dealing with this complex and widespread problem.
OUD is a product of environmental, biological, genetic, and psychosocial factors. Although some opioids, like heroin, are illicit, most opioids, like morphine, are prescription drugs. Combining medications with therapeutic approaches has proven effective for getting patients off opioids and keeping them off.
One therapeutic approach psychotherapists use to alleviate OUD symptoms is cognitive behavioral therapy (CBT). CBT is mostly used with patients in recovery. The therapist helps the patient identify and challenge negative thoughts that may predispose them to opioid use.
CBT looks at how one assigns meaning to events and responds to them. CBT can last eight to 24 weeks, during which time the patient takes an active role in the discussion. Over time they shift from seeking relief to addressing underlying negative habits.
Some of the exercises patients engage in during CBT are cost-benefit analysis, where patients write the pros and cons of using drugs and quitting. There are also relaxation techniques, mindfulness exercises, and emotional regulation. CBT empowers patients to develop positive habits to replace negative ones.
Counseling has proven just as effective as CBT in changing patients’ attitudes and behaviors. Counseling helps patients identify negative thoughts and behaviors. It also enables them to develop positive coping skills, helping improve the efficacy of other treatments, including medication.
The biggest challenge in OUD treatment is relapse. Contingency management (CM) helps patients stay off opioids after stopping use. It’s a reward system for incentivizing patients in recovery.
In CM, one receives positive reinforcement for staying clean. Because drug tests and attendance records precede incentives, CM helps patients become self-accountable. However, CM is not a substitute for opioid medications or as a primary clinical intervention.
Studies show that CBT, counseling, and CM in a group setting produce superior patient outcomes. Therapies that involve the patient’s family members have also proven effective. Group settings offer additional advantages, such as peer support and accountability. Additionally, patients can learn from others.
Group therapy for OUD can take the form of Narcotics Anonymous, where patients share experiences, struggles, and coping mechanisms. There is also psychoeducation, where patients learn about addiction. Pain education, in particular, educates patients, helping them to overcome pain, disability, and anxiety associated with chronic pain, which predisposes people to opioid dependence.
Group therapies, however, are often not popular among patients due to the stigma around substance use. One way to improve participation in group therapies is to schedule prescribing and group therapy in the same visit. CM may also be used to incentivize patients.
Non-medical therapies, while they may not be the primary clinical interventions, have proven effective in helping people overcome OUD in the long term. Unlike medication, there is no standard therapeutic approach. Generally, though, a strong support system helps improve OUD treatment outcomes.
