For treating opiate dependence?

 

Abstract: the article suggests that combining pharmacology with psychosocialinterventions generates positive outcomes for substance misusing patients

Keywords: addiction, drug dependence, psychosocial intervention, treatment.

 

The World Health Organization defines drug dependence as a “cluster of physiological, behavioral and cognitive phenomena of variable intensity in which the use of psychoactive substances takes on a high priority” (Amato et al., 2011, 5). It has been estimated that there are between 15-39 million opiate users worldwide (Mattick et al., 2014). Previous research indicates that less than 25% of opiate addicts undergoing a maintenance treatment will remain abstinent after finishing it (Veilleux et al., 2010). It has been proposed that the chances of reten-tion in treatment for opiate addicts decrease by 6% with each additional sub-stance used (Gossop et al., 2006). Although evidence is limited, it suggests that combining pharmacology with psychosocial interventions generates positive out-comes for substance misusing patients (Wanigaratne et al., 2005).

 

Methodology. Most data available on the subject of treating opiate de-pendence included in this dissertation comes from the USA although there is some data from the UK, other European countries, Australia and China. The

 

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literature chosen for this dissertation is peer reviewed and uses approved and standardized forms of outcome measure tools. To avoid producing a piece of work based on old and possibly outdated information, I focused on meta-analysis and randomized controlled trials dating to no older than 15 years, alt-hough one study included in this review dates to 1998. The literature included in this dissertation also assesses the risk of bias and heterogeneity and clearly states any potential or obvious issues and limitations.

 

Results. Most services providing maintenance treatment for opiate ad-dictions offer basic support services like key work and group work (Amato et al., 2008). Data suggests that for opiate addicts any form of psychological treatment is better than no treatment at all but it is hard to distinguish one ther-apy which is the most favorable (Wanigaratne et al., 2005).

 

Evidence shows that regular counseling contributes to reduction in opi-ate and cocaine use and chances of relapse, as well as improves psychiatric symptoms, legal status and family functioning (Gossop et al., 2006).

 

The UK National Institute for Clinical Excellence suggests that metha-done maintenance treatment (MMT) should be accompanied by key work based on CBT approaches (Kuimtsidis et al., 2012). Evidence shows that add-ing cognitive behavioral therapy (CBT) to methadone maintenance treatment (MMT) reduces heroin use (Kuimtsidis et al., 2012; Pan et al., 2015) and equips patients with problem solving skills and positive reappraisal (Kui-mtsidis et al., 2012), increases employment function and decreases psycholog-ical stress (Pan et al., 2015).

 

Other evidence shows that CBT approaches including contingency man-agement (CM) and community reinforcement approaches (CRA) are success-ful in treating opiate dependence (Wanigaratne et al., 2005). CRA has been proven to generate positive outcomes in terms of addiction severity and de-crease in illicit heroin use and risk taking behaviors (Abbott et al., 1998). Alt-hough it has been suggested that the success of CM depends on conditions like frequency of urinalysis, type of reinforces and time scale of their implementa-tion, CM in addition to standard MMT reduces illicit heroin use (Veilleux et al., 2010) and is especially recommended for patients with previous episodes of failed attempts at treatment (Griffith et al., 2000).

 

Opinions are divided about the application of psychosocial interventions in treating of opiate addictions and some evidence shows that adding psycho-social interventions to a long-term maintenance treatment which already pro-vides patients with certain levels of psychological support is of little benefit

 

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(Veilleux et al., 2010). However, there is also a good evidence base indicating that some forms of therapeutic interventions based on the cognitive behavioral approach as well as standard counseling and psychoanalytic interventions gener-ate positive outcomes for opiate addicted individuals (Wanigaratne et al., 2005).

Recommendations. Evidence on psychosocial interventions is limited asmost studies focus on outcomes of pharmacological approaches, i.e. the correct dosing etc. More attention should be paid to psychological interventions either on their own or in conjunction with pharmacology (Veilleux et al., 2010).

 

More evidence is needed on a variety of outcome measures including mor-tality, criminal activity, adverse effects, physiological and psychological health (Mattick et al., 2009).

 

Most of the evidence available comes from the United States and questions arise as to whether the outcomes could be applicable to other ethnicities (Wani-garatne et al., 2005). Specific approaches like contingency management (CM) and community reinforcement approaches (CRA) are very rarely used in the UK which leaves a great need for further research (Wanigaratne et al., 2005).

 

Literature

 

Abbott P.J, Weller S. B., Delaney H. D. Community reinforcementapproach in the treatment of opiate addicts // American Journal of Drug and Alcohol Abuse. 1998. 24(1). P. 17–30.

Amato, L., Minozzi, S., Davoli, M., Vecchi, S., Ferri, M. and Mayet, S. Psychosocial combined with agonist maintenance treatments versus agonistmaintenance treatments alone for treatment of opioid dependence // Cochrane

 

Database of Systematic Reviews, 4. URL: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004147.pub2/pdf (accessed: 25 March 2017).

 

Amato L., Minozzi S., Davoli M. Psychosocial combined with ago-nist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence // Cochrane Database of Systematic Reviews,

10. URL: http://onlinelibrary.wiley.com.proxy.library.lincoln.ac.uk/doi/10.1002/146518 58.CD004147.pub4/epdf (accessed: 28 March 2013).

 

Gossop M., Stewart D., Marsden, J. Effectiveness of drug and alco-hol counseling during methadone treatment: content, frequency, and duration of counseling and association with substance use outcomes // Society for the Study of Addiction. 2006. № 101. P. 404–412.

 

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Griffith J.D., Rowan-Szal G.A., Roark R.R. Contingency manage-ment in outpatient methadone treatment: a meta-analysis // Drug and Alcohol Dependence. 2000. № 58. P. 55–66.

Kuimtsidis K., Reynolds M., Coulton S. How does cognitive behav-iour therapy work with opioid-dependent clients? Results of the UKCBTMM study // Drugs: education, prevention and policy. 2012. № 19(3). P. 253–258.

 

Mattick R.P., Breen C., Kimber J. Methadone maintenance therapyversus no opioid replacement therapy for opioid dependence // Cochrane Da-

tabase of Systematic Reviews, 3. URL: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002209.pub2/epdf (accessed: 10 March 2017).

 

Mattick R.P., Breen C., Kimber J. Buprenorphine maintenance ver-sus placebo or methadone maintenance for opioid dependence // Cochrane Da-

 

tabase of Systematic Reviews, 2. URL: http://onlinelibrary.wiley.com.proxy.library.lincoln.ac.uk/doi/10.1002/146518 58.CD002207.pub4/pdf (accessed: 26 March 2017).

 

Veilleux J.C., Colvin P. J., Anderson J. A review of opioid depend-ence treatment: pharmacological and psychosocial interventions to treat opioid addiction // Clinical Psychology Review. 2010. № 30. P. 155–166.

 

Wanigaratne S., Davis P., Pryce K. The effectiveness of psychologi-cal therapies on drug misusing clients.London: National Treatment Agency for

 

Substance Misuse. URL: http://www.dldocs.stir.ac.uk/documents/rb11_final.pdf (accessed: 26 March 2017).

 

Kate Jacklin

 

University of Lincoln, BSc (Hons) Health and Social Care, UK, Lincoln Supervisor: Dr Valeria Carroll, University of Lincoln