Psychosocial interventions in drug-free treatment for opiate misuse. Conclusions from RCTs

Abstract

Background

Methadone and buprenorphine are well-documented treatment options for opiate dependence, and there is substantial evidence to support adjunct psychosocial support for methadone maintenance treatment. Although drug-free treatment is preferred by a large number of patients and has considerable political support, less is known about treatment to support and maintain complete abstinence from all opiates, both illicit and prescribed.

Method

We conducted a review of studies of psychosocial interventions to support complete abstinence from opiates, to identify what conclusions, if any, can be drawn based on the existing literature. In total, 12 studies were identified. The quality of many studies was excellent, but follow-up was generally short, with only half the studies reporting post-treatment follow-up, and no follow-up longer than 21 months.

Discussion

Given that drug free treatment aims at lasting abstinence from opiates, this is a serious shortcoming of the literature. Among the few studies with post-treatment follow-up, studies using individual behaviour therapy showed little advantage over the control group with no individual behaviour therapy, and one study using behavioural family therapy showed an advantage for the experimental intervention over the standard intervention.

Conclusion

The limited evidence that exists suggests that treatment involving the family is superior to individual treatment. more research is required in this important field.