Systematic Review: Adding Psychosocial Support to Routine Counseling in Opioid Agonist Treatment Does Not Provide Additional Benefits

Opioid agonist treatment (OAT) in the form of methadone or buprenorphine has become a standard treatment for opioid dependence and has been shown to be effective. Evidence of the effectiveness of additional psychosocial interventions is less clear. This systematic review, which included 35 studies with 4319 participants, looked at 13 different psychosocial interventions combined with OAT. Most of the studies (24) looked at behavioral interventions; 7 assessed counseling interventions. When comparing the effectiveness of OAT plus psychosocial interventions with OAT alone:

• investigators found no significant difference in treatment retention (relative risk [RR), 1.02), opioid abstinence during treatment (RR, 1.19), or any of the following measures: compliance, psychiatric symptoms, depression, or abstinence at the end of treatment.

Comments:

Although this review failed to find benefit from the addition of specific psychosocial interventions to OAT, it is important to keep in mind that most of these studies were performed in methadone maintenance programs where standard treatment included routine counseling. Moreover, studies evaluated a wide range of treatments with different goals; it is possible some of the psychosocial interventions may have benefited patients in other ways than those assessed in this meta-analysis.

Darius A. Rastegar, MD

Reference:

Amato L, Minozzi S, Davoli M, et al. Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database Syst Rev. 2011;10:CD004147.