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J Subst Abuse Treat. 2019 Sep;104:51-63. doi: 10.1016/j.jsat.2019.06.009. Epub 2019 Jun 12.

Medication-assisted treatment for opioid use disorder within a 12-step based treatment center: Feasibility and initial results.

Author information

1
Pear Therapeutics, Boston, MA, United States of America.
2
Hazelden Betty Ford Foundation, 15251 Pleasant Valley Road, Center City, MN 55012, United States of America. Electronic address: mseppala@hazeldenbettyford.org.

Abstract

RATIONALE:

Opioid overdose deaths and healthcare costs associated with opioid use disorder (OUD) continue to escalate while the majority of addiction treatment providers in the United States do not use medication-assisted treatment (MAT) in spite of proven efficacy. The primary resistance to the use of MAT has been associated with the philosophical conflict many 12-step based treatment programs have with the use of these medications.

OBJECTIVE:

This study sought to determine whether patients self-selecting into a treatment program based upon the 12-step philosophy would elect to use MAT and, if so, what initial outcomes might result.

METHODS:

This naturalistic, prospective study of patients (N = 253) with OUD included a combination of OUD-specific group therapy and the use of buprenorphine-naloxone, oral naltrexone, injectable naltrexone, or no medication with standard 12-step treatment initiated in a residential or day treatment setting with outpatient follow-up. Baseline assessment of subjects with OUD included level of craving and opioid withdrawal symptom severity. Post-residential treatment outcomes at 1- and 6-months included craving, opioid withdrawal, residential treatment completion, continuing care compliance, medication compliance, substance use frequency and 12-step meeting attendance.

RESULTS:

Irrespective of medication condition, nearly all patients successfully completed residential treatment and the majority attended additional programming afterward. Among those who elected to take a medication (71%), differences were associated with medication compliance. Patients who reported compliance with their medication at 1 and 6 months following residential treatment had significantly higher abstinence rates than patients who reported noncompliance. Among those who relapsed post-discharge, neither medication use nor compliance was significantly related to a change in the frequency of alcohol use days or drug use days at 6 months.

CONCLUSION:

These preliminary results suggest that it is feasible to administer medications, including partial opioid agonists like buprenorphine, within the context of 12-step based treatment and taking these medications as prescribed is associated with favorable outcomes.

KEYWORDS:

12-step treatment; Buprenorphine/naloxone; Medication-assisted treatment; Naltrexone; Opioid use disorder

PMID:
31370985
DOI:
10.1016/j.jsat.2019.06.009

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