title: Counseling and directly observed medication for primary care buprenorphine maintenance: a pilot study.
abstract: OBJECTIVE
  Counseling and medication adherence can affect opioid agonist treatment outcomes. We investigated the impact of 2 counseling intensities and 2 medication-dispensing methods in patients receiving buprenorphine in primary care.
  
  
  METHODS
  In a 12-week trial, patients were assigned to physician management (PM) with weekly buprenorphine dispensing (n = 28) versus PM and directly observed, thrice-weekly buprenorphine (DOT) and cognitive-behavioral therapy (CBT) (PM+DOT/CBT; n = 27) based on therapist availability. Fifteen-minute PM visits were provided at entry, after induction, and then monthly. Cognitive-behavioral therapy was weekly 45-minute sessions provided by trained therapists.
  
  
  RESULTS
  Treatment groups differed on baseline characteristics of years of opioid use, history of detoxification from opioids, and opioid negative urines during induction. Analyses adjusting for baseline characteristics showed no significant differences between groups on retention or drug use based on self-report or urines. Patient satisfaction was high across conditions, indicating acceptability of CBT counseling with observed medication. The number of CBT sessions attended was significantly associated with improved outcome, and session attendance was associated with a greater abstinence the following week.
  
  
  CONCLUSIONS
  Although the current findings were nonsignificant, DOT and individual CBT sessions were feasible and acceptable to patients. Additional research evaluating the independent effect of directly observed medication and CBT counseling is needed.
authors.affiliation: Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, 495 Congress Ave, Second Floor, New Haven, CT 06519, USA. brent.moore@yale.edu
authors.forename: Brent A
authors.initials: BA
authors.lastname: Moore
authors.forename: Declan T
authors.initials: DT
authors.lastname: Barry
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Sullivan
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Oʼconnor
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cutter
authors.forename: Richard S
authors.initials: RS
authors.lastname: Schottenfeld
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D023801:Directly Observed Therapy; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011320:Primary Health Care
chemical_list: D009294:Narcotics; D002047:Buprenorphine