title: A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine.
abstract: OBJECTIVE
  To determine the impact of cognitive behavioral therapy on outcomes in primary care, office-based buprenorphine/naloxone treatment of opioid dependence.
  
  
  METHODS
  We conducted a 24-week randomized clinical trial in 141 opioid-dependent patients in a primary care clinic. Patients were randomized to physician management or physician management plus cognitive behavioral therapy. Physician management was brief, manual guided, and medically focused; cognitive behavioral therapy was manual guided and provided for the first 12 weeks of treatment. The primary outcome measures were self-reported frequency of illicit opioid use and the maximum number of consecutive weeks of abstinence from illicit opioids, as documented by urine toxicology and self-report.
  
  
  RESULTS
  The 2 treatments had similar effectiveness with respect to reduction in the mean self-reported frequency of opioid use, from 5.3 days per week (95% confidence interval, 5.1-5.5) at baseline to 0.4 (95% confidence interval, 0.1-0.6) for the second half of maintenance (P<.001 for the comparisons of induction and maintenance with baseline), with no differences between the 2 groups (P=.96) or between the treatments over time (P=.44). For the maximum consecutive weeks of opioid abstinence there was a significant main effect of time (P<.001), but the interaction (P=.11) and main effect of group (P=.84) were not significant. No differences were observed on the basis of treatment assignment with respect to cocaine use or study completion.
  
  
  CONCLUSIONS
  Among patients receiving buprenorphine/naloxone in primary care for opioid dependence, the effectiveness of physician management did not differ significantly from that of physician management plus cognitive behavioral therapy.
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8093, USA. david.fiellin@yale.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Declan T
authors.initials: DT
authors.lastname: Barry
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Sullivan
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cutter
authors.forename: Brent A
authors.initials: BA
authors.lastname: Moore
authors.forename: Patrick G
authors.initials: PG
authors.lastname: O'Connor
authors.forename: Richard S
authors.initials: RS
authors.lastname: Schottenfeld
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010349:Patient Compliance; D011320:Primary Health Care; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine