title: A preliminary randomized controlled trial of a distress tolerance treatment for opioid dependent persons initiating buprenorphine.
abstract: BACKGROUND
  Buprenorphine opioid agonist treatment (OAT) has established efficacy for treating opioid dependency but early relapse rates are high and are often associated with withdrawal-related or emotional distress.
  
  
  METHODS
  To determine whether a novel distress tolerance (DT) intervention during buprenorphine initiation decreases opioid relapse, we conducted a preliminary randomized controlled trial with opioid-dependent outpatients. Participants received buprenorphine-naloxone induction and 3-months of maintenance buprenorphine plus seven, 50-min manualized, individual sessions (DT vs. health education (HE) control) over a 28-day period, linked to clinician medication dosing visits, and beginning 2 days prior to buprenorphine induction. Primary outcomes included use of illicit opioids (positive defined as any self-reported use in the prior 28 days or detected by urine toxicology) and treatment drop out.
  
  
  RESULTS
  Among 49 participants, the mean age was 41 years, 65.3% were male. Persons randomized to DT had lower rates of opioid use at all three monthly assessments, and at 3-months, 72% of HE participants were opioid positive compared with 62.5% of DT participants. Rates of dropout were 24% and 25% in the HE and DT arms, respectively.
  
  
  CONCLUSIONS
  This distress tolerance treatment produced a small, but not statistically significant reduction in opioid use during the first three months of treatment although no differences were found in drop-out rates between conditions. If replicated in a larger study, DT could offer clinicians a useful behavioral treatment to complement the effects of buprenorphine.
authors.affiliation: Alpert Medical School of Brown University, Department of Medicine, Providence, RI, USA; Butler Hospital, Providence, RI, USA. Electronic address: Michael_Stein@brown.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stein
authors.affiliation: Alpert Medical School of Brown University, Department of Medicine, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
authors.forename: Debra S
authors.initials: DS
authors.lastname: Herman
authors.affiliation: Alpert Medical School of Brown University, Department of Medicine, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
authors.forename: Ethan
authors.initials: E
authors.lastname: Moitra
authors.affiliation: Butler Hospital, Providence, RI, USA.
authors.forename: Jacki
authors.initials: J
authors.lastname: Hecht
authors.affiliation: Butler Hospital, Providence, RI, USA.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Butler Hospital, Providence, RI, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Anderson
authors.affiliation: Alpert Medical School of Brown University, Department of Medicine, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Brown
mesh_terms: D064869:Acceptance and Commitment Therapy; D000328:Adult; D000553:Ambulatory Care; D002047:Buprenorphine / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D008297:Male; D009292:Narcotic Antagonists / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000628:therapy*; D010045:Outpatients; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine
keywords: Buprenorphine; Distress; Opioid; Relapse; Trial registered at clinicaltrials.org. Trial number NCT01556087