Do People with Opioid Use Disorder and Posttraumatic Stress Disorder Benefit from Adding Behavior Therapy to Buprenorphine?

Alexandra Chase, BS

McLean Hospital
Do People with Opioid Use Disorder and Posttraumatic Stress Disorder Benefit from Adding Behavior Therapy to Buprenorphine?

Scientific Abstract

Background: Posttraumatic stress disorder (PTSD) is a common co-occurring diagnosis among people with opioid use disorder (OUD). Previous findings indicate the addition of a behavioral intervention to buprenorphine maintenance plus medical management (MM) does not improve outcomes for OUD in general. Subgroups, such as those who have more significant psychosocial needs may benefit from additional behavioral therapy. This secondary analysis aims to examine if PTSD moderates the effect of behavioral therapy plus buprenorphine and MM on OUD outcomes compared to buprenorphine and MM alone.

Method: Data were analyzed from a multi-site randomized clinical trial examining the efficacy of buprenorphine treatment plus MM, with or without the addition of a behavioral intervention for OUD. Of the total sample with complete data for PTSD diagnostic status (N = 357), 66 participants were diagnosed with co-occurring PTSD. A logistic regression was used to determine whether PTSD moderated the association between treatment condition and OUD outcome. Outcome was defined using a binary indicator of “successful outcome.”

Results: A logistic regression showed significant interaction between PTSD diagnosis and treatment condition (OR = 3.81, 95% CI = 1.20, 12.07, p <.05). With and without PTSD, there was no difference in likelihood of successful outcome between treatment conditions among those without a PTSD diagnosis (OR = 1.01, 95% CI = 0.63, 1.61, p = .98). With PTSD, there was a higher likelihood of a successful outcome when receiving the behavioral intervention (OR = 4.26, 95% CI = 1.39, 13.08, p < .05). Specifically, 67% of those who received behavioral therapy had successfully outcomes compared to only 36% of those who did not.

Conclusion: The results suggest the addition of a behavioral intervention to buprenorphine maintenance plus MM has benefit over buprenorphine maintenance plus MM alone for people with both OUD and PTSD. This supports that certain subgroups of OUD may benefit from adding behavioral therapy to buprenorphine. This finding had implications for treatment of OUD and PTSD and highlights needs for further research on how comorbidities may affect OUD treatment.

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research Areas

Authors

Alexandra R. Chase, B.S., R. Kathryn McHugh, PhD, Blake T. Hilton, PsyD, Margaret L. Griffin, PhD, & Roger D. Weiss, MD.

Principal Investigator

R. Kathryn McHugh, PhD