Counseling or psychotherapy in the absence of opioid agonist or antagonist treatment has been shown to be ineffective due to very high dropout and continuing drug use (Mayet et al. 2005). Methadone maintenance markedly reduces both of these problems, allowing psychotherapy and drug counseling to be studied. The same probably holds true for buprenorphine. In a study conducted at a VA medical center, drug counseling alone was compared with drug counseling plus supportive-expressive psychotherapy or CBT. Patients who received the additional psychotherapy improved more than those who received counseling alone, but these benefits were mainly due to improvements among psychotherapy patients who had high levels of psychiatric symptoms; patients with low symptom levels improved as much with counseling alone as with the extra psychotherapy (Woody et al. 1983, 1985). These findings were later confirmed in a study conducted in three community-based programs in Philadelphia (Woody et al. 1995).