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Published Online: 16 December 2016

The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review



Although counseling is a required part of office-based buprenorphine treatment of opioid use disorders, the nature of what constitutes appropriate counseling is unclear and controversial. The authors review the literature on the role, nature, and intensity of behavioral interventions in office-based buprenorphine treatment.


The authors conducted a review of randomized controlled studies testing the efficacy of adding a behavioral intervention to buprenorphine maintenance treatment.


Four key studies showed no benefit from adding a behavioral intervention to buprenorphine plus medical management, and four studies indicated some benefit for specific behavioral interventions, primarily contingency management. The authors examined the findings from the negative trials in the context of six questions: 1) Is buprenorphine that effective? 2) Is medical management that effective? 3) Are behavioral interventions that ineffective in this population? 4) How has research design affected the results of studies of buprenorphine plus behavioral treatment? 5) What do we know about subgroups of patients who do and those who do not seem to benefit from behavioral interventions? 6) What should clinicians aim for in terms of treatment outcome in buprenorphine maintenance?


High-quality medical management may suffice for some patients, but there are few data regarding the types of individuals for whom medical management is sufficient. Physicians should consider a stepped-care model in which patients may begin with relatively nonintensive treatment, with increased intensity for patients who struggle early in treatment. Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in buprenorphine treatment.

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Information & Authors


Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 738 - 747
PubMed: 27978771


Received: 15 July 2016
Revision received: 15 September 2016
Accepted: 26 September 2016
Published online: 16 December 2016
Published in print: August 01, 2017


  1. Psychotherapy
  2. Opioid Use Disorder
  3. Buprenorphine
  4. Treatment
  5. Addiction
  6. Behavioral Treatment



Kathleen M. Carroll, Ph.D.
From the Department of Psychiatry, Yale University School of Medicine, West Haven, Conn.; the Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Mass.; and the Department of Psychiatry, Harvard Medical School, Boston.
Roger D. Weiss, M.D. [email protected]
From the Department of Psychiatry, Yale University School of Medicine, West Haven, Conn.; the Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Mass.; and the Department of Psychiatry, Harvard Medical School, Boston.


Address correspondence to Dr. Weiss ([email protected]).
The authors contributed equally to this article.
Presented in part at the 39th Annual National Conference of the Association for Medical Education and Research in Substance Abuse, Washington D.C., Nov. 5–7, 2015.

Competing Interests

Dr. Carroll is a member in trust of CBT4CBT LLC; her conflict of interest is managed by Yale University. Dr. Weiss has served as a consultant for GW Pharmaceuticals, Indivior, and US WorldMeds.

Funding Information

National Institute on Drug Abuse10.13039/100000026: K24 DA022288, P50 DA09241, UG1DA015831
Supported by NIDA grants UG1DA015831 (to Drs. Carroll and Weiss), P50 DA09241 (to Dr. Carroll), and K24 DA022288 (to Dr. Weiss).

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