Cognitive behavioral therapy
DISORDER
Research on CBT for substance use disorder has predominantly examined effects of CBT on substance use abstinence, not MOUD adherence. CBT provides individuals with strategies designed to help the patient identify high-risk situations and triggers and to promote the use of effective coping strategies to avoid substance use in high-risk situations [Substance use disorder treatment compliance may also be enhanced by other interventions that include a reinforcement focus [Murphy and colleagues developed a brief intervention called the substance-free activity session (SFAS) which uses a motivational interviewing approach to target the behavioral economic mechanisms of substance-free reinforcement and delay discounting [In addition to the focus on goals and substance-free activities, strategies that address MOUD adherence should consider the issues specific to opioid withdrawal and initiation of buprenorphine-naloxone. MOUD initiation is fraught with opioid craving and the unpleasantness of withdrawal from the illicit opioid, an unavoidable outcome. Therefore, individuals in MOUD may benefit from an approach that helps them deal with those unpleasant experiences. Witkiewitz et al. describe how mindfulness techniques can be practiced with the patient to develop their ability to observe their emotional and physiologic state without reactivity, thereby providing space to engage in behavioral responses that are more aligned with patient values and to engage in coping with craving and urges to reduce substance use [