Mental Health Month: Does Therapy Increase Time in Treatment for People with OUD on MAT?

Photo of adults in group therapy setting

In our treatment centers across the country, we support people with a wide variety of substance use disorders and co-occurring disorders with a wide range of treatment approaches, including therapy, counseling, and medication-assisted treatment (MAT). Patients who participate in our treatment programs may have developed the disordered use of the following types of substances:

  • Opioids, including:
  • Depressants, including:
    • Alcohol
    • Benzodiazepines
    • Other sedatives
  • Psychoactive drugs, including:
    • Cannabis
    • MDMA
    • LSD
  • Amphetamines, including:

Some of those substances belong to more than one category, but they all have one thing in common: they’re associated with a risk of misuse that can escalate to disordered use. Many of our patients meet the clinical criteria for opioid use disorder (OUD), specifically, which is a significant threat to public health in the U.S. right now.

To learn more about this public health threat, known as The Opioid Crisis, please navigate to the blog section of our website and read these articles:

The Opioid Crisis: A New National Strategy

The Opioid Crisis: What is Harm Reduction?

Opioid Crisis: Update on Settlements with Opioid Manufacturers, Distributors, and Retailers

Those articles will give you a good overview of the opioid crisis, where we are now, and where we’re headed. This article will discuss the gold-standard treatment for OUD, medication-assisted treatment, or MAT, which we mention above. When an intake assessment indicates a new patient can benefit from MAT, we offer treatment with MAT with one of the three medications for opioid use disorder (MOUD): buprenorphine, methadone, or Naltrexone.

What is Medication-Assisted Treatment?

In simple terms, medication-assisted treatment is a type of substance use disorder treatment that includes medication as a primary component at some point during the treatment process. MAT can be short-term, used only during the detoxification phase of treatment, as a transition that prepares patients for recovery without medication, or in some cases, as a core component of a long-term recovery plan.

The way MAT is used depends on the individual, the substance of misuse or disordered use, and the goals for treatment as determined by each patient, in collaboration with their treatment team. The type of MAT we discuss in this article is long-term MAT for people with opioid use disorder using the medication buprenorphine.

Before we continue, we’ll share the definition of MAT as published by the Substance Abuse and Mental Health Services Administration (SAMHSA), because two parts of their definition are important to the our discussion:

“Medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Medications used in MAT are approved by the Food and Drug Administration (FDA) and MAT programs are clinically driven and tailored to meet each patient’s needs.”

The two parts of this SAMHSA definition relevant to our discussion are in combination with counseling and behavioral therapies and programs are clinically driven and tailored to meet each patient’s needs. They’re important because evidence shows that time-in-treatment – especially MAT program with buprenorphine – has a direct impact on treatment outcomes.

More time-in-treatment typically leads to more favorable outcomes than less time-in-treatment. Tailoring the type and amount of therapy is similar: more immersive therapy and counseling typically lead to more favorable outcomes than less time in treatment.

However, there’s not a wide base of evidence that examines how these components interact in the context of MAT with buprenorphine. That’s why a study published in the Journal of Substance Abuse Treatment in March 2022 got our attention.

The Effect of Therapy on Treatment Adherence: About the Study

The paper “Psychosocial And Behavioral Therapy in Conjunction With Medication For Opioid Use Disorder: Patterns, Predictors, and Association With Buprenorphine Treatment Outcome” fills a void in research on the interaction between psychosocial/behavioral therapy and time-in-treatment for people with OUD in MAT programs with buprenorphine.

Here’s how the research team describes the situation, and the need for their work:

“Current evidence indicates that buprenorphine is a highly effective treatment for opioid use disorder (OUD), though premature medication discontinuation is common. Research on concurrent psychosocial and behavioral therapy services and related outcomes is limited.”

Translation: the research team recognized a need to add to our knowledge about whether therapy – psychotherapy or behavioral therapy – affected time-in-treatment and overall treatment outcomes for people in buprenorphine-based MAT programs. To explore this topic, the research team defined three clear goals for the study. They sought to:

  1. Define patterns of psychosocial and behavioral therapy services patients in MAT programs for OUD received in the first 6 months after initiating treatment with buprenorphine
  2. Identify the characteristics associated with the patterns defined in goal #1
  3. Examine common patterns of buprenorphine treatment, with a focus on the relationship between behavioral and psychosocial therapy and treatment duration

The overall idea here is that the more we know about the factors that keep people in treatment, the better providers can tailor treatment plans to emphasize those factors and improve outcomes.

Let’s take a look at the results.

Did Therapy Increase Time-in-Treatment for Patients on MAT?

After collecting claim information on 61,076 patients 18-64 years old using the database Marketscan Multistate Medicaid Database and applying advanced statistical analysis to the data, researchers reported several findings that confirmed what many treatment professionals know from firsthand experience, with outcomes in one group that were surprising.

Here’s what they found.

Treatment Trajectories, Treatment Adherence, and The Effect of Therapy in MAT

Patients in MAT programs followed three primary trajectories:

  • No therapy: 73.8%
  • Low-intensity therapy: 17.2%
  • High-intensity therapy: 9.0%

Patient characteristics associated with the three trajectories:

  • No therapy:
    • Records showed patients in this group had fewer co-occurring mental health disorders
    • Records showed patients in this group had fewer previous claims for overdose-related services
  • Low-intensity therapy:
    • Records indicated presence of higher rates of co-occurring disorders in this group, compared to the no therapy group
    • Records indicated a higher rate of claims for overdose-related health services in this group, compared to the no therapy group
  • High-intensity therapy:
    • Records indicated higher rates of co-occurring disorders for this group, compared to patients in the no therapy group
      • Records indicated higher rates of claims for overdose-related health services for this group, compared to patients in the no therapy group

Effect on treatment adherence, a.k.a. time-in-treatment:

  • Patients who did not engage in therapy had the highest risk of discontinuing treatment before six months
  • Among patients who engaged in therapy, those in the low-intensity group showed the lowest risk of discontinuing treatment before six months
  • Patients in the high-intensity group showed higher risk of discontinuing treatment than patients in the low-intensity group

Other relevant findings:

  • Patients in the high-intensity group showed:
    • Increased risk of opioid-related health care events during treatment
    • Increased risk of opioid overdose during treatment
  • Patients in both therapy groups – low- and high-intensity – showed higher rates of polysubstance misuse, including cannabis and stimulants

As we mention above, those results confirm what most treatment professionals know and understand: therapy increases likelihood of treatment retention for people in buprenorphine-based MAT programs.

The Results: Unexpected Outcomes in One Group of Patients

Specifically, we should talk about the results related to patients in the high-intensity therapy group.

These patients had a higher risk of discontinuing treatment, higher risk of opioid-related medical problems during treatment, and higher risk of opioid overdose during treatment. These phenomena are related to another component of the data: the increased prevalence of co-occurring mental health disorders and polysubstance misuse among patients in the high-intensity group. What this data tells us is that patients with this specific array of disorders – OUD, co-occurring mental health disorders, and polysubstance misuse – are at increased risk of adverse events during the course of their MAT program, and therefore may benefit from intentional, targeted therapy and support that follows the integrated treatment model.

That’s important for researchers and treatment professionals to know. For researchers, it can inform future avenues of research. For treatment professionals, it can help tailor treatment programs to meet the specific needs of these high-risk patients. And finally, it reiterates the importance of including counseling, therapy, and other emotional or psychosocial supports for patients with OUD and co-occurring disorders in MAT programs.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.