Development of an integrated intervention involving recovery coaching and cognitive behavioral therapy for opioid use disorder - PROJECT SUMMARY/ABSTRACT Opioid use disorder (OUD) has led to an unprecedented public health crisis in the United States. An estimated 2.1 million people have opioid use disorder, although these numbers are likely to be underestimated. The opioid epidemic has caused a staggering toll in the US in terms of causing opioid-related overdoses, emergency department visits, and hospitalizations. Medications for opioid use disorder (MOUD), including methadone and buprenorphine, have proven to be effective pharmacologic strategies for treating OUD and are associated with decreased mortality. Unfortunately, retention to medication is suboptimal; only 56.8% of individuals who initiate buprenorphine are retained 6 months later. Another major issue in this population is related to multiple comorbid substance use disorders (SUDs). Thus, the incorporation of additional strategies in the buprenorphine protocols aimed at addressing these deficits is warranted. Cognitive-behavioral Therapy (CBT) is one of the most used interventions for treating SUDs and is broadly recognized as an evidence-based intervention. Unfortunately, studies to date have not demonstrated that adding in-person CBT to MOUD for treating OUD reduce drug use or increase treatment retention, attendance, or medication adherence. However, a recent study of web-based CBT (CBT4CBT-Buprenorphine) provided favorable results regarding the preliminary efficacy of CBT as an add-on to buprenorphine. Recovery coaching (RC) services provided by individuals with substance use experience and successful recovery involve a form of nonclinical, peer support aimed at helping individuals with SUDs to achieve and maintain recovery. In a recent systematic review, we demonstrated that the use of recovery coaches for people living with OUD is associated with increases in MOUD initiation, including buprenorphine and methadone. In addition, the utilization of recovery coaches was proven to be useful in decreasing opioid use. However, recovery coaches have not yet been shown to improve outcomes for those already on MOUD. In a small pilot study, we demonstrated that combining recovery coaching (with the model of Assertive Community Engagement) and CBT4CBT-Buprenorphine led to decreased illicit drug use and optimized social determinants of health. We propose an integrated intervention combining RC and CBT. We hypothesize that both components will improve behavioral skills with CBT4CBT-Buprenorphine teaching discrete skills and RC providing role modeling, reinforcing skills and practice, providing social support (emotional/informational, tangible, affectionate and positive social interaction), and motivating participants to complete modules and homework, which will result in decreased substance use and increased retention. The specific aims of this proposal are: (1) to conduct a 3-arm randomized clinical trial to evaluate the efficacy of the integrated Recovery Coach + CBT4CBT-Buprenorphine intervention vs. CBT4CBT- Buprenorphine vs. Treatment as Usual (N=90); (2) to investigate whether the integrated intervention reduces cue-reactivity and improves inhibitory control; (3) to refine our Recovery Coach + CBT4CBT-Buprenorphine intervention for a multi-site R01 clinical trial.
