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.