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Randomized Controlled Trial
. 2023 Sep;41(3):377-388.
doi: 10.1037/fsh0000791. Epub 2023 May 25.

Adapting psychotherapy in collaborative care for treating opioid use disorder and co-occurring psychiatric conditions in primary care

Rachel French  1 , Julie Worley  1 , Margaret Lowenstein  2 , Hillary R Bogner  3 , Tara Calderbank  1 , Dominick DePhilippis  1 , Andrew Forrest  1 , Mary Beth Connolly Gibbons  1 , Rebecca Arden Harris  2 , Saida Heywood  1 , Kyle Kampman  1 , David S Mandell  1 , James R McKay  1 , Schyler Tristen Newman  1 , David W Oslin  1 , Steven Wadden  1 , Courtney Benjamin Wolk  1
Affiliations
Randomized Controlled Trial

Adapting psychotherapy in collaborative care for treating opioid use disorder and co-occurring psychiatric conditions in primary care

Rachel French et al. Fam Syst Health. 2023 Sep.

Abstract

Introduction: Opioid use disorder (OUD) and psychiatric conditions commonly co-occur yet are infrequently treated with evidence-based therapeutic approaches, resulting in poor outcomes. These conditions, separately, present challenges to treatment initiation, retention, and success. These challenges are compounded when individuals have OUD and psychiatric conditions.

Method: Recognizing the complex needs of these individuals, gaps in care, and the potential for primary care to bridge these gaps, we developed a psychotherapy program that integrates brief, evidence-based psychotherapies for substance use, depression, and anxiety, building on traditional elements of the Collaborative Care Model (CoCM). In this article, we describe this psychotherapy program in a primary care setting as part of a compendium of collaborative services.

Results: Patients receive up to 12 sessions of evidence-based psychotherapy and case management based on a structured treatment manual that guides treatment via Motivational Enhancement; Cognitive Behavioral Therapies for depression, anxiety, and/or substance use disorder; and/or Behavioral Activation components.

Discussion: Novel, integrated treatments are needed to advance service delivery for individuals with OUD and psychiatric conditions and these programs must be rigorously evaluated. We describe our team's efforts to test our psychotherapy program in a large primary care network as part of an ongoing three-arm randomized controlled trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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Conflict of interest statement

Conflict of interest statement: None of the authors have any conflicts of interests to declare. The contents of this paper do not necessarily reflect the views of the Department of Veterans Affairs or the United State Government.

Figures

Figure 1.
Figure 1.
Algorithm Guiding Selection of Psychotherapy Approach Used in Collaborative Care Model+ (CoCM+) Integrated Treatment for Comorbid Opioid Use Disorder and Psychiatric Conditions Abbreviations: Patient Health Questionnaire (PHQ); Brief Addiction Monitor for Intensive Outpatient Programs (BAM-IOP); General Anxiety Disorder (GAD); Cognitive-Behavioral Therapy for Substance Use Disorders (CBT-SUD) Key: *BAM-IOP items 6-7 assess drug use in the past 30 days ±BAM-IOP items 4-5 assess alcohol use in the past 30 days
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