Psychosocial interventions in office-based opioid treatment: A systematic review

Abstract

Objective: Medication-assisted treatment (MAT) in office-based opioid treatment (OBOT) is expanding treatment of opioid use to primary care settings. OBOT combines MAT and behavioral health interventions; however, the literature varies on best practices. This review focuses on psychosocial interventions as an OBOT component. Method: Protocol and eligibility criteria were published on PROSPERO; intervention characteristics, setting, provider, location, and duration were considered. Results: Search results and initial screening yielded 539 articles for abstract review; 67 articles were retained for full-text review. Of these, 30 articles (reporting on 25 studies) met inclusion criteria. The majority of studies were conducted in academic medical centers (72%), primarily in the Northeast U.S. Study samples consisted of a majority of men and White participants. Psychosocial interventions included individual counseling (88%), mutual help programs (36%), group counseling (28%), case management (24%), and referral to outpatient treatment (24%). Therapeutic approaches used motivational interviewing, cognitive behavioral therapy, and 12-step facilitation. Interventions were administered by interprofessional providers—most frequently medical providers, social workers, and a variety of behavioral health providers. Conclusions: Despite progress in expanding OBOT, a critical need remains to identify and support psychosocial interventions as essential, concurrent components of MAT. Implications for practice, workforce, team-based care, and future research needs are addressed.