Clinical Question In heroin addiction therapy, is the addition of counseling to opioid agonist treatment (e.g. methadone) more effective than pharmaceutical treatment alone at ? P Heroin Addiction I Counseling C Pharmaceutical Treatment O Relapse
Citations Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Amato L, Minozzi S, Davoli M, Vecchi S. Cochrane Database of Syst Rev. 2011 Oct 5;(10):CD004147. doi: 10.1002/14651858.CD004147.pub4. Review. PMID: 21975742
Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Amato L, Minozzi S, Davoli M, Vecchi S. Cochrane Database of Syst Rev. 2008 Oct 8;(4):CD004147. Doi: 10.1002/14651858.CD004147.pub3. Update in: Cochrane Database Syst Rev. 2011:10:CD004147. PMID: 18843654
Randomized trial of standard methadone treatment compared to initiating methadone without counseling: 12-month findings. Schwartz RP, Kelly SM, OGrady KE, Jaffe JH. Addiction. 2012 May;107(5):943-52. Doi: 10.1111/j.1360-0443.2011.03700.x. PMID: 22029398
Bottom Line A Cochrane systematic review and a later randomized controlled trial were located regarding this clinical question. In the Cochrane review, the Cochrane Drugs and Alcohol Group trial registry, Cochraine Central Register of Controlled Trials, PUBMED, and several other databases were searched to locate randomized controlled trials and controlled clinical trials that fit the criteria, for a total of 35 studies with 4319 participants. Trials selected for this review compared opioid agonist treatment alone to agonist treatment in addition to psychosocial counseling. Twenty-seven studies showed no significant change in treatment retention, eight showed no difference in opiate abstinence, and others showed no difference in psychiatric symptoms, depression, or patient compliance. The randomized trial compared interim methadone treatment with only emergency counseling to standard methadone treatment with regular counseling. There were 230 patients enrolled in the trial, and there was no significant difference in treatment retention, opiate abstinence, or arrests between the groups. At this time, more study is recommended, as there is not a great deal of evidence available. Additionally, the previous version of the Cochrane review made conclusions contrary to those provided in the current version. However, the available evidence indicates that counseling in addition to opioid agonist therapy does not help with heroin addiction in a measurable way.