Date Published: June 24, 2015
Publisher: Public Library of Science
Author(s): Shujun Pan, Haifeng Jiang, Jiang Du, Hanhui Chen, Zhibin Li, Walter Ling, Min Zhao, Bernard Le Foll.
Methadone maintenance treatment (MMT) is widely available in China; but, high rates of illicit opiate use and dropout are problematic. The aim of this study was to test whether cognitive behavioral therapy (CBT) in conjunction with MMT can improve treatment retention and reduce opiate use.
A total of 240 opiate-dependent patients in community-based MMT clinics were randomly assigned to either weekly CBT plus standard MMT (CBT group, n=120) or standard MMT (control group, n=120) for 26 weeks. The primary outcomes were treatment retention and opiate-negative urine test results at 12 weeks and 26 weeks. The secondary outcomes were composite scores on the Addiction Severity Index (ASI) and total scores on the Perceived Stress Scale (PSS) at 12 weeks and 26 weeks.
Compared to the control group in standard MMT, the CBT group had higher proportion of opiate-negative urine tests at both 12 weeks (59% vs. 69%, p<0.05) and 26 weeks (63% vs. 73%, p<0.05); however, the retention rates at 12 weeks (73.3% vs. 74.2%, p=0.88) and 26 weeks were not different (55.8% vs. 64.2%, p=0.19) between the two groups. At both 12 and 26 weeks, all of the ASI component scores and PSS total scores in the CBT group and control group decreased from baseline; but the CBT group exhibited more decreases in ASI employment scores at week 26 and more decrease in the PSS total score at week 12 and week 26. CBT counselling is effective in reducing opiate use and improving employment function and in decreasing stress level for opiate-dependent patients in MMT in China. ClinicalTrials.gov NCT01144390
Drug abuse has been prevalent in China for decades. In 2013, the number of registered drug users on the Chinese mainland reached 2.2 million , with heroin being the most commonly used illicit drug. Heroin and related problems have become a major concern for the Chinese government and for public health departments. The prevalence of HIV, HCV and co-infection with both was 6.0%, 60.1%, and 4.6%, respectively, among heroin-dependent people in methadone maintenance treatment (MMT) programs on the Chinese mainland . Approximately 780,000 people are HIV seropositive and receive treatment for AIDS in China . MMT was introduced in 2004 to respond to the problems of heroin and to reduce consequences, and there are more than 700 community-based MMT clinics in China . However, lapse, relapse, and premature dropout among MMT patients are commonly reported [5,6]. Findings from studies exploring the reasons for poor outcomes of MMT have suggested that the majority of these patients had various psychological problems and emotional disorders, held negative attitudes toward MMT, and had various difficulties and stresses associated with abstinence during the recovery process [7,8,9]. These problems are barriers to treatment outcomes and must be addressed in MMT programs. One strategy is to combine a psychosocial intervention to improve treatment efficacy. However, formal psychological or behavioral interventions are not implemented in most MMT programs in China for various reasons, such as personnel shortage and resource limitations.
To the best of our knowledge, this report is the first study on the efficacy of CBT among MMT patients in China. The primary aim was to examine the efficacy of a manual-based CBT intervention for MMT patients to improve treatment retention, reduce opiate use, and reduce addiction severity and psychological stress compared to standard MMT without CBT. The primary analysis revealed that retention rate at week 26 from participants in the MMT combined with CBT group was not significantly different than those from the MMT-only group. Some previous studies [26,27,28] also did not find a significant effect of CBT during treatment, however, findings from follow-up suggested that delayed effects may occur after the cessation of short-term CBT. It was necessary to follow-up the participants for a period after the intervention stopped to explore whether CBT would produce comparable long-term outcomes. We observed that participants who received the CBT intervention had a higher proportion of negative urine test results for opiates at week 12 and week 26. This finding is consistent with other studies, which showed that CBT is effective in reducing opiate use and relapse [18,23,36,37,38].
In sum, the findings of the present study support the efficacy of manual-based CBT in reducing opiate use and psychological stress and improving employment function for patients in MMT clinics. The long-term efficacy of CBT for reducing opiate use and improving psychosocial functions must be followed up after the end of treatment in the study. It is recommended that CBT can be combined with standard care of MMT treatment to improve treatment outcomes.