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Abstract

This pilot study evaluated a previously untested cognitive-behavioral therapy (CBT) intervention designed specifically to treat opioid use disorder (OUD). Adults (N = 20) taking medication for OUD were recruited from a public health organization providing harm reduction and treatment services to people who use drugs in Philadelphia. Outcomes collected at baseline and 12 weeks included urinalysis-confirmed use of illicit drugs and surveys of mood (Patient Health Questionnaire-9; Generalized Anxiety Disorder-7), recovery capital (Brief Assessment of Recovery Capital-10), and cravings (Brief Substance Craving Scale). Feasibility and acceptability were assessed via retention rates, the Client Satisfaction Questionnaire-8, and the number of CBT sessions attended. The twelve, 50-minute modules followed standard CBT format (e.g., agenda, action plans) and applied the foundational tenets of CBT to reduce the behavior of illicit opioid use (e.g., cognitive restructuring, functional analysis). Change in outcomes and effect sizes were calculated using paired t-tests, McNemar’s tests, and Cohen’s d. Enrolled participants (N = 20, 66.7% male, 8.3% Black) were a mean age of 41.8 years, SD = 9.0. In total, 12 participants completed pre- and post-treatment study visits and were included in analyses (60%). From baseline to week 12, completers (n = 12) reported improvements in recovery capital (t [11] = -1.83, p = .047, Cohen’s d = -.53), reductions in anxiety (t [11] = 2.22, p = .024, Cohen’s d = .64), and reductions in depression (t [11] = 3.58, p = .002, Cohen’s d = 1.0). No changes were observed in positive urine screenings for illicit opioid use specifically (OR = 1.0). Participants attended the majority of CBT sessions (M = 10.8, SD = 1.6) and reported high satisfaction with the program (M = 31.3, SD = 1.4). Overall, satisfaction ratings were high and moderate effect sizes observed for most of the survey-based psychosocial outcomes. Utilizing measures that quantify reductions in opioid use versus abstinence only, and that assess for behaviors that can increase the risk of overdose, may better capture the impact of psychosocial interventions on opioid use in this population.

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