Cognitive-Behavioral Therapy for Opiate Users in Methadone Treatment: A Multicenter Randomized Controlled Trial

Background: Opiate use on a stable methadone dose is a health concern in Iran (Persia). Cognitive-behavioral therapy (CBT) is a suggested treatment for this problem. Objectives: The study aimed to assess the CBT effectiveness in the treatment of regular opiate use on a stable methadone dose in Shiraz, near the Persian Gulf of Iran. Methods: The study design was a multicenter randomized controlled trial. The study was conducted at two methadone clinics during 2015. Overall, 118 patients who were regular opiate users were selected. Participants were randomly assigned (1:1) to receive either CBT (n = 59) or remain in a control condition (n = 59). The Opiate Treatment Index, Contemplation Ladder and Severity of Dependence Scale were completed at baseline, post-treatment and a three-month follow-up. The primary outcome was the reduced mean score of regular opiate use. Other outcomes included an increased readiness to reduce opiate use and reduced severity of opiate dependence. Data were analyzed performing intentions-to-treat analyses, independent samples t-tests and Wilcoxon Rank- Sum tests. Results: CBT significantly reduced opiate use (z = 3.73, P = 0.01, d = 0.89) and the severity of opiate dependence (z = 7.36, P = 0.01, d = 0.64) after four weeks of treatment. Readiness to reduce opiate use significantly increased (t (116) = 9.55, P = 0.01, d = 0.81) over the same time. All study results remained stable at three-month follow-up while no significant change was found in the control group. Conclusions: CBT can be used as an effective intervention to reduce regular opiate use on a stable methadone dose. A larger study with more Persian participants and a six-month follow-up is suggested.