Author Name Rob Brumer

Author Name Cathy Cepeda

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.