Points to Consider

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1) There is a big difference between offering psychosocial services and making medical treatment contingent upon psychosocial service compliance. Offering psychosocial services can provide helpful supports to patient recovery and foster patient self-efficacy. Requiring psychosocial services can create barriers to medical treatment—treatment that is often critical to patient safety, health, and well-being.

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2) Patients often experience involuntary discontinuation of buprenorphine therapy due to their failure to meet psychosocial program requirements. This premature discontinuation is associated with a high rate of relapse and associated health risks. Psychosocial treatment barriers are less common in methadone treatment programs where the priority of medical treatment is a well-established principle.

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4) All medical services involve psychosocial interaction. When patients develop trust in their medical team and the effects of buprenorphine or methadone treatment, they may become more amenable to engaging in ancillary psychosocial services. In the meantime, the medications by themselves confer significant health benefits and reduce the risk of acute morbidity and mortality.

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5) The traditional step-down model of addiction treatment front-loads psychosocial services; but intensive psychosocial treatment is not known to improve treatment retention or decrease illicit opioid use in the early stages of buprenorphine or methadone treatment. In the chronic care model of opioid use disorder treatment, psychosocial interventions are selected through shared decision making processes that prioritize patient self-determination in an open-ended course of care.