What non-pharmacological interventions are effective in supporting patients with opioid dependence?

Effective non-pharmacological interventions for supporting patients with opioid dependence include psychosocial interventions that aim to support behavioural change and build resilience. Standard care interventions typically offered by a key worker include motivational interviewing, harm reduction advice, brief interventions, relapse prevention, goal setting, problem solving, recovery planning, support to address social issues, and peer-based recovery support.

For patients with complex needs or poor response to standard care, enhanced care interventions may be provided. These include more formal motivational interviewing techniques, contingency management, assertive outreach, cognitive-behavioural approaches, family, couple or social network interventions, social skills training, and in some cases, inpatient assessment and stabilisation.

Contingency management, which involves offering incentives for positive behaviours such as abstinence or reduction in illicit drug use, has clear evidence for effectiveness as an adjunct to detoxification. Incentives can include vouchers exchangeable for goods or services, privileges like take-home methadone doses, or modest financial rewards. This approach increases the likelihood of positive behaviours and is cost effective.

Residential and inpatient psychosocial interventions should include contingency management, behavioural couples therapy, and cognitive behavioural therapy, and participation in self-help groups is encouraged. Residential treatment may be considered for those seeking abstinence with significant comorbid physical, mental health, or social problems, especially if community-based psychosocial treatments have been ineffective.

Overall, psychosocial interventions are integral to opioid dependence treatment and should be tailored to the individual's needs, preferences, and complexity of their condition.

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