A Randomized Pilot Trial of an Integrated Intervention Combining Computerized Behavioral Therapy and Recovery Coaching for People With Opioid Use Disorder: The OVERCOME Study

Background: People with opioid use disorder (OUD) often exhibit high rates of nonprescribed drug use and low retention on buprenorphine. This study tested the feasibility, acceptability, and preliminary efficacy of an intervention combining peer recovery coaching and CBT4CBT-buprenorphine (CBT4CBT+RC) to reduce nonprescribed drug use and increase buprenorphine retention. Methods: A randomized trial conducted from December 15, 2020, to November 24, 2021, compared an 8-week CBT4CBT+RC intervention to treatment as usual (TAU). Outcomes included feasibility (recruitment, treatment initiation, and completion), acceptability (of CBT4CBT, recovery coaching, and integrated intervention), and preliminary efficacy (saliva toxicology and buprenorphine retention during treatment and at 1- and 3-mo follow-ups). Participants (N=38) had been receiving buprenorphine for an average of 270.1 days (SD=444.0) and reported recent nonprescribed drug use. Results: Recruitment feasibility was 33.7%. Of the 19 participants assigned to CBT4CBT+RC, 94.7% met with a coach, and 52.6% initiated CBT4CBT. The average number of modules completed was 6.0 (299.7 min). Satisfaction with the intervention, coach, and CBT4CBT-buprenorphine was high (M≥4.9). Drug use was significantly lower in the CBT4CBT+RC group compared with TAU during treatment (35% vs. 69%, P =0.03), at 1 month (34% vs. 69%, P =0.009), and at 3 months (0% vs. 88%, P <0.001). Retention and opioid-positive tests did not differ between groups. Conclusions: The CBT4CBT+RC condition resulted in lower rates of saliva toxicology positive for drug use during treatment and follow-ups, but showed comparable buprenorphine retention rates to TAU. These findings provide promising support for the potential of CBT4CBT+RC to reduce drug use among individuals with OUD.