Unpacking behavioural therapy for opioid addiction: effectiveness, types, techniques, & how it works

Despite efforts to reduce the number of prescribed opioids1, the opioid addiction crisis continues to cast a long shadow over public health in the UK. Consider these figures:

• The government estimates 337,574 adult individuals are currently addicted to heroin and/or fentanyl alone2 – a higher rate than in any EU nation.
• Opioid-related deaths represent the largest proportion of drug-related deaths in the UK3, with an average of 40 deaths per week.
• Opiate-related drug poisoning deaths have increased by 388% since 19934.
• More than five in every hundred adults (aged 16 to 59) have misused a prescription-only painkiller that was not prescribed to them5. 
• There are over one million people in the UK on prescription opioids6 – over 50,000 of whom have been taking these for six months or more. 

With opioids having highly addictive characteristics, this substance use disorder significantly impacts physical, psychological, and social wellbeing, underscoring an urgent need for effective treatment pathways. 

Among the available interventions, behavioural therapy has emerged as a key modality in managing opioid use disorder (OUD). By addressing the psychological and behavioural dimensions of addiction, behavioural therapy offers a structured, evidence-based approach to recovery. In this article, we delve into the fundamentals of behavioural therapy, its efficacy, and the techniques that support individuals on their journey to sustainable recovery.

Make a referral for OUD today → 

An introduction to behavioural therapy

Behavioural therapy is a psychological intervention that focuses on modifying maladaptive behaviours and thought patterns7. 

Developed from the principles of learning theory, it has proven highly effective in treating substance use disorders, including OUD8. By fostering self-awareness, enhancing coping mechanisms, and reshaping behavioural responses, this therapeutic approach empowers patients to regain control over their lives.

Studies highlight the efficacy of behavioural therapy in reducing opioid misuse, improving treatment adherence, and preventing relapse. 

One meta-analysis revealed that integrating behavioural therapy with pharmacological interventions, such as methadone or buprenorphine, significantly enhances recovery outcomes9. This synergy demonstrates the critical importance of addressing both the physiological and psychological dimensions of addiction.

Types of behavioural therapy used in opioid addiction treatment

Various behavioural therapies have demonstrated effectiveness in treating OUD. 

While some modalities (such as psychoanalysis) or behavioural therapies delivered in isolation may have “limited efficacy” in this context10, structured approaches like CBT and contingency management have shown significant promise, particularly when integrated with appropriate medications. 

Cognitive behavioural therapy (CBT)

CBT is a widely utilised therapeutic approach for OUD11. It addresses the interplay between thoughts, feelings, and behaviours, equipping individuals with tools to identify and challenge cognitive distortions. For example, an individual struggling with opioid cravings might learn to reframe automatic thoughts (“I need opioids to cope”) into healthier perspectives (“I can use relaxation techniques to manage stress”).

Recent research underscores CBT’s efficacy in reducing opioid cravings and enhancing relapse prevention12. In clinical practice, therapists may employ structured sessions to help patients develop coping strategies, improve problem-solving skills, and strengthen emotional regulation.

Contingency management

Contingency management (CM) leverages positive reinforcement to encourage abstinence and adherence to treatment13. Individuals receive tangible rewards, incentives, or ‘privileges’ for meeting predefined goals, like maintaining drug-free urine samples. 

Studies highlight CM’s role in improving retention rates in opioid treatment programs14. 

How behavioural therapy helps in opioid addiction recovery

Behavioural therapy’s strength lies in its ability to address the multifaceted nature of addiction. By reshaping behaviours and thought patterns, it empowers patients to navigate the complexities of recovery.

Modifying harmful behaviours

Addiction typically involves entrenched patterns of harmful behaviour, such as compulsive drug-seeking. Behavioural therapy identifies these patterns and replaces them with constructive alternatives15. 

For example, a patient might transition from using opioids to manage stress to employing mindfulness or exercise. This shift not only mitigates substance use but also fosters resilience against future triggers.

Addressing underlying issues

Opioid addiction can frequently coexist with mental health disorders, such as depression or anxiety. 

Behavioural therapy provides a structured framework for exploring and addressing these underlying issues. Techniques like cognitive restructuring and motivational interviewing enable patients to gain insight into the emotional drivers of their addiction16, paving the way for a deeper, further-reaching recovery. 

A comprehensive approach to behavioural therapy ensures that treatment extends beyond symptom management to address the root causes of substance use.

Key techniques in behavioural therapy

Behavioural therapy employs a range of techniques to support recovery, each tailored to the individual’s unique needs.

• Cognitive restructuring

Cognitive restructuring focuses on identifying and challenging irrational beliefs and cognitive distortions. For instance, an individual might work with their therapist to recognise the false belief that opioids are essential17 for emotional stability. 

By replacing this belief with evidence-based thinking, the individual develops healthier coping mechanisms. This technique is particularly valuable in addressing the negative self-perceptions that often accompany addiction18.

• Coping skills training

Coping skills training equips patients with practical strategies to manage stress, cravings, and high-risk situations. Techniques may include role-playing scenarios, relaxation exercises, and stress management protocols. Practicing these skills in a safe, therapeutic environment enables individuals to build confidence in their ability to maintain abstinence19 in real-world contexts.

The long-term benefits of behavioural therapy

The benefits of behavioural therapy extend far beyond the initial phases of recovery20. Long-term outcomes include improved emotional regulation, enhanced interpersonal relationships, and sustained abstinence. By fostering a proactive approach to mental health and wellbeing, behavioural therapy empowers individuals to rebuild their lives. Studies indicate that patients who engage in behavioural therapy demonstrate lower relapse rates21 and higher overall life satisfaction22 – underscoring its enduring impact.

Treating the whole person in opioid addiction

Opioid addiction is a complex, multifaceted condition – one that requires a whole-person approach. At Harbor London, we specialise in curated, individualised care; integrating behavioural therapy with pharmacological support and personalised treatment plans. Our team of world-leading clinicians collaborates with individuals to address not only the symptoms of addiction but also its underlying causes.

By combining evidence-based therapies, personalised care, and a commitment to confidentiality, Harbor London provides a safe space for recovery. Whether through CBT sessions, contingency management, or aftercare planning, we empower individuals to take control of their lives and achieve long-term sobriety.

If you know someone struggling with opioid addiction, make a referral to Harbor London today. 

References

1. https://www.england.nhs.uk/long-read/reducing-long-term-opioid-use/#:~:text=As%20a%20result%2C%20between%20January,on%20the%20body%20and%20mind.
2. https://www.ukat.co.uk/addiction/drug/prescription/opiate/
3. https://www.gov.uk/government/news/expansion-of-life-saving-opioid-overdose-treatment
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC10278447/
5. https://fpm.ac.uk/opioids-aware-clinical-use-opioids/current-uk-data-opioid-misuse
6. https://www.southtees.nhs.uk/news/new-treatment-helps-people-stop-addictive-opioid-painkillers-used-for-chronic-pain/#:~:text=There%20are%20over%20one%20million,saving%20an%20estimated%20350%20lives.
7. https://www.healthline.com/health/behavioral-therapy
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC2897895/
9. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767358
10. https://psychiatryonline.org/doi/10.1176/appi.prcp.20180006 
11. https://pmc.ncbi.nlm.nih.gov/articles/PMC2897895/
12. https://pmc.ncbi.nlm.nih.gov/articles/PMC5119533/
13. https://pmc.ncbi.nlm.nih.gov/articles/PMC3083448/
14. https://pmc.ncbi.nlm.nih.gov/articles/PMC5558146/#:~:text=Contingency%20management%20(CM)%20reduces%20other,use%20in%20opiate%20addiction%20treatment.&text=Meta%2Danalyses%20did%20not%20find,for%20non%2Dprescribed%20opiate%20use.&text=CM%20is%20effective%20for%20cocaine,cocaine%2C%20tobacco%2C%20polysubstance%20use.&text=Evidence%20is%20lacking%20for%20long%2Dterm%20effects.
15. https://www.healthline.com/health/behavioral-therapy
16. https://pmc.ncbi.nlm.nih.gov/articles/PMC5580948/#:~:text=MI%20has%20been%20applied%20as,%2C%20exposure%2C%20cognitive%20restructuring).
17. https://mental.jmir.org/2021/10/e31173/
18. https://pmc.ncbi.nlm.nih.gov/articles/PMC3905528/
19. https://pmc.ncbi.nlm.nih.gov/articles/PMC11164602/
20. https://www.verywellmind.com/what-is-behavioral-therapy-2795998
21. https://www.sciencedirect.com/science/article/pii/S0165032724007511#:~:text=Overall%2C%20results%20demonstrate%20that%20CBT,to%20an%20active%20control%20group.
22. https://pubmed.ncbi.nlm.nih.gov/27910997/