Cognitive Behavior Therapy as Relapse Prevention for Opioid Use Disorders

Opioid use disorder (OUD) is a prevailing psychiatric illness that provides foundations of morbidity and mortality. Objective: To investigate the effectiveness of Cognitive Behavior Therapy (CBT) in terms of relapse prevention in the treatment of patients with opioid use disorders. Methods : After the period of detoxi�cation, an individualized treatment plan was made based on CBT. To assess the effectiveness of planned and executed CBT sessions, pre and post assessment method was opted. Results: Results specify that CBT worked successfully as relapse prevention in one-on-one sessions. CBT attested to be working in treating patients' lapses as well as relapses by increasing control on cravings and improving assertive behavior. Conclusions: The conclusion can be drawn that CBT is an effective methodology that successfully deals with patients' cravings, and develops assertive behavior thereby preventing relapse.

and withdrawal issues [7].Another research highlighted that the signs of Opioid withdrawal cover agitation, craving, abdominal cramps, diarrhea, anxiety, sneezing, elevated heart rate, pupil dilation, elevated blood pressure, sweating, rhinorrhea, tearing, shakiness, goosebumps, muscle pain, and insomnia [8].Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5-TR) describes Opioid Use Disorder (OUD) as a problematical and periodic pattern of opioid use, that causes notable damage or suffering for at least 12 months [9].In Pakistan, the intake of heroin opium, and other illegal opiates and the non-therapeutic use of medically prescribed opioids like OxyContin has widespread, and rates are still escalating [10].In the 1990s, there was increasing heroin usage, with the most common drugs used being cannabis and opiates [11].Based on evaluations, 320,000 individuals (0.3%) and 860k individuals (0.8%) habitually use opium and heroin, respectively.one million sixty thousand individuals overall (1% individuals in the age range 15years-64years) are using opiates [12].Opioid Use Disorder is a curable and manageable Psychopathological condition.CBT is an effective approach for treating OUD and can be administered in group or individual sessions following the detoxi cation period [13].Predominantly CBT addresses behavioral and cognitive issues of patients.The current investigation was intended to examine the e ciency of CBT in patients with opioid withdrawal disorder.
The very rst step of this study was to take permission from hospital (Silver Lining Hospital Faisalabad) to conduct this research.In that hospital two patients who came with presenting complaints of opioid use disorder were selected for our investigation.Both the patients were male, in case-1 patient was thirty-year-old and married, while in case-2, patient was a twenty-seven-year-old and unmarried.Treatment was initiated following the patients' consent.Through clinical interviews the information was collected from patents.Additionally, for the screening and assessment of patients, the Addiction Severity Index (ASI) and Alcohol Smoking and Substance Involvement Screening Test (ASSIT) were administered.Two selfreporting tools The Brief Substance Craving Scale (BSCS) and The Rathus Assertiveness Schedule (RAS) were used for pre and post assessment purpose.BSCS contains eight items intended to assess the degree of craving for substance abuse.Participants rate the intensity and frequency of their cravings using a ve-point Likert scale.The time duration required for administering it is usually 10 minutes; and it can be used at any stage of treatment including follow-up sessions [14].However, the RAS consists of 30 items in a self-reporting layout.This tool

R E S U L T S
The current nding screening tool (Table 1) revealed that both patients (case 1 and case 2) scored high-risk levels on tobacco which showed the main gateway to addiction.Similarly, both patients also scored high on opioid substances which showed disturbance in their daily routine of life.However, the results of table 1 indicate a detailed assessment (Addiction Severity Index: ASI) to rule out the severity on different issues/ problems.Table 3 shows that there was a signi cant difference in the baseline scores and post-testing scores between the patients with opioid use disorder over time.In addition, analysis revealed that signi cant differences were found on the scales (i.e., BSCS and RAS).
. THE THERAPIST, Crosslinks Publishers a l l ows c o n s i s t e n t a n d u s e a b l e a s s e s s m e n t o f assertiveness or social boldness[15].The scores of pre and post-test show a signi cant difference.For formal diagnosis, the Diagnostic criteria from the DSM-5 were taken in to account.Thus, both patients were o cially diagnosed with opioid withdrawal disorder.[292.0 (F11.23)].After formal diagnosis 16 CBT-based individualized therapeutic sessions were planned and executed for both of them.Afterward, 3 months follow-up session was conducted to educate the patients about lapse and relapse prevention.Starting from March 2023 and extending through December 2023.
This study concluded that Cognitive Behaviour Therapy is an effective intervention strategy for the treatment of Opioid use disorders (OUD).It e ciently enhances the cognitive, behavioural, as well as occupational functioning of the patient.

Table 1 :
Scores of both Cases on ASSIST

Table 2
shows the impact of opioids on their different domain of life such as medical, social, and legal issues.Each score represents the severity level of the respective problem area for the individual case.The result of ASI showed that both patients have severity on family and social level, employment level, and drug level.Due to the effects of substances, an individual's family is affected as well as one can't give attention in the workplace because of craving and lack of assertiveness.

Table 2 :
Scores of both Cases on Addiction Severity

Table 3 :
Scores of Pre and Post Testing of both Case Studies One of the main issues, in the treatment of OUD, is relapse[21]and CBT is the most ex te n s i ve l y s t u d i e d fo r m of p syc h ot h e ra p e u t i c intervention, as it methodically targets the thoughts, feelings, and behaviours that in turn support relapse prevention[22].In the present analysis, carefully planned individualized CBT sessions were conducted as intervention plan.Each of those sessions was based on a certain agenda.But in general, the overall goal of these sessions was cognitive restructuring of patients, improve their daily living functioning, and Preventing lapses and relapses.There was an outstanding improvement in the