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Landmark Recovery MAT Program

What is OBOT

Office-Based Opioid Treatment Programs – also called OBOTs – are a type of outpatient addiction treatment designed for people living with opioid use disorder (OUD). OBOTS are classified under the general umbrella of Medication-Assisted Treatment (MAT).

OBOTs that treat patients with Suboxone, which is the commercial name for a combination of two medications: buprenorphine and naloxone. Together, buprenorphine and naloxone work to minimize opioid withdrawal symptoms, reduce opioid cravings, and block the effects of opioids in the brain and body.

What is DBT

Dialectical behavior therapy (DBT) is a modified type of cognitive behavioral therapy (CBT). DBT was originally developed as a successful treatment for individuals diagnosed with borderline personality disorder (BPD); however, the model has been adapted to treat other mental health conditions, including individuals diagnosed with substance use disorders.

DBT has four areas of focus:

  • Mindfulness: Learning to how to live in the present moment
  • Distress Tolerance: Learning how to increase a person’s tolerance of negative emotions, rather than escaping from them
  • Emotional Regulation: how to decrease vulnerability to painful emotions and change emotions that you want to change, and Interpersonal
  • Effectiveness: How to maintain self-respect and improve relationship with others

The overall goal of DBT is to help clients create a “life worth living.” Clients are encouraged to define what a “life worth living” looks like and the therapeutic work is focused on addressing problem behaviors that are barriers to realizing that life.

Why Do These Go Together?

To best help individuals recover from opioid use disorders and co-occurring mental health disorders, the OBOT/DBT program offers a holistic person-centered approach:

  • Providing prescription medications in combination with an effective therapeutic approach that has proved outcomes in helping individuals develop the skills necessary to improve quality of life..
  • This therapeutic model and the use of Suboxone work in tandem by providing relief from opioid withdrawal symptoms while reducing cravings for continued opioid use.

Suboxone vs Subutex vs Methadone

Suboxone versus Subutex

The main difference is that Suboxone contains both buprenorphine and naloxone, whereas Subutex contains only buprenorphine. Bothoth medications were developed at around the same time; however, Subutex was formulated first and while it was found to be relatively effective in the treatment of opiate addiction, there was still potential risk of abuse because if used incorrectly, the medication could create a state of euphoria.   Additionally, there was a higher risk of diversion, meaning, selling the medication on the street market because of the potential for euphoric effect.

Naloxone was combined with buprenorphine to deter abuse of the medication. Naloxone is an opioid antagonist, which means that it blocks the effects of opioids at the receptor sites.  If someone injects Suboxone, the individual will immediately go into precipitated withdrawal, which  means the individual would experience physical discomfort versus a euphoric effect.

Suboxone versus Methodone

While methadone is a Schedule II substance, buprenorphine is a Schedule III substance, meaning it as a drug with a lower potential for abuse. As a result, burprenorphine is often considered to be a safer opiate treatment medication than methadone. According to the Drug Enforcement Agency, almost 16,000 physicians were certified to prescribe buprenorphine-based products, like Suboxone and Subutex, in 2013. In 2012, 9.3 million prescriptions were written for these medications.

Much like the differences between Suboxone and Subutex, Suboxone is a much safer medication for use in treatment of opioid use disorders than Methadone as it does not have the potential for abuse and diversion as its counterparts.

What Will Treatment Look Like?

DBT therapy and suboxone maintenance working together!

Evidence-based treatments, also known as evidence-based practices, are treatments that have been researched scientifically or academically and proven to be helpful in more than one study. Research shows that a combination of medication and therapy can successfully treat substance use disorders, including Opioid Used Disorder (OUD), and for some people struggling with OUD, suboxone maintenance can help sustain recovery. MAT programs, including OBOT, are also used to prevent or reduce opioid overdose. Dialectical behavior therapy (DBT) is also classified as an evidenced based treatment backed by empirical research, with the most effective program length for DBT being 12-months.

The DBT 12-month treatment schedule involves weekly hour-long individual therapy, twice a week group skills training, between-session telephone consultation for the individual, and weekly therapist consultation team meetings designed to support, motivate, and enhance the skills of therapists.

  • Group sessions: Two groups a week, 1.5 hours each, beginning each group with a mindfulness moment, followed by psychoeducation or processing of the current week’s skill.

Statistics

Nearly 841,000 people have died since 1999 from a drug overdose.1 Over 70% of drug overdose deaths in 2019 involved an opioid.2 Opioids are substances that work in the nervous system of the body or in specific receptors in the brain to reduce the intensity of pain.

Overdose deaths involving opioids, including prescription opioids, heroin, and synthetic opioids (like fentanyl), have increased over six times since 1999.1 Overdoses involving opioids killed nearly 50,000 people in 2019, and nearly 73% of those deaths involved synthetic opioids.2

  1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. Available at http://wonder.cdc.gov.
  2. Mattson CL, Tanz LJ, Quinn K, Kariisa M, Patel P, Davis NL. Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019. MMWR Morb Mortal Wkly Rep 2021;70:202–207. DOI: http://dx.doi.org/10.15585/mmwr.mm7006a4external icon.

Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them and between 8 and 12 percent develop an opioid use disorder. Additionally, an estimated 4 to 6 percent who misuse prescription opioids transition to heroin

Daubresse M, Chang H, Yu Y, Viswanathan S, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000 – 2010. Medical Care 2013; 51(10): 870-878

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

Naloxone is a medication designed to rapidly reverse opioid overdose. The number of prescriptions for naloxone doubled from 2017 to 2018.

https://www.cdc.gov/vitalsigns/naloxone/index.html?deliveryName=DM8022