The opioid crisis led to a large number of patients being rapidly tapered off their medications. Many patients were subjected to tapering had developed psychological and physical dependence to their medication but did not exhibit signs of frank addiction. The abrupt discontinuation, however, had unintended consequences, leading some to develop substance use disorders, experience higher levels of emotional distress, and, too often, attempt or complete suicide. The FDA and CDC cautioned prescribers about these potential outcomes and recommended use of supportive therapies to help make medication changes more successful. Conversely, some patients did meet criteria for opioid use disorder (OUD) and needed treatment for pain and their underlying substance use disorder. Cognitive behavioral therapy (CBT) is often viewed as the gold standard of treatment for pain and OUD, but many clinicians have limited awareness of the theoretical underpinnings of this model or how it is applied. This session will deconstruct CBT, reviewing its foundations, application, and the data supporting its use.
