Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Effectiveness of Cognitive Behavioral Therapy Combined with Gradual Tapering of Benzodiazepine Use on Anxiety in Men with Opioid Use Disorder: A Randomized Clinical Trial

Document Type : Original Article(s)

Authors
Farzaneh Ghorbanpour Ahmadsargourabi 1
Shahnam Abolghasemi 2
1 MSc, Department of Clinical Psychology, Tonkabon Azad University, Tonkabon, Iran
2 Associate Professor, Department of Clinical Psychology, Tonkabon Azad University, Tonkabon, Iran
10.48305/jims.v44.i854.0358
Abstract
Abstract
Background: Benzodiazepines are frequently prescribed for anxiety management in patients with Opioid Use Disorder (OUD); however, they often lead to subsequent pharmacological dependence themselves. The present study aimed to investigate the efficacy of Cognitive Behavioral Therapy (CBT) combined with a structured benzodiazepine taper on anxiety levels in male patients with OUD.
Methods: This semi-experimental study employed a randomized controlled clinical trial design with both experimental and control groups. The statistical population consisted of all male patients with OUD seeking treatment at an addiction cessation clinic in Nowshahr County in 2022. A purposive sample of 30 individuals was selected and randomly assigned to either the experimental group (n=15), which received combined CBT and a structured benzodiazepine taper, or the control group (n=15), which was managed with tapering alone. The research instrument was the standardized Beck Anxiety Inventory (BAI)(1988). The cognitive behavioral therapy, based on the Wildermuth (2008) treatment protocol, comprised 9 weekly 90-minute sessions. Data analysis was performed using Mixed Model Analysis of Variance (Mixed ANOVA) with repeated measures.
Findings: A significant reduction in anxiety levels was observed by the fourth week of the treatment period. Furthermore, anxiety scores demonstrated significant improvement at the post-test and follow-up assessments compared to the first month.
Conclusion: The results indicate the beneficial effect of Cognitive Behavioral Therapy as an adjunct to a structured benzodiazepine taper for treating anxiety in patients with OUD.
Keywords
Anti-Anxiety Agents
Benzodiazepines
Cognitive Behavioral Therapy
Methadone
Opiate Substitution Treatment
Opioid-Related Disorders
Subjects
1.     Larney S, Tran LT, Leung J, Santo T, Jr., Santomauro D, Hickman M, et al. All-Cause and cause-specific mortality among people using extramedical opioids: a systematic review and meta-analysis. JAMA Psychiatry 2020; 77(5): 493–502.
2.     Hoffman LA, Vilsaint CL, Kelly JF. Attitudes toward opioid use disorder pharmacotherapy among recovery community center attendees. J Subst Abuse Treat 2021; 131: 108464.
3.     Degenhardt L, Grebely J, Stone J, Hickman M, Vickerman P, Marshall BDL, et al. Global patterns of opioid use and dependence: harms to populations, interventions, and future action. Lancet 2019; 394(10208): 1560–79.
4.     Brandt J, Bressi J, Lê ML, Neal D, Cadogan C, Witt-Doerring J, et al. Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: an international scoping review. EClinicalMedicin 2024; 70: 102507.
5.     Archambault L, Jutras-Aswad D, Touré EH, Artunduaga AC, Roy S, Barbeau D, et al. Profiles of Patients with Opioid Use Disorders Presenting a History of Suicidal Ideations and Attempts. Psychiatr Q 2022; 93(2): 637–50.
6.     Stathopoulou G, Gold AK, Hoyt DL, Milligan M, Hearon BA, Otto MW. Does anxiety sensitivity predict addiction severity in opioid use disorder? Addict Behav 2021; 112: 106644.
7.     Parekh SV, Paniccia JE, Lebonville CL, Lysle DT. Dorsal hippocampal interleukin-1 signaling mediates heroin withdrawal-enhanced fear learning. Psychopharmacology (Berl) 2020; 237(12): 3653–64.
8.     Holen B, Shadrin AA, Icick R, Filiz TT, Hindley G, Rødevand L, et al. Genome-wide analyses reveal novel opioid use disorder loci and genetic overlap with schizophrenia, bipolar disorder, and major depression. Addict Biol 2023; 28(6): e13282.
9.     McHugh RK, Fitzmaurice GM, Votaw VR, Geyer RB, Ragnini K, Greenfield SF, et al. Cognitive behavioral therapy for anxiety and opioid use disorder: Development and pilot testing. J Subst Use Addict Treat 2024; 160: 209296.
10.  Matheson C, Vucic C, Dumbrell J, Robertson R, Ritchie T, Duncan C, et al. Clinical outcomes of benzodiazepine prescribing for people receiving opioid agonist treatment: a systematic review of the evidence. Pharmacy (Basel) 2024; 12(5): 152.
11.  Family HE, Vojt G, Poulter H, Bailey CP, Abdala Sheikh AP, Cavallo D, et al. A qualitative study of benzodiazepine/z-drug and opioid co-use patterns and overdose risk. Harm Reduct J 2025; 22(1): 24.
12.  Khantzian EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv Rev Psychiatry 1997; 4(5): 231–44.
13.  Meyer M, Gygli F, Westenberg JN, Schmid O, Strasser J, Lang UE, et al. Benzodiazepine use, quality of life and psychiatric symptom burden in oral and injectable opioid agonist treatment: a cross-sectional study. Addict Sci Clin Pract 2023; 18(1): 43.
14.  Chen KW, Berger CC, Forde DP, D'Adamo C, Weintraub E, Gandhi D. Benzodiazepine use and misuse among patients in a methadone program. BMC Psychiatry 2011; 11: 90.
15.  Arriaza N, Papuzinski C, Kirmayr M, Matta M, Aranda F, Stojanova J, et al. Efficacy of methadone for the management of postoperative pain in laparoscopic cholecystectomy: A randomized clinical trial. Medwave 2021; 21(2): e8135.
16.  Boen C, Ridley J, Hawley P. Methadone for Pain Management in Chemotherapy-Induced Peripheral Neuropathy: A Retrospective Review. J Pain Palliat Care Pharmacother 2024; 38(4): 345–54.
17.  Vandse R, Vacaru A, Propp D, Graf J, Sran JK, Pillai P. Retrospective Study of the Safety and Efficacy of Intraoperative Methadone for Pain Management in Patients Undergoing Elective Intracranial Surgery. World Neurosurg 2023; 175: e969–e75.
18.  Nakao M, Shirotsuki K, Sugaya N. Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. Biopsychosoc Med 2021; 15(1): 16.
19.  Martin S. Using values in cognitive and behavioral therapy: A bridge back to philosophy. J Eval Clin Pract 2023; 29(7): 1189–95.
20.  Cronin-Golomb A, McDaniels B, Mathur S, Pontone GM, Reynolds GO, Subramanian I. Using Principles of Cognitive Behavioral Therapy to Treat Anxiety in Parkinson's Disease. Mov Disord Clin Pract 2025; 12(7): 895–903.
21.  Soni A, Thiyagarajan A, Reeve J. Feasibility and effectiveness of deprescribing benzodiazepines and Z-drugs: systematic review and meta-analysis. Addiction 2023; 118(1): 7–16.
22.  Rossi R, Cutter CJ, Beitel M, Covelli M, Fiellin DA, Kerns RD, et al. Stepped Care for Patients to Optimize Whole Recovery (SC-POWR): An Effectiveness Trial Evaluating a Stepped Care Model for Individuals With Opioid Use Disorder and Chronic Pain. Subst Use Addctn J 2025; 46(1): 146–54.
23.  Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56(6): 893–7.
24.  Vøllestad J, Sivertsen B, Nielsen GH. Mindfulness-based stress reduction for patients with anxiety disorders: evaluation in a randomized controlled trial. Behav Res Ther 2011; 49(4): 281–8.
25.  Kaviani H, Mousavi AS. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI) [in Persian]. Tehran Univ Med J 2008; 66(2): 136-40.
26.  Knapp P, Beck AT. [Cognitive therapy: foundations, conceptual models, applications and research]. [in Portuguese]. Braz J Psychiatry 2008; 30 Suppl 2: s54-64.
Journal of Isfahan Medical School
Volume 44, Issue 854
2nd Week, May
May and June 2026
Pages 358-365

  • Receive Date 17 September 2025
  • Accept Date 15 April 2026