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Author ORCID Identifier


Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program


Year Degree Awarded


Month Degree Awarded


First Advisor

Lisa Chiodo

Second Advisor

Genevieve Chandler

Third Advisor

Daniel Gerber

Subject Categories

Social and Behavioral Sciences


In 2017, more than 70,000 people in the United States died due to drug overdoses; of that number, approximately 68% involved prescription or illicit opioids (CDC, 2019). Presently, insurance companies and physicians require all opioid use disorder (OUD) patients to receive counseling during medication treatment for OUD, despite the lack of evidence it is necessary for all patients. This requirement restricts access and creates hardship for those who may benefit from medication alone. In an effort to inform policy and improve quality of treatment, this nonexperimental, correlational study examined the relationship between individual counseling status and treatment outcomes in patients receiving medication treatment for OUD. Treatment outcome variables (treatment utilization, medication use, and opioid use) were extracted from the electronic health records of 11,551 adults who received treatment between January 2016 and January 2018. The impact of individual counseling on outcome variables was examined while controlling for confounding variables (gender, age, race, ethnicity, PTSD/trauma, anxiety, and criminal justice involvement). Bivariate analyses suggested women in OUD treatment were prone to have experienced PTSD/trauma and anxiety, while males were more likely to have CJS involvement. Women were more often retained in care and were in treatment for longer periods of time than males. In addition, older patients used OUD medication more often than younger patients; however, older patients were also more prone to use benzodiazepines and alcohol. Multivariate analyses revealed patients with increased rates of treatment utilization were more likely to utilize medication treatment and demonstrate reduced opioid use. In addition, higher rates of treatment utilization were related to reduced opioid use. Patients with more frequent interruptions in OUD treatment more often tested positive for opioids. This study revealed very little evidence that counseling during OUD treatment had a positive impact on treatment utilization. Yet, it found no evidence that counseling while active in treatment had an impact on medication utilization or opioid use. Although counseling may have some benefit for some patients in OUD treatment, these findings do not support mandating counseling during OUD treatment.


Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.