Cognitive-Behavioral Therapy for Co-occurring Anxiety and Opioid Use Disorder in People with Chronic Pain

Opioid use disorder is associated with an elevated risk of most psychiatric disorders, as well as many health conditions. Among the most common co-occurring conditions are anxiety disorders and chronic pain. As opioids can provide potent relief of both negative affect and pain, the presence of these co-occurring conditions can complicate recovery from opioid use disorder. The objective of this chapter is to provide an overview of the co-occurrence of anxiety and pain among people with opioid use disorder and guidance on the application of cognitive-behavioral strategies for these conditions. Common mechanisms that can be targeted transdiagnostically are highlighted, as are possibilities for navigating potentially discrepant treatment elements (e.g., approach-oriented exposure techniques vs. avoidance-oriented environmental risk modification). Treatment principles are illustrated using with case examples of their application. Importantly, the treatment of this co-occurrence is understudies, and research on optimal treatment approaches for this population is needed.