Galantamine and CBT4CBT Pilot to Prevent Relapse.

Inclusion Criteria

• Are male and females, between the ages of 18 and 65
• Are enrolled in the APT methadone or buprenorphine program, have been stabilized for at least one year, and who voluntarily wish to taper off MAT.
• For women of child-bearing age, have a negative serum pregnancy test at screening, agree to adequate contraception to prevent pregnancy, and agree to have monthly urine pregnancy tests at the clinic.
• Are fluent in English and have a 6th grade or higher reading level.
• Can commit to at least 12 weeks of treatment and are willing to be randomized to treatment

Exclusion Criteria

• Are undergoing administrative (non-voluntary) tapering (e.g., example due to non-payment of program fees, program rule infractions).
• Meet DSM-V psychiatric classifications for lifetime schizophrenia or bipolar disorder, or have a depressive or anxiety disorder with current use of a prescribed psychotropic medication that cannot be discontinued;
• Current DSM-V diagnosis of drug or alcohol use disorder (other than opioids or tobacco);
• Demonstrate significant medical conditions, including asthma or chronic obstructive lung disease, history or current gastrointestinal ulcer, hepatic or renal impairment and cardiac rhythm disturbances or any other medical conditions that the study physician deems contraindicated for galantamine treatment;
• Use of other medications including a) drugs that slow heart rate (e.g., beta-blockers),which may increase the risk of bradycardia and AV block and b) NSAIDs; increased potential for developing ulcers/active or occult gastrointestinal bleeding;
• Have a screening liver function test (AST or ALT) greater than 3 times normal;
• Known allergy or adverse reaction to galantamine