By Alison Knopf
Many people have questions about the role of counseling in methadone maintenance treatment, sometimes suggesting that nothing is needed but the medication itself. The Substance Abuse and Mental Health Services Administration (SAMHSA), which certifies opioid treatment programs (OTPs), has long recommended counseling be part of treatment in an OTP. While SAMHSA does not “require” this in buprenorphine treatment provided outside an OTP, there are concerns that providing no counseling shortchanges the patient.
Many patients may not want counseling, and indeed, if they are long-term patients who are stable, they probably don’t need it. But new patients do.
What is it? According to SAMHSA, recommended focuses are:
- Providing support and guidance, especially to eliminate substance misuse
- Monitoring other problem behaviors
- Helping patients comply with OTP rules
- Identifying problems needing referral and extended services
- Identifying and removing treatment barriers
- Providing motivational enhancement
But standard components are basic:
- Identification of problems needing immediate attention (eg, homelessness)
- Help locating and joining mutual-help groups
- Education about addiction and effects of substance abuse
- Education about relapse-prevention strategies
- Information about stress- and time-management techniques
- Assistance in developing a healthy lifestyle (eg, exercise, good nutrition, smoking cessation, avoidance of risky sexual behaviors)
- Assistance in joining socially constructive groups (eg, community and faith-based organizations)
- Continuing education on health issues (eg, HIV/AIDS, hepatitis)
Types of Group Counseling in MAT
- Psychoeducational groups
- Skill-development groups (eg, relapse prevention, stress management, substance use cessation)
- Cognitive–behavioral groups
- Interpersonal-process groups
- Support groups
In fact, counseling, including helping patients find a place to live, is what differentiates OTP treatment from office-based outpatient treatment (OBOT). And many medical experts feel that OBOT patients deserve more than medication alone. Those with experience in the field already know that medication alone doesn’t work. There is no “magic pill.”
Facing Addiction in America: The Surgeon General’s Spotlight on Opioids, notes that individual counseling is better than group counseling. “Most studies support the use of individual counseling as an effective intervention for individuals with substance use disorders as part of MAT.” The report added that “Group counseling should primarily be used only in conjunction with individual counseling or other forms of individual therapy. Despite decades of research, it cannot be concluded that general group counseling is reliably effective in reducing substance use or related problems.”
However, charging the patient for counseling, if insurance doesn’t pay for it, may be a growing trend, especially among proprietary OTPs. Perhaps counseling could be reserved for patients who need it, and individualized. But the likelihood of new patients needing it the most is great.
The “dose-and-go” model doesn’t allow for counseling.
Finally, thinking of counseling as relating to psychological issues only is incorrect. Methadone isn’t a treatment for depression, and it’s not a treatment for HIV. By the time most patients show up at an OTP for treatment, they have many problems. Or they may be doing well and just need the medication. Someone needs to assess that.
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