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Is Counseling Really
Necessary with Buprenorphine Treatment?
Ideally, Buprenorphine care includes
medication, doctor visits and counseling.
Studies such
as those done by A. T. McClellan1 and
David Fiellin, MD2, have shown that
people with
opioid addiction do better with counseling
and agonist therapy than those who
receive
medication alone. One barrier often
identified by prescribing physicians
in the primary
care setting is the inability to meet
the counseling needs of the patient.
There are no clear
guidelines as to type or amount of
counseling needed. The work being done
at Yale will
ultimately provide a reproducible manual
for counseling using the Cognitive
Behavioral 12-step informed counseling
approach to treatment which can be
used by nurses who
are already accustomed to patient education.
The cost of seeing a psychologist or
psychiatrist may be out of reach for
many, yet no counseling is less than
optimum when
new behaviors and relapse prevention
are crucial to maintaining abstinence.
When
available, individual counseling sessions
and group sessions with drug counselors
are
always a viable option.
Michael Pantalon, PhD,
and David Fiellin, MD, at Yale University
developed the medically focused Cognitive
Behavioral 12-step informed counseling
approach to
treatment. Pantalon describes it as “An
approach to daily life as an addicted
person, based
on now strategies for abstinence. The
patient and nurse counselor work collaboratively
to
identify triggers and alternative responses
to establish abstinence based lifestyle.”
Although not a panacea
for treatment, especially for the dually
diagnosed, patients
who object to counseling in general
may find this method compatible because
it doesn’t
probe emotional traumas. The focus
is on the patient’s strongest
motivators not on a
higher power. This alternative is empowering
for those who find NA’s format
of publicly
confessing personal character flaws
to be self defeating. Pantalon says, “Patients
need to
remember that counseling is not a forever
commitment. The patient who doesn’t
plan for
abstinence is in effect planning to
relapse. People need to know there
are options outside
of NA, AA and psychotherapy. As prolonged
abstinence is achieved, visits usually
decrease
over time.” – Kathleen
Gargano, RN
1 McLellan, A.T., I.O.
Arndt, et al. (1993). The effects of
psychosocial services in substance
abuse treatment.
JAMA 269 (15): 1953-1959
2 Pantalon, M.V.; Fiellin, D.A.; O’Connor.
P.G.; Charwarski, M.C.; Pakes, J.R.,
and Schottenfeld, R.S.
Counseling requirements for Buprenorphine
Maintenance in Primary Care: Lessons
Learned from a Preliminary
Study in a Methadone Maintenance Program.
Addictive Disorders and their Treatment
2004; 3: 71-76.
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| The
NAABT discussion board has evolved into
an adjunct to traditional counseling
and support groups. Besides 24/7 access
and the world wide potential for people
with
similar experiences, it offers something
new, “Anonymous Group Therapy” many
of
the benefits of a group while maintaining
anonymity. It’s also serves as
a nonintimidating
first step toward recovery. It allows
someone exposure to many view
points and often sparks passionate debates.
Ultimately it has the ability to inspire
people to better educate themselves about
their treatment, which leads to realistic
patient expectations and thus better
outcomes. |
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Mike,
a member of the NAABT discussion
board, took his topic “Counseling
with
Buprenorphine Treatment” and
synthesized it into an article for
us. The full topic and
ensuing discussion can be found by
following this link:
http://www.naabt.org/forum/topic.asp?TOPIC_ID=808
Buprenorphine
Treatment Counseling. When I first started counseling
I viewed it as a penance, a necessary
inconvenience that I needed to get
through, as
punishment for my addiction. I sat
through it and got very little out
of it, due to this
attitude. It wasn’t until I started
looking at it as a way to make my life
better, and began
to proactively manage and direct my
treatment, that I started to make progress.
This
required an increase in my self esteem.
I didn’t have cravings,
or triggers, so there was no motivation
to dwell on that then,
I needed to rebuild my self esteem,
to allow me to repair the rest of my
life. Employment
counseling, financial counseling, family
counseling, general life planning,
and doing
“non-addict” things is
what helped me. I wanted to act and
do things like a “normal
person” with an illness and not
be labeled a “recovering addict”.
Whenever I talked with
someone I didn’t say “I
am a recovering addict”, I said
my “addiction is in remission” if
I was pressed to answer at all. It’s
a little thing, but it reminded me
that I had a medical
condition, and helped me feel better
about myself and view my treatment
as positive.
I saw my medication as a tool, not
a crutch.
In my opinion, counseling
needs are different with Buprenorphine
Treatment (BT).
With most addiction counseling, cravings,
relapse, and dealing with triggers,
are the
main issues. With BT those things virtually
vanished almost immediately for me.
I could
start to work on the other things,
the main issues, the original issues,
right away. Then
when tapering off, developing tools
to deal with cravings and triggers
became useful.
Sarah, another member
offered this view:
http://naabt.org/forum/topic.asp?TOPIC_ID=891
Should
I stay with the same counselor long
term? When I met
my first addiction counselor I was
at my lowest point. First impressions
must account for
something even with experienced counselors.
As the next couple of months went by,
with
the help of the counselor and my treatment
I got back to normal. For me, drugs
were a
brief detour in my life and now that
I was back to normal I felt much better.
It might be just
my imagination but I felt my counselor
saw me as that person who first entered
treatment
and all of my improvement, was a direct
result of the counseling, instead of
a return to
normal. I think my counselor felt I
had tendency to revert back to that
low state, since she
saw that as my “normal” when
in reality my “normal” was
drug free and the drug use was
only a temporary deviation. It’s
hard to put my finger on it but a slight
condescending tone
and the focus on consequences of drug
use, makes me think she saw my normal
state as
the one she met that first day of treatment,
and that really isn’t who I am.
I decided to get a new
counselor whose first impression of
me was more accurate, who
understood that my drug use was only
a temporary detour. That worked wonderfully,
I was
able to focus on my current issues
and felt I had the respect of my counselor
who seemed
to know and understand me better. I
have since ended counseling, but if
I have the need in
the future I will have no problem seeking
it again.
I don’t know if my reasoning
was correct, but if anyone finds they
are hitting-the-wall
with counseling, it may not be the
counseling, but the match between you
and your
counselor may no longer be the best
match. Please don’t give up on
counseling, but try to
find another counselor that better
understands and respects you. |
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 |
| For
updates on the 30 limit restriction
see:
http://naabt.org/30_patient_limit.cfm
4,442
physicians on the SAMHSA
physician locator nationwide.
(Ability to treat 133,260 of the
4,500,000 estimated in need.)
If you
are a certified physician please be
sure your information is correct on
the
locator. Please check for spelling
and
correct phone number. If you know of
a
colleague who is on the list but should
not be due to no longer practicing,
please advise. 1-866-287-2728
info@buprenorphine.samhsa.gov |
 |
BuprenorphineCME.com
is now an official
buprenorphine training program that
satisfies the SAMHSA training requirement
for a DATA 2000 physician waiver.
Physicians can take the 12 courses on
BuprenorphineCME.com to qualify for
their waiver to prescribe buprenorphine.
ASAM DATA-2000 Qualifying Training
Program Earn – up to 8 hours AMA
PRA
Category I Credit.
http://www.buprenorphinecme.com
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PCSS releases
clinical guidelines for
buprenorphine treatment concerning,
Acute pain, liver function testing, Billing,
Pregnancy, and Management of
psychiatric medications. See: PCSS
Resources at
http://www.pcssmentor.org/
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In
addition to Connecticut, the Patient-
Physician Matching System is now available
in Maryland, Washington DC, and the
greater Atlanta and Pittsburgh areas.
Patients in these locations now have
an additional way to connect with a
certified physician. Click Patient/Doctor
Connection at naabt.org |
 |
• Patient
expectations
• Damage due to stigma |
 |
The
Physician Locator (Doctor/Patient
button) sorts physicians
by distance in geographic proximity,
regardless of city, town, county,
or state borders.
Click
here to try it for yourself.
Current Newsletters are
available at the naabt.org homepage.
Past editions are available as PDF
files on our Literature
page, under Other Literature. |
| |
Disclosure: NAABT, Inc. has accepted funding
from Reckitt Benckiser (Richmond, VA,
pharmaceutical company that manufactures
buprenorphine products) in the form
of an“Unrestricted Educational
Grant.” The
grant
is “unrestricted” so that
there are no “strings”
attached. NAABT, Inc. has complete
control
over how the funds are used, there
are no
restrictions on the content or mission
of this
site, and Reckitt has no control over
the
content of the site or NAABT’s
activities.
Reckitt is currently the only FDA approved
maker of a buprenorphine based product
for
addiction. NAABT, Inc. is not affiliated
with
Reckitt Benckiser.
Click
here to learn
more about NAABT. |
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