“John” (not his real name) described his use of opioids and heroin as an attempt to fill an empty hole inside himself. As his misuse of opioids and other illicit substances increased, the hole never seemed to get any smaller and on some days it felt bigger. Today, after ten years in recovery, “John” no longer feels consumed by that empty hole in himself and instead has discovered how his personal goals, relationships and spiritual beliefs have allowed that hole to be filled. “John” believes that his ability to overcome opioid use disorder required two crucial elements – support with a Medication Assisted Treatment program and access to counseling to understand himself better and learn to take responsibility for his own actions.
In the case of OTPs (Outpatient Treatment Programs) who are prescribing methadone, access to onsite counseling services is a requirement of the OTP. For programs who are prescribing buprenorphine or suboxone, onsite counseling services are not required, but assistance with identifying available counseling services in the area must be part of the program. The combination of Medication Assisted Treatment and counseling has shown to be most effective in helping individuals with opioid use disorder achieve long term recovery.
The Substance Abuse and Mental Health Services Administration (SAMHSA) highlights the following as key benefits of counseling as a supplement to MAT.
”Dedicated counseling can help clients address the challenges of extended recovery. For clients who seek a self-directed, purposeful life, counseling can help them:
Improve problem-solving and interpersonal skills.
Find incentives for reduced use and abstinence.
Build a set of techniques to resist drug use.
Replace drug use with constructive, rewarding activities.”
Counseling is especially effective when the counselor has specialized training in addiction counseling and treatment. With these specialized credentials the counselor has the background and understanding of underlying conditions and past experiences that may have contributed to the substance use disorder. The counselor is equipped with resources and suggestions for where the person might go for additional support whether through a 12-Step program, counseling group or faith-based organization.
A key role of the counselor is helping the newly recovering person develop coping strategies for dealing with stress and daily challenges. The counselor can also provide guidance on building or rebuilding relationships with family members or friends. Dealing with conflict at work is another area where the counselor can offer tools and techniques for appropriate responses and processes for handling conflicts in a professional manner. Most importantly, the counselor listens without judgment and acknowledges the feelings that the newly recovering person may be experiencing.
In some instances, the counselor may encourage the family to be part of the counseling experience, with the permission of the newly recovering person. The counselor can help the family understand opioid use disorder (OUD) and educate them on MAT (medication assisted treatment). Family members may need a safe space to express their frustration at past events with the person suffering from OUD and the counselor can provide this safe space. The counselor may also encourage family members to remember positive past experiences with the individual as well. If the family would benefit from support groups or other resources, the counselor can offer suggestions.
Group counseling may be a consideration for individuals receiving MAT. Being part of a group can provide a setting where others have shared experiences. Many times, people receiving MAT may feel isolated and group counseling can help them know they are not alone in their journey. The group can provide a support community where they learn accountability to others and have an opportunity to practice new skills in difficult situations and when faced with difficult emotions. The presence of others in the group allows each person to hear different perspectives and views.
Counseling offers the person newly in recovery the chance to understand their own moods, triggers, and reactions. A personal commitment to participating fully in counseling can help you replace negative thoughts with positive ones and help you take responsibility for your past actions while rebuilding relationships with family and friends. Counseling provides the opportunity to be listened to – and heard.
TIP 63: Medications for Opioid Use Disorder, SAMHSA