25 Nov Methadone Without Counseling is a Recipe for Relapse
Recent research has emerged that indicates that methadone treatment for opiate addiction doesn’t need to be combined with counseling in order to be effective. The Federal Government currently mandates that anybody receiving methadone must also be receiving counseling, with only interim methadone treatment being available without additional treatment. This is highly restricted, which leaves many addicts on long waiting lists for standard treatment. Although this is far from ideal, prescribing methadone without counseling does nothing to address the underlying issues, which often contribute to addiction. There are numerous good points on both sides of this debate, so any calls for a change to current legislation need to be thoroughly evaluated before they’re implemented.
How Does Methadone Treatment Work?
Methadone is essentially a substitute treatment that is used to manage the symptoms of opiate withdrawal. The unpleasant, flu-like symptoms of opiate withdrawal encourage addicts to start using again. They know that if they take a hydrocodone or have some heroin, the symptoms will disappear, which makes getting clean much more difficult. By stimulating the required centers in the brain without causing the same “high” (euphoric effects) as illicit drugs, methadone makes it easier to tackle the problem and ultimately get clean.
The substitute drug also carries its own withdrawal, however, so the general approach is to lower the dosage gradually. Addicts transition from other opiates to methadone and are then gradually weaned until they aren’t taking opiates at all. Traditionally, this allows time for other methods of treatment, such as counseling, to tackle the deep-seated issues, which caused the individual to become addicted in the first place. Only by addressing these issues can a person stay clean and overcome their everyday “triggers” to use drugs. This approach is the standard methadone treatment program.
The interim counterpart to the ordinary program offers methadone to reduce the symptoms of withdrawal without offering ongoing psychological support. Counseling is available for emergencies, but there is no regular meeting with a professional to discuss the contributing issues for the individual. This is currently only provided on an interim basis, meaning it is a transitory period until the standard program becomes available.
A randomized trial has been conducted which compared two different methadone treatment programs, one for interim treatment and another for the standard approach. The groups had the same dosing regimen, but the interim group only received treatment for four months and had at least three tests for illegal drugs. The standard treatment group also had weekly counseling and more frequent drug tests. There was a third group, whose counselors had smaller caseloads and therefore could devote more attention to each patient.
They found that there was no difference between the groups in retention of patients, drug use and related issues or crime after four months. The researchers suggested that by making interim programs more widely available, the government would help more addicts get into treatment without lengthy waiting lists. The latest review was at one year, and there was still no significant difference between the groups. However, the researchers only conclude that lack of counseling services shouldn’t be a barrier to the provision of treatment for the first four months.
The reason that counseling is still required by law, and that researchers with contrary findings still only advise interim treatment for four months, is because addiction is a complex issue. Most people know and accept that there are several contributing factors in most cases of addiction, whether it’s problems with stress management, peer pressure, depression, or substance abusing parents. There is also the potential of a genetic link for susceptibility to addiction, which means that affected individuals will obviously need extra help.
The psychological elements of addiction still need to be addressed. Methadone treatment is a purely physical treatment, and the physical effects of drugs arise with addiction. It’s important to remember that in order to become addicted a person still has to start taking drugs initially, and then continue until the point where tolerance occurs. The things that drove the person to do this in the first place cannot be addressed by simply reducing the physical cravings with methadone. Despite the positive results of research as to the efficacy of interim methadone treatment, there is no denying that the problem isn’t entirely a physical one. Leaving anything unaddressed opens a door for relapse.
It’s evident that although relatively short-term studies have shown no major difference between standard and interim forms of methadone treatment, there are obviously marked advantages to counseling, particularly in identifying the underlying causes of the problem. Simply throwing substitute drugs at people isn’t going to help them institute a lasting change in their lives, and assuming they can tackle their own problems without additional support is misguided. Proper therapy makes it much easier to institute lasting changes.
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