Basic Philosophy of Treatment

We believe it is important to address all issues of a client to the extent possible. Client willingness to work on these issues is critical. Areas addressed include: opiate/opioid and other substance and non-pharmacologic abuse/addiction problems; psychiatric and psychosocial (including sex/gender and spiritual/religious) issues and problems; general health issues, and chronic pain syndromes; social and vocational problems.

The initial goal of this opioid agonist treatment program is to move patients from an extremely dysfunctional pattern of psychological and physical opiate addiction and polydrug abuse to a managed opioid dependence that allows normal functioning and meaningful psychological treatment. In a later treatment phase, patients may be gradually withdrawn.

If clearly indicated, not simply on patient's request, patients may be medically withdrawn with short-term methadone or buprenorphine treatment, while being offered individual therapy, group therapy, ear acupuncture, and follow-up narcotic antagonist treatment, or they may be referred to a physician specialized in medical withdrawal, possibly using experimental approaches. If patients demand treatment that is not indicated, they are referred to other treatment centers.

In contrast to "recovering" drug users on no medication, patients in synthetic narcotic treatment programs may have lapses into substance abuse without relapse into addiction. A patient, while still physiologically dependent, can live an essentially normal life and should show little or no symptoms of addiction. This means there is little or no craving or withdrawal and the client has the ability to cope with withdrawal-like symptoms or fear of withdrawal. Patients should learn to deal with and prevent drug craving, and they are helped to develop strong, positive motivation for a drug-free, healthy life style. Relaxation, meditation, contemplation and self-hypnotic techniques are taught in groups, which are offered to all clients. Many younger patients, patients with a relatively short addiction history, and patients who functioned well in the past greatly benefit from an intensive style of treatment participation in the first few days and weeks of therapy. This helps to prevent development of a pattern of substance abuse while on methadone. The long-term goal for most patients is to accomplish slow medical withdrawal while showing no substance abuse behaviors, in addition to learning to cope with anxiety, depression, drug craving, and life stressors.

The treatment team's role is to help the patient clarify problems and goals, to show some caring while being appropriately confrontive. This is particularly important in the very early stage of treatment and during a crisis. In addition, the treatment team works to move the patient into active treatment when he/she is resistant but shows some signs of treatment readiness. Both general psychiatric and substance abuse problems are addressed in psychotherapy and in groups. Indicated psychotropic medications, mainly antidepressants, are prescribed by a psychiatrist of this clinic, unless the patient is presently treated by another psychiatrist. All additional addiction problems are addressed, particularly smoking. General health evaluations, teaching and referrals are important parts of treatment. Group approaches are preferred over individual teaching and counseling whenever possible. Significant others, including close friends, parents and older teenage children of patients, may participate in groups and other treatment. Counseling is primarily cognitive-behavioral and otherwise eclectic. Groups emphasize tertiary abuse prevention, understanding of psychological problems, dealing with stress, anxiety and mood disorders, and use of a wide range of self-help approaches. Spirituality is valued by many patients. However, it is recognized that 12-step self-help groups (AA, NA, CA, etc.) are very helpful to some, but not necessarily most, severely opiate-addicted persons. While emphasizing positive motivation and relapse prevention, we like to stress the methadone client's health rather than disease and slow recovery. Nurse-case managers often function to some degree as social workers and may make appropriate referrals for any type of problem.