Counseling and Addiction

Kicking the prescription drug abuse habit -- or any other addiction -- is a major accomplishment. But for most people with opioid addiction, detox is only the beginning of a long-term battle against craving and relapse.

Counseling is an essential part of drug abuse treatment for many people. Cognitive behavioral therapy, family counseling, and other therapy approaches can help people recovering from opioid addiction stay clean. Psychotherapy can also treat the other mental health conditions that often contribute to prescription drug abuse.

Why Counseling Is Important in Addiction Treatment

Opioid addiction is more than a physical dependence on drugs. Even after detox, when physical dependence has resolved, addicts are at high risk for relapse. Psychological and social factors are often powerful stimuli for prescription drug abuse relapse:

  • Stress, especially sudden life stresses
  • Cues in the environment, like visiting a neighborhood
  • Social networks, like spending time with friends who continue to use drugs

These factors can create ongoing, nearly irresistible urges to use drugs. Prescription drug abuse counseling helps addicts escape craving and learn to cope with life, without using drugs.

Several counseling therapies are available for prescription drug abuse, and no one established method is known to be better than another. Likewise, no one approach is appropriate for everyone with opiate addiction. The right drug abuse treatment plan is tailored to a person's addiction and his or her individual needs.

Individual vs. Group Therapy

While any counseling therapy for drug abuse treatment is better than none, group therapy is generally preferred over individual therapy. In group therapy, a person is more likely to be both challenged and supported by peers who are also going through drug rehab. Twelve-step programs such as Narcotics Anonymous are peer support groups (not led by a trained psychotherapist and, thus, not the same as group therapy) that can be a useful part of a recovery program.

Individual therapy can be helpful in the case of a dual diagnosis: coexisting depression, bipolar disorder, or other significant mental health condition that requires treatment in its own right, separate from the opioid addiction.

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Outpatient vs. Residential Treatment

Residential therapy separates the addicted person from the environment that allowed him or her to use drugs, and teaches new habits or skills for sober living. A person goes away to a specialized facility for a period of weeks to months. While highly effective in the short term, there is debate as to whether residential programs lead to longer abstinence from prescription drug abuse than outpatient programs. Relapse is often higher if someone then goes back to a home environment where opportunities to resume drug use are in easy reach. Residential drug abuse treatment programs are expensive, usually costing tens of thousands of dollars and are not always covered by commercial insurance plans.

Outpatient treatment programs are the usual setting for ongoing prescription drug abuse treatment.

Cognitive Behavioral Therapy

Cognitive behavioral therapy -- or CBT -- teaches a person how to recognize moods, thoughts, and situations that stimulate drug craving. A therapist helps the person avoid these triggers, and replace negative thoughts and feelings with healthier ones that are more consistent with sobriety.

The skills learned in cognitive behavioral therapy can last a lifetime, making it a potentially powerful method of drug abuse treatment. However, not all therapists are trained in cognitive behavioral therapy techniques, which can be complex.

Contingency Management Therapy

In contingency management therapy, a person in drug abuse treatment receives positive incentives for staying clean. Vouchers for goods and services, or privileges in a more rigid treatment setting are common incentives. Contingency management therapy is effective in drug rehab studies. But skeptics point out its high costs, and that when incentives stop, its positive effects decline.

Motivational Interviewing

Traditional therapies for drug abuse treatment involved confrontation. Addicts are masters of denial, the thinking went, and therapy should break down walls to force them to accept the reality of their addiction.

While confrontation may still have a role, many therapists instead promote motivational interviewing, a newer counseling method. In motivational interviewing, a therapist seeks to understand and enhance an addicted person's natural motivation for change. For example, if the person reveals he is motivated by love of his family, or returning to work, these may become the focus of therapy.

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Couples and Family Therapy

Prescription drug abuse and opioid addiction don't only affect the user's life; the whole family is transformed. Strong relationships with family and friends are essential for successful drug abuse treatment. Various counseling methods include the spouse and other family members of the addicted person.

There are several potential benefits of family or couples therapy:

  • Family members can act as a powerful force for change in the addicted person's life.
  • Including family members can increase the likelihood a person will stay in therapy.
  • Each family member can begin to heal the damage their loved one's addiction has caused in their own life.

Studies show family therapy results in lower relapse rates, increased happiness in the family, and better functioning in children of addicted parents.

Maintenance Therapy

Most experts today consider opioid addiction to be a chronic, relapsing illness. Just like other chronic illnesses such as diabetes or high blood pressure, opioid addiction treatment in some form must be lifelong.

Many people with opioid addiction will continue to take maintenance therapy. A form of buprenorphine (Probuphine) is now available as an implant under the skin for preventing a relapse of opioid dependence. It provides a constant dose of buprenorphine for six months and can be used by people who have completed acute detoxification and are already maintained on a stable dose of oral buprenorphine. Other medications include methadone, naltrexone (which blocks opiate receptors and prevents opiates from causing a high) or Suboxone (buprenorphine/naloxone) -- medications that are sometimes taken for many years in order to minimize relapse risk. By the same token, experts say, they should also continue some form of counseling.

The idea of long-term, open-ended treatment runs counter to the one-time view that a person was likely "cured" in a relatively short time after attending a drug rehab program. However, evidence is mounting that lifelong treatment with maintenance medication along with counseling or therapy should be standard drug abuse treatment for most people with relapsing opioid addiction.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on July 16, 2016

Sources

SOURCES:
Carroll, K.M. American Journal of Psychiatry, 2005.
Dennis, M. Addiction Science & Clinical Practice, December 2007.
FDA. "FDA approves first buprenorphine implant for treatment of opioid dependence."
Harvard Mental Health Letter, "Treating opiate addiction, part II: Alternatives to maintenance," January 2005.
Medline Plus: "Opiate withdrawal."
Narcotics Anonymous web site.
National Institute on Drug Abuse, "Treatment Approaches for Drug Addiction."
National Library of Medicine, "Estimating the Client Costs of Addiction Treatment: First Findings from the Client DATCAP."
O'Brien, C. The Journal of the American Medical Association, 2008.
Van den Brink, W. Canadian Journal of Psychiatry, 2006.

 

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