Chapter 6 - Counselling and other services

Methadone Maintenance Treatment: Client Handbook

In this chapter:

Counselling services
The benefits of counselling
- Talking to your counsellor
- Group therapy
- Family therapy
Methadone Anonymous
Learning to live without drugs
What’ll I do if I don’t do drugs?

Counselling services

All methadone clients are encouraged to combine methadone treatment with counselling. Some people benefit enormously from the support, encouragement and guidance they get from counselling. It is generally accepted that methadone treatment with counselling is far more effective than methadone treatment alone.

The level of counselling services that are available through your methadone treatment can vary widely depending on your treatment provider. Some providers make counselling or group therapy participation a condition of receiving methadone. Others may or may not provide counselling, and leave it up to clients to decide whether or not they wish to seek out counselling services.

Counselling may be supplied by a drug treatment counsellor or a social worker, or you may be counselled by your doctor. The level of training and expertise of counsellors can vary widely, from those who can tell you where to find food banks and hostels, to those who are able to treat complex psychological problems. Be sure to discuss your counselling needs with your treatment provider to see if you need a referral to outside services.

Other services available in conjunction with your methadone treatment vary depending on where you go:

If you have your methadone prescribed by your doctor and go to your local pharmacy to take your dose, services in addition to medical counselling will depend on your doctor.
Methadone clinics offer a variety of additional services. Counselling services are standard. Other services may include advocacy on your behalf with welfare and children’s aid, legal, medical and dentistry services, housing services and needle exchange. Some clinics provide a resource area or a community space for clients to drop in and spend time.
Many short- or long-term residential treatment centres and therapeutic communities are abstinence-based, but more and more are accepting residents in methadone treatment. The services offered by these facilities vary depending on the program.

The benefits of counselling

It’s accepted wisdom that talking out your problems with someone you trust can help to make things clearer, simpler and easier to solve.

Most often the person you trust is a friend or family member. This is the person you call when you want help or advice. This is the person who listens. If you have someone like this in your life, someone who can offer you support, you may be more fortunate than you know. Strong personal relationships give emotional strength, and you need that strength to learn to live without drugs.

Even if you have a good friend, it is still a good idea to seek out the services of a qualified counsellor. Your friend may be wise in many ways, but he or she may not know how to help you in your struggle with drugs. Sometimes your friend may be too close and too involved to be able to see clearly. You need someone from outside, someone who can listen and give you back a clear reflection of what’s really going on. Find a counsellor with experience in helping people in your situation.

Having the services of a good counsellor can also help to ensure that you keep your good friend. If you’re trying to get through a difficult time in your life, you may be looking to your friend for help a little too often. You may not be able to offer much in return. You can avoid stressing your relationship by laying the heavy stuff on your counsellor. Your counsellor’s job is to listen, to understand, and to help you learn how to solve your problems for yourself.

Talking to your counsellor

You may find it difficult to open up and trust your counsellor at first. He or she understands that, and is willing to help you at whatever level you need. To begin with, you might need help to find a better place to live, to get a job, to get through court, to get your kids back, or to get into school. When you’re ready, you’ll be encouraged to talk about your drug use.

As you progress in counselling, you should find it easier to relax and open up. Your counsellor is not going to judge you for what you have or haven’t done. Your counsellor’s job is to understand and, more importantly, to help you understand why you use drugs. You’ll talk about what will happen if you continue to use, and what will happen if you stop. You’ll talk about taking responsibility for your drug use, and for the things you may have done to get the money to pay for drugs. You’ll talk about making a future plan.

Counselling is sometimes optional, but the success of your treatment may depend on it.

“My counsellor has been a solid force in trying to get to the bottom of my using. She never gives up on me. She makes me feel worthwhile, and her confidence in me really helps.” — Bonnee, 43, on methadone two years.

“Talk to your doctor and therapist. Don’t listen to what you hear from other clients. The staff is understanding of the pressures and problems you have, and are always there to listen. The counselling programs are very helpful.

“Take it one day at a time.” — Jalima, 30, on methadone three years.

“I changed counsellors because the one I had was inexperienced with drug problems. I had to seek out professional therapeutic help. I found someone who is empathetic and good, whom I continue to see regularly. After a few months of coming to him I was able to see the root of my problems. I’d needed that insight for 30 years.” — Janet, 46, on methadone four years.

Group therapy

In addition to individual counselling, you may want participate in group therapy. This usually involves sharing your experiences with others who are seeking help for problems similar to your own. Some methadone providers require that you participate in group therapy in order to receive treatment.

Family therapy

Depending on your situation, involving your family in counselling can be very helpful in overcoming a drug problem. Your family needs to understand why you use drugs and how they can help you to stop using. Family therapy can also help you to understand the other members of your family, and what support you can expect from them.

Methadone Anonymous

Methadone Anonymous is based on the same 12-step program and meeting format as Narcotics Anonymous and Alcoholics Anonymous. The emphasis of all the 12-step programs is on achieving a desire to stop using drugs, spiritual growth, honesty and helping others help themselves.

At an MA meeting, all members are methadone clients. Talking with others who are dealing with their drug dependence in the same way can offer an understanding that may not be available from family and friends. Meetings include the opportunity to share experiences with other group members.

MA groups are still rare in Ontario. To find out if there is an MA group in your community, check with your doctor or counsellor. For more information, check out Methadone Anonymous on the web at http://www.methadone-anonymous.org.

“I never feel like going out to the meetings, but when I get there I’m always glad I came. Sometimes, you know, my wife doesn’t understand, so it’s good to talk with other addicts. The group helps each other. It works for me, I’ve been off drugs now for three years, and I tell ya, the only time I stayed straight before was when I was in jail. When I was out, I’d take maybe 70 Tylenol 3 and 10 Percodans a day, plus, I was a drunk. A skid row drunk. I’m straight now because of the meetings. It works for me, and it could work for anybody.” — Dan, 45, on methadone four years.

Learning to live without drugs

Few people can stop using drugs overnight just because they decide they want to quit. For most, it is an ongoing process that takes time, patience and determination. You may have to learn a whole new way of living.

Say, for example, you wanted to learn to play the guitar. You know you’d have to practise many, many hours before you were any good. You’d have to learn the chords and listen to the great players. A good teacher could really help. As you got better, there would be moments of reward, like when a difficult chord change got easier, and sounded so good. If you already play guitar, or any instrument, or if you do any sport, or art, you know what it took to get you to be as good as you are. You know what it will take to get better.

Becoming great at anything takes time, patience and determination. You can become great at not using drugs. Make your decision and follow through. Don’t be afraid to ask for help when you need it. The more you practise living without drugs, the better you’ll get at it. Someday it will just be a part of what you are and what you do, like playing guitar or cooking supper or driving a car. You won’t need help any more. You may even be able to offer help to others. It will get easier.

“For me the ‘harm reduction’ approach really worked. I could continue to use until I was ready to quit, and could stay on the program. I used heroin for 29 years. I’ve been clean for four-and-a-half years. I now have a future to work towards. I no longer have the fear that I could die any time, any where, any day – alone. I have my life back.

“My advice to those coming onto methadone is this: If you fail, don’t punish yourself, just try again.” — Sharon, 46, on methadone five years.

“The biggest problem people face is not actually the drugs themselves, but trying to find ways to spend time. By the time people go on methadone, they’ve lost their friends and the only people they have left are their “drug buddies,” and they don’t want to hang out with them. So they are alone trying to find ways to have fun but they are so used to their routine that they are now trying to stay away from that they have no idea of things to do.” — Laura, 22, on methadone one year.

What’ll I do if I don’t do drugs?

Doing drugs can fill up your day. It’s a busy life: getting the cash, finding your dealer and getting high. Drugs can be a reason to get up and go out. They can offer an identity, a lifestyle, a career. Drugs can block out the past, and stand in the way of planning for what’s ahead. When you go on methadone and you stop doing other drugs, the days will open up. You’ll be able to choose from a variety of possibilities of what you might do with your time. Drugs won’t decide it for you.

The surprising thing is, this newfound freedom can be hard to adjust to. For some, the time is easily filled and welcome. This may be the chance to get back to school or to get ahead in your work. If you have small children, your days can fly by taking care of them. Others may need to search harder to fill the gap that drugs have left. You need to learn new ways to spend your day. If your day is empty, you may think you’re bored, and that drugs would make your life more interesting. When you learn to jump over that trap, your life becomes more your own.

Having things you want to do with your time, that you enjoy, that you take pride in, and that make you feel good about yourself can be a great motivator to staying off drugs. Getting out to get your methadone takes up a chunk of the day, but it still gives you plenty of time to get into something else. If it seems like everyone else is busy and you’re left with nothing to do, take that time to work out what you want to do. Talk it over with your family, your friends, your counsellor. And while you’re thinking about it, keep busy. Don’t give yourself time to get high. Be creative, be productive. Fill up your life with things you love that can love you back, and make no time for drugs.

“Got a job, went back to school, got a better job. You’ve got to quit the life, not just the dope. Maintenance allows you to adjust slowly to life without heroin, and eventually drugs. My life is normal now. I only have boredom to fight.” — Spacey, 30, on methadone six years.

“Channel the energy you used to use to support your habit into positive things. If you’re at all religious, even if you never thought of it while addicted, open yourself to spiritual ways. It’s the most powerful source of strength that’s out there, and it’s free.” — Janet, 46, on methadone four years.