Group Psychotherapy with Recovering Addicts

Buprenorphine Post
Posts: 49

Postby sdaviss » Mon Dec 22, 2003 12:33 pm

As with any other treatment, review the potential risks and benefits of weaning vs continued maintenance. What are the risks of relapse after wean? Is there a good support network if you relapse? If you did relapse, is this a good time in your life for that interruption? (eg, if you just got a new job/new relationship/new stressor, maybe now is not a good time to wean)

Sounds like you are doing a great job, trip!

=Steve Daviss MD
=GBMC, Baltimore

Posts: 5

Postby jrothmd » Mon Dec 22, 2003 12:33 pm

Bravo, trip! Thanks for offering hope for the sane cooperation between medicine and recovery. I can not say that I am surprised that the ones who go to meetings are the ones who stay clean consistently, since that is my experience as well. And I hope we can both be patient with the changes that take time, particularly the contempt prior to examination about the possibility of turning over the opiates to a physician as a legitimate way to work the program in NA and AA.

Posts: 19

Postby trip » Mon Dec 22, 2003 12:33 pm

I am a family doc, not trained to do group. In our county we have a system where one way to get on suboxone is to get screened by our drug and alcohol agency, get involved in a typical drug and alcohol counseling service, 2or 3 groups a week and see me. I start them on suboxone, and insist they start attending either NA or AA. Being a recovering addict myself I have the advantage of knowing what they are doing, are they going regularly, do they have a sponsor, do they call their sponsor etc.... Of the 30 patients I have right now, about 10 are staying clean consistently. The ones that go to meetings. Now I have to figure out when to wean them. Some of the NA hardliners dont think they are really clean on suboxone, I disagree. They believe they have to go through withdrawal once more. Heck all of them are heroin addicts and they spent 1/2 their using lives "dope sick". Any feedback welcome.

Posts: 5

Postby jrothmd » Mon Dec 22, 2003 12:33 pm

Thanks for your message, CPRx. The model I am hoping to develop would ideally include the patients on buprenorphine participating in a Twelve Step or other mutual help group that would not be professionally led. I believe that a therapy group of more standard size, about 8 members, could then be used to work with the patients on their resistances to joining and using such a group, and this same group could also be used to work on acheiving optimal dosing with medication.

Posts: 26

Postby CPRx » Mon Dec 22, 2003 12:33 pm

I appreciate jrothmd candor re group with NA folks. I wonder if running a group within the office practice would "count" for the psycho-social component that is supposed to be part of our therapeutic approach to the Bup patient. With a good moderator, and some time constraints, I don't see why all 20-30 patients could not attend one group meeting per week at the office in the evening with your senior most trusted suboxone or Buprenex patient running that group.

Posts: 5

Postby jrothmd » Mon Dec 22, 2003 12:33 pm

Thanks for your message, Jack. I have been conducting therapy groups for a long time, too, since 1978. I am currently doing ten groups a week with members in various forms and stages of recovery. I like the idea of having at least one experienced member in the group. One of the barriers I see in a model using buprenorphine is the split between the methadone treatment models and the Twelve Step models. The prejudice against replacement therapies creates a stigma about patients on buprenorphine participating fully in NA. I am hoping to interest some long time NA folks in doing Twelve Step work with some of these patients starting in treatment and recovery while on buprenorphine. The function of the group therapy then becomes supportive of the patients letting go of their resistance to accepting interpersonal support for sobriety (that includes maintenance use of buprenorphine.)

Posts: 15

Postby jack28nm » Mon Dec 22, 2003 12:33 pm

I ran two psychotherapy groups from about 1964 until about 1992. As time went on a higher and higher percentage were on medications. I no longer have enough "draw" for a group, but I think it is a highly successful and superior therapy. I think a buprenorphine group would be a good idea. I use my original buprenorphine patient like a consultant and have had him sit in with other patients, with their permission of course. He is older, mid-40s, so with his experience and my knowledge we have a stronger effect on those who are 25 to 35. I think a group could function in such a manner even better. I think the model would be similar to any group except you'd have one diagnosis in common. My only question is whether you have had training or experience doing group psychotherapy. Fortunately, I had training in Group during my residency. I aimed for 8 members meeting for 90-100 minutes. I once had 9 members briefly since I expected to discharge someone, but more than that is too many. Attendence rules are important. A group with less than six members no longer functions well as a group, but that is membership number, not attendance number.

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