I read with interest the story highlighted on today's Daily Dose - 'Tackling substance abuse in families'. Bruce Thomson starts by saying-
"Debate regarding the most appropriate ways to help people to get off drugs has resulted in what often seem to be polarised positions in favour of either methadone prescribing or abstinence-based interventions."This has long been the case in the substance misuse field - why it is so I'm not sure, as it is a pointless debate with both sides losing out. In my opinion the "extras" that usually come with abstinence based programs, i.e. counselling, fellowship groups, reflection/meditation groups, one to one/group therapy etc, are what make the difference.
Why aren't all of these "extra" interventions offered with methadone maintenance or reduction prescribing? I don't see any reasons why they couldn't fit together, in fact, I've worked in a project myself that offered this kind of methadone prescribing service, which was then reduced leading to abstinence as the final goal - with good success rates I'd like to add. To my knowledge this project is the only one of it's kind. It could work just as well with methadone maintenance for those wanting that.
I'd like to see the whole range of interventions being offered to prospective clients with a kind of self-selection (with professional guidance) of the particular services they'd like to have in their recovery program, kind of like choosing what subjects to take for your GCSE's! This way service users aren't being forced into doing something that they don't need just to get the services that will help them. Of course for this to happen there would need to be co-operation between different services throughout treatment, all governed by a new kind of direct access free service, doing the initial assessment, referrals and overseeing/supporting the clients throughout the whole process including the aftercare.
That would be my 'perfect world' answer to substance misuse! No black or white but black AND white - I think I'd call it 'The zebra intervention'!
1 comment:
In the USA, all clinics are obliged to offer counseling services along with methadone treatment, and many also offer referrals, group therapy, and other health services in addition to the medication. However,as you stated, it's not helpful to force people to accept treatment they do NOT want or need just to get the treatment they DO need, and that works both ways. Many long term MMT patients, who have long since resolved whatever social issues and problems accompanied them into treatment and who may now be living stable, fully functional lives, no longer require weekly counseling sessions or intensive group therapy--yet they are required to attend thses sessions for the rest of their lives in order to stay on methadone. Usually these sessions fall during the workday, requiring the patient to take time off work--sometimes an entire day, depending on the distance they must travel to the clinic (many must travel hundreds of miles round trip), for services they do not need or want.
Again, individualized treatment is what each patient needs and deserves.
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