In reviewing the manuscript for "Navigating the Methadone Maze: A Guide for Patients and Professionals," by William Santoro, M.D., I had some concerns about the quality of counseling in Methadone Maintenance Treatment (MMT).
Tip 1
Even if taking a Harm Reduction approach, don’t give up on helping the client move in the right direction.
The rationale for continuing MMT while the client still uses other substances seems to be, understandably, that it is better to continue the MMT indefinitely than to have a person overdose and die. While I agree with that, it seems to me that the team should then decide:
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Which people are they going to designate as harm reduction patients where the focus will be more on medication adherence than counseling?
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Which people are they going to really try to attract into recovery; continue the methadone, but be free of other drugs?
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This would require careful assessment and motivational enhancement work involving family or significant others as well as accountable, shared decision-making, individualized treatment planning and outcomes monitoring in real time.
This is how Bill Santoro, M.D., responded when I raised my concerns about the quality of counseling in many MMT programs: “I am thinking I will... get across the point that counseling should NOT be done just to check the regulation box. It should be used for growth and development. And even if it is used for harm reduction, a constant guidance to try to have the patient move in the right direction is still beneficial.”
Tip 2
Help MMT clients to start with just one “day-at-a-time” goal.
Bill:
"I was a family physician for more than 30 years, but my journey into Addiction Medicine began unexpectedly early in my career when I covered for a colleague on vacation. I met a patient who completed the following sentence: 'JUST FOR TODAY… I want to not trade sex for drugs.'; This was not a long-term goal — it was a desperate hope for just one day.
“That single sentence convinced me that I needed to help more people like her. I included addiction medicine in my everyday practice of family medicine, and it gradually grew until I did nothing but addiction medicine.”
Doing recovery “one day at a time” applies not only to MMT, but to all addiction and mental health treatment. It actually is relevant for all behavior change, which can seem like an unsurmountable task and journey.
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How do you eat an elephant? One bite at a time!
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Authored by Dr. David Mee-Lee, “Tips & Topics” is a monthly blog covering three sections: Savvy, Skills and Soul, with additional sections varying from month to month. Topics include Stump the Shrink, Success Stories and Shameless Selling.