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Regular involvement in some form of counseling during your SUBOXONE treatment is strongly encouraged. Counseling helps patients develop coping skills that can help them to avoid relapse and has been shown to significantly improve the likelihood of long-term treatment success (for more on this, see Importance of Counseling).1-4
In addition to counseling, you may also be interested in support group participation. Many patients supplement their weekly or monthly counseling with support group meetings, because the format lends itself well to day-to-day encouragement in less formal surroundings.2
This section starts with an overview of a "typical" counseling schedule (when does it begin, how often, etc.) and explores some of the different options available for counseling as well as support groups.
Typical Schedule
Formal Counseling
Support Groups
Typical Schedule
Counseling may not start right away—many doctors may wait until after your daily SUBOXONE dose has been stabilized.
How often you go to counseling depends on what works best for meeting your treatment needs. In general, counseling occurs more frequently during the earlier part of treatment—daily visits are not unusual for new patients. Weekly (and eventually monthly) visits are sufficient for most patients on a stable SUBOXONE dose.
You and your doctor will evaluate how your treatment is progressing and whether your current level of counseling is still effective for you. How frequently you participate in counseling or in support groups can be determined by you in consultation with your healthcare provider.
Formal Counseling
Counseling is far from a "one size fits all" situation. For one thing, there are many different types of counseling techniques—some may be a better fit for your personality or treatment goals. Another choice you have is whether you would prefer group therapy or individual therapy.
Together, you and your doctor will decide on the type and setting of therapy that best meets your needs. And because your needs may change over time, it is a good idea to talk with your doctor periodically about whether your current therapy is continuing to help you meet your treatment goals.
Group therapyIndividual therapy
Not everyone thrives in a group-counseling situation. You and your doctor may decide that your needs would be better met with the privacy and individual attention possible in a one-on-one setting.
One-on-one counseling is generally considered the best setting for addressing confidential issues. Private sessions with a psychiatrist are recommended for patients being treated for depression, anxiety, or other mental health conditions that may be contributing to their opioid use.
Support Groups
Participation in a support group is recommended as something patients may want to do in addition to their regular counseling.2 Support groups offer many of the same benefits as group therapy, except that they are generally focused more on accepting and encouraging patients in treatment (and less on abstinence strategies).
Support group participation can be in person or online.
In person
Participation in a support group allows opioid-dependent patients to come together with other individuals who understand each other's treatment challenges. Do let your doctor know if you are involved with a support group of some kind. It is always smart to keep your doctor "in the loop" as far as anything that affects your treatment, but, also, if your experience with a particular support group is positive, your doctor may want to recommend it to future patients.
Online
If being physically present at a support group meeting is inconvenient or impractical for you, or if you simply prefer remaining anonymous, then an online support group may be a good option for you. Here, too, it is a good idea to let your doctor know if you are participating in an online support group, because:
| 1. | Your doctor should know about anything that potentially affects your treatment. |
| 2. | If your online support group is a chat room, your doctor may want to confirm that it is reputable (some chat rooms are better than others as far as the quality of information and advice offered). |
| 3. | If your experiences with a particular online support group are positive, your doctor may want to recommend it to future patients. |
| 1. | McCann M, Olbert J, Ling W. Buprenorphine treatment of opioid addiction: a counselor's guide [Danya Learning Center website]. Available at: http://www.danyalearningcenter.org/courseprofile.asp?cid=7. Accessed April 1, 2005. |
| 2. | Center for Substance Abuse Treatment (CSAT). Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, Md: Substance Abuse and Mental Health Services Administration, 2004. |
| 3. | Lavignasse P, Lowenstein W, Batel P, et al. Economic and social effects of high-dose buprenorphine substitution therapy. Ann Med Interne. 2002;153(suppl 3):1S20-1S26. |
| 4. | Kakko J, Svanborg KD, Kreek MJ, et al. 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial. Lancet. 2003;361:662-668. |
| 5. | CSAT. Substance Abuse Treatment: Group Therapy. Treatment Improvement Protocol (TIP) Series 41. DHHS Publication (SMA) 05-3991. Rockville, Md: Substance Abuse and Mental Health Administration; 2005. |
