“Group therapy vs. one-on-one therapy for substance abuse?”
My son is addicted to taking prescription painkillers, and we are trying to get him help--especially since he finally seems to want the help. What is the best form of therapy for substance abuse? Should we have him join group therapy, or should he have one-on-one time with a specialist?
4 Answers
All of the above. There is also now the trend of using medications to help decrease craving for opioids... goal of course is to prevent relapse.
See an addiction medicine doctor or addiction psychiatrist. Opioid problems must be treated with medication. Group or individual therapy is useful as addiction support
The most important factor is the individual wanting/seeking help. I have found a combination of treatment modalities to provide a better outcome,
rather that either/or. Finding a physician that is certified in addiction medicine and/or addiction psychiatry to facilitate treatment is second priority. In my experience nearly all treatment plans developed specifically for the patient and that patients needs are optimal. If the individual has healthcare insurance, that is also a factor to consider, and whether the care provider accepts the insurance or the patient will need to file with the insurance company for reimbursement. A decision by the physician, (initial appointment) whether treatment should begin with inpatient care or can occur in an outpatient setting is necessary. If there are co-occurring issues along with the substance abuse/dependence, such issues should also be part of the treatment plan. Usually treatment which includes medication assisted therapy (MAT) is standard of care. Participating in a combination of group and individual therapy sessions also enhances the treatment outcome. Optimal goal is stable sustained abstinence by the person. Of utmost importance is to always remember addiction is a disorder of brain chemistry and the brain reward system, thus, like diabetes or high blood pressure can be a disorder that goes into remission but can reoccur in the future, thus a chronic medical condition not a character defect.
rather that either/or. Finding a physician that is certified in addiction medicine and/or addiction psychiatry to facilitate treatment is second priority. In my experience nearly all treatment plans developed specifically for the patient and that patients needs are optimal. If the individual has healthcare insurance, that is also a factor to consider, and whether the care provider accepts the insurance or the patient will need to file with the insurance company for reimbursement. A decision by the physician, (initial appointment) whether treatment should begin with inpatient care or can occur in an outpatient setting is necessary. If there are co-occurring issues along with the substance abuse/dependence, such issues should also be part of the treatment plan. Usually treatment which includes medication assisted therapy (MAT) is standard of care. Participating in a combination of group and individual therapy sessions also enhances the treatment outcome. Optimal goal is stable sustained abstinence by the person. Of utmost importance is to always remember addiction is a disorder of brain chemistry and the brain reward system, thus, like diabetes or high blood pressure can be a disorder that goes into remission but can reoccur in the future, thus a chronic medical condition not a character defect.
The answer is, it depends. Usually, entering a rehab that emphasizes group and individual therapy is the best bet. Treatment is more comprehensive, and they can detox your son easily. The problem with many rehabs is their quality varies enormously. Some rehabs are scams, especially a large group in south Florida. Moreover, if the rehab is full of 20-something heroin addicts, your son would be at risk of learning how to shoot up and coming home with a worse addiction - HEROIN - and a much greater danger of overdose. Individual therapy also varies enormously in quality. A good therapist can be very helpful, and a bad one can harm their patients.
But, one of the most important considerations is finding a treatment that includes Medication Assisted Treatment (MAT). Look this up online, emphasizing reputable sources like SAMHSA (e.g., https://www.integration.samhsa.gov/clinical-practice/mat/mat-overview <https://www.integration.samhsa.gov/clinical-practice/mat/mat-overview>). Unfortunately, the majority of treatment programs emphasize a strict abstinence approach: just stop using all drugs. This approach works for alcohol and many drug addictions, but not opiates/painkillers, where the success rate is only about 5%. Because opiate addiction is so lethal, insisting on a treatment approach proven to fail 95% of the time means many of your patients won't survive. They say Suboxone is "just another addicting drug." But used properly, it PREVENTS further opiate use. Suboxone does NOT foster addiction. It has no significant harmful effects on the body. Yes, addicts can abuse cocaine or marijuana or meth while on MAT. Most of us believe those drugs aren't nearly as dangerous as opioids.
INSIST on MAT unless there are compelling reasons your son shouldn't take it. You'll need to find a physician addiction specialist who can prescribe it. The most commonly prescribed MAT medication is Suboxone, also known by other names/brands like Zubsolv, Bunavail, and generic buprenorphine/naloxone. It is now widely covered by health insurance. The alternatives are methadone maintenance at a federally licensed methadone clinic, and Vivitrol, a monthly injection of an opioid blocker/antagonist. Most people choose Suboxone.
If you research Suboxone online, you'll encounter enormous opposition to its use, purely for ideological reasons. Buprenorphine is the active ingredient in Suboxone. It IS an opiate AND an opiate blocker. Properly used, it prevents further opiate use. Buprenorphine doesn't get you high, but it fills the "hole" left if you've been addicted to opiates and quit. Even after the acute withdrawal has resolved, most people enter "post-acute withdrawal," consisting of months of fatigue, depression, and extreme craving for opioids. That's why it's so hard to stop with abstinence alone. Buprenorphine prevents these symptoms. If successful, people feel NORMAL, and their families notice the difference. "I have my son back!"
The major downside of Suboxone is you have to take it for AT LEAST 5-10 years. I've had many male opiate addicts start a career, get married, buy a house, and have children while on this medication. Stopping Suboxone sooner is almost a guaranteed relapse. While taking it, most people feel a lot better, have more energy, and return to normal function.
There's more to be said about MAT and treatment for opioid addiction, but this will at least get you started.
But, one of the most important considerations is finding a treatment that includes Medication Assisted Treatment (MAT). Look this up online, emphasizing reputable sources like SAMHSA (e.g., https://www.integration.samhsa.gov/clinical-practice/mat/mat-overview <https://www.integration.samhsa.gov/clinical-practice/mat/mat-overview>). Unfortunately, the majority of treatment programs emphasize a strict abstinence approach: just stop using all drugs. This approach works for alcohol and many drug addictions, but not opiates/painkillers, where the success rate is only about 5%. Because opiate addiction is so lethal, insisting on a treatment approach proven to fail 95% of the time means many of your patients won't survive. They say Suboxone is "just another addicting drug." But used properly, it PREVENTS further opiate use. Suboxone does NOT foster addiction. It has no significant harmful effects on the body. Yes, addicts can abuse cocaine or marijuana or meth while on MAT. Most of us believe those drugs aren't nearly as dangerous as opioids.
INSIST on MAT unless there are compelling reasons your son shouldn't take it. You'll need to find a physician addiction specialist who can prescribe it. The most commonly prescribed MAT medication is Suboxone, also known by other names/brands like Zubsolv, Bunavail, and generic buprenorphine/naloxone. It is now widely covered by health insurance. The alternatives are methadone maintenance at a federally licensed methadone clinic, and Vivitrol, a monthly injection of an opioid blocker/antagonist. Most people choose Suboxone.
If you research Suboxone online, you'll encounter enormous opposition to its use, purely for ideological reasons. Buprenorphine is the active ingredient in Suboxone. It IS an opiate AND an opiate blocker. Properly used, it prevents further opiate use. Buprenorphine doesn't get you high, but it fills the "hole" left if you've been addicted to opiates and quit. Even after the acute withdrawal has resolved, most people enter "post-acute withdrawal," consisting of months of fatigue, depression, and extreme craving for opioids. That's why it's so hard to stop with abstinence alone. Buprenorphine prevents these symptoms. If successful, people feel NORMAL, and their families notice the difference. "I have my son back!"
The major downside of Suboxone is you have to take it for AT LEAST 5-10 years. I've had many male opiate addicts start a career, get married, buy a house, and have children while on this medication. Stopping Suboxone sooner is almost a guaranteed relapse. While taking it, most people feel a lot better, have more energy, and return to normal function.
There's more to be said about MAT and treatment for opioid addiction, but this will at least get you started.
