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PostPosted: Wed Mar 09, 2011 8:44 am 
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I've read several studies over the past 3 years that talk about addiction treatments and long term absintence/recovery. I'm posting three studues below...the first has nothing to do with Sub, but just that NIDA published a study where they added the opportunity for patients to attend a 12 step meeting onsite at their treatment facility in NY. I have read, but cannot find, another study giving a very high percentage rate for long term recovery (one year) when Sub was combined with some kind of additional therapy. This is not to start any kind of fight on the forum...Addiction is so complex and for instance if you look at SAMHSA's relapse prevention recommendations alone I think that by itself shows that it recovery requires various kinds of support for long term sobriety.

In a study comparing clients’ results at two outpatient substance-abuse treatment programs in New York City, NIDA-funded researchers found that attending a treatment program holding a 12-step meeting onsite increases almost sixfold the likelihood of abstaining from drugs for a full year after leaving treatment, relative to attending a program without an onsite 12-step meeting.

Another study by the clinical trial network showed that continuing Suboxone in addition to counseling was more effective than detoxification with counseling. This confirms the thought that detoxification is not a treatment on its own and that Suboxone treatment can be very effective in the recovery process when combined with behavioral interventions.

In 2005 a NIDA funded study looked at Network therapy in addition to Suboxone. It was found that outpatient therapy that involves family and friends enhances abstinence among patients receiving buprenorphine for outpatient treatment of opiate addiction. By the end of the 18 week study the abstinence rates in those patients receiving network therapy was twice as high compared to those patients receiving Suboxone alone.

Just some info...

My tech question: Does anyone have trouble signing onto the forum? No matter if I check the box to remain signed on I have to sign on TWICE each time. Even in the middle of a session where I am actively reading or posting I'll click on my messages or the index and find I have to sign in again. This is becoming frustrating because it is every time I'm on the forum. Any input would be appreciated.


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PostPosted: Wed Mar 09, 2011 2:20 pm 
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This logging in thing happens to me sometimes too. I've only exprienced it while trying to complete/submit a post though. Sometimes, I'll preview my post before sending it out. Other times, I'll just proofread from the original posting page and then try to submit my post. It seems like, if I've spent a long time on the posting page before submitting, that Im then requested to re-log in....only to be brought to a blank post page. It takes me awhile to post sometimes since my typing sucks. So when this happens, Im like- holy crap where's my post! I don't know how, but I've been able to retrieve most of them.

As for the studies your trying to share...thanks. I don't believe that ALL addicts have demons and issues in which they were using behind and are now fighting to stay in remission over. I do believe that THIS IS THE CASE for alot of us though. In this instance, I personally believe that some type of therapy is helpfull. And even if there aren't any dark secrets you need to let out, it's refreshing to just talk to someone about you'r everyday life and anything your going through (good or bad).

I think I understand where Dr. Junig is coming from with his blog on the subject. Especially with the 100 patient cap, and such strict rules/regulations which are placed on Suboxone....it can make it quite difficult, maybe even impossible for some addicts to obtain sub (at least legally). Then, you put heavy counseling mandations in place for all patients (some of which may not even need/benefit from therapy).....and it could make sub treatment quite unatainable for someone in a life/death situation. Just MY op.


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PostPosted: Wed Mar 09, 2011 2:36 pm 
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I found the study that I was looking for. I believe it is the one that Dr. Junig spoke of. The link to a summary of the trial is below. This deals with shorter term treatment.

This study was presented at the American Psychiatric Association’s 2010 conference and included over six hundred prescription opioid addicts. Relapse rates were remarkably high when patients were tapered over the course of one month, after two months of stabilization. (2) The addition of fairly intensive addiction counseling didn’t improve relapse rates. In the treatment as usual group, prescription opioid addicts met weekly with their doctors, and after their taper, ninety-three percent had relapsed within four weeks. Even in the group getting doctor visits plus twice- weekly one hour counseling sessions, ninety-four percent relapsed within the first four weeks after buprenorphine was tapered. This was the largest study done so far, specifically on prescription opioid addicts, as opposed to heroin addicts. The overall message from results of this study seems to be that adding fairly intense counseling doesn’t improve patient outcomes.

In looking for this specific study, I found MANY professionals as well as laypersons who stated that adding counseling to sub treatment improved success rates, but I didn't see any clinical trials that backed that up (it seemed to mostly be personal opinion), although I'm not saying there aren't any. I just didn't find them.

Chinagirl, do you have links to the clinical trials you mentioned?

I am not trying to get into a debate about which is more true. I mentioned previously that a study showed that counseling didn't improve success and I was heavily questioned on it. So I am presenting the information now, since this thread was started to cover this specific topic. I will also add the link to the other thread where this was brought up.

I hope this clears up the questions and confusion that ensued after I brought this up.

http://www.drugaddictiontreatment.com/d ... ependence/

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PostPosted: Wed Mar 09, 2011 2:40 pm 
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Thanks for that info. I know I've read about this or that study that shows recovery rates improve when Sub is combined with meetings or counseling, but I didn't feel like trying to find them. :D

Regardless of whatever a study finds or doesn't find, I think people need to understand that you will get back what you put in. I went to meetings and sat in the back with my arms folded and my eyes rolling and my defenses up....and I gained absolutely nothing. When I went with an open mind and was eager to squeeze any knowledge I could out of the meetings, it all changed for me. For one thing, you go from being loaded to being clear and you have to learn normal routines and just how to construct a day that does not revolve around getting drunk or high or recovering from being high or drunk. Meetings were a starting place for my new routine. They were a place to vent what I was struggling with. Just because I quit drinking certainly did not mean life became a piece of cake and nothing ever went wrong. At first, I was coping with cravings, but thankfully, those went away. Still, life threw crap at me and I needed to vent and hear other people's stories about how they handled problems. There can be a gigantic amount of collective knowledge in one room. As far as counseling goes, I didn't get as good a result. I see now that I should have gotten a different counselor. For anyone who's considering either of these things, I'd advise you to go into with an open-mind and a positive attitude. Get what you can. Give what you can. Enjoy that you aren't alone. You are one of many; you aren't some crazy oddball....just an addict; your stories won't shock everyone because trust me, people have done worse. I loved meeting other addicts/alcoholics, and some of those people became my best friends. I know that I had a bit of arrogance when it came to meetings....like "maybe other people need those, but not me." Somehow, in identifying with other people, I stopped being so unsure about myself and so embarrassed and ashamed about my history. What a relief. It was also just a time to hang out with other people and be social without it revolving around drugs or alcohol. I don't think every single person needs meetings or counseling to stay sober. I think it's obvious that without Suboxone, meetings and counseling would be much more necessary. However, those things are not just about getting sober. They are about growing as a person, recovering from the past, and learning how to handle being an addictive person. It's about getting sober and then working to free yourself from the things that are dragging you down. Getting sober is really only the starting point. There are sober people who are pretty damn unhappy and haven't gotten very far since they quit using. I can truly see how if someone is required to attend meetings/counseling, it could have a negative impact on their attitude towards meetings/counseling. Nobody likes to be told what to do, including me! For people who are required to go, I'd just suggest trying to see it as someone they are supposed to be doing for themselves, and to try to gain whatever they can. They may be surprised.

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PostPosted: Wed Mar 09, 2011 3:07 pm 
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As I said on the other thread, but failed to mention here, I'm in no way saying counseling/therapy isn't important or valuable - just the opposite. In fact, it changed my life. And once my addiction was behind me, I was in a much clearer, better frame of mind to get more out of it. For me, counseling is a much more preferable option than 12-step meetings. I tried that in the past and just couldn't get past the whole higher power thing due to my disbelief. I know people say it's "spiritual" and not religious, but it just doesn't fit with who I am. I'd have to fake who I am to even pretend to work the steps and that would defeat the whole purpose. Plus the weird thing was, when I left the meetings, I always left wanting to use even more than I did when I arrived. I found that to be very odd. Of course I recognize that many people get quite a bit out of the meetings and I would encourage people to try it. Just because it's not my thing doesn't mean it wouldn't work for me.

Anyway, back to the counseling subject...As for finding the right one, yes, that takes time unfortunately, sometimes too much time, and it can be very frustrating. I can't even count how many I've been through before I finally found the right one 6 years ago. Now I actually drive an hour to get there! That's how much I value him and my time there.

So I hope no one misunderstands how I was just presenting that clinical trial and not saying counseling isn't important.

Thanks for the opportunity to clarify.

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PostPosted: Wed Mar 09, 2011 6:07 pm 
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Holy Smokes! I just read that article that Hat posted a link to and I realize just how lucky I am to have 9 months off of suboxone.

It reinforces just how diligent I have to be in keeping my sobriety the most important thing in my life.


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PostPosted: Thu Mar 10, 2011 1:25 pm 
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hatmaker510 wrote:
As I said on the other thread, but failed to mention here, I'm in no way saying counseling/therapy isn't important or valuable - just the opposite. In fact, it changed my life. And once my addiction was behind me, I was in a much clearer, better frame of mind to get more out of it. For me, counseling is a much more preferable option than 12-step meetings. I tried that in the past and just couldn't get past the whole higher power thing due to my disbelief. I know people say it's "spiritual" and not religious, but it just doesn't fit with who I am. I'd have to fake who I am to even pretend to work the steps and that would defeat the whole purpose. Plus the weird thing was, when I left the meetings, I always left wanting to use even more than I did when I arrived. I found that to be very odd. Of course I recognize that many people get quite a bit out of the meetings and I would encourage people to try it. Just because it's not my thing doesn't mean it wouldn't work for me.

Anyway, back to the counseling subject...As for finding the right one, yes, that takes time unfortunately, sometimes too much time, and it can be very frustrating. I can't even count how many I've been through before I finally found the right one 6 years ago. Now I actually drive an hour to get there! That's how much I value him and my time there.

So I hope no one misunderstands how I was just presenting that clinical trial and not saying counseling isn't important.

Thanks for the opportunity to clarify.


I sincerely do understand what you mean. I grew up in a confused house, as far as religion went. My mom hauled us off the church on holidays and my dad was an atheist and he's be complaining the whole while about what a big load of crap it all was. I believed in something...I felt there was a God, but I still get weird with the details of religion. My dad, of all people, converted to Christianity and told me he scientifically proved to himself that it was real, although he had started his research with the intent to prove to my mother it was NOT true. This was insane and quite interesting to me, and I started to read the stuff he gave me, but there were so many dozens of books.....lol. My dad's the most voracious reader I've ever known. My DAD wears a cross and is an usher....this is still insane to me...

The meetings I was going to were in CA, and the Higher Power concept was TRULY very individualized, which is why I felt comfortable. I mean, when you have such a diverse group of people, you really have to keep it open or you'll alienate people. The community I live in now is basically all Catholic or LDS, neither of which suit me. Meetings are much more Jesus-oriented. That doesn't always feel natural to me to be around, because I was just not raised like that. I've concluded that I do believe in a Higher Power, and I call that power God. I just feel that presence and I don't think we have evolved to such a high state of consciousness on our own. JMO. God is not going to be mad that I consider that reincarnation may be true, that I tend to believe in Karma, that I'm interested in past-life regression, that I wonder if there ARE aliens, and that I question the absolute accuracy of religious books. God and I are good, lol. I'll find out eventually and I didn't ask for this damn questioning brain!!

laddertipper

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PostPosted: Thu Mar 10, 2011 2:06 pm 
Romeo and anyone else who has 9 or more months off all opiates including buprenorphine......I have a feeling there is far more than "luck" involved in your success!!
Regarding the results of this study that some of us are looking at/thinking about, and which is the one that is thought to be that which Dr. Junig referenced in his blog: I have a few thoughts about it that I would like to add to the discussion. I learned at the very beginning of my treatment for opiate dependence/addiction that the "success" rates of long-term recovery were quite dismal. The relapse rates that were found in this study certainly weren't any surprise to me and I doubt they were to much of anyone else, nor was that the focus of the study, if I read it correctly. What I understood the focus to be, and the issue I think we're discussing here is whether or not counselling or 'therapy' has any impact on these horrible relapse rates. The study apparently concluded that it did not. I can't really say that surprised much either.
What I feel like is key to note and take into consideration here is the time-frame over which this study was conducted. It was, in my opinion, a very short time-frame. In my mind, that quite nearly explains everything! All this study did for me was reinforce what I have learned throughout my own experience with addiction, remission and recovery, and what I have learned from all of you here through my participation in this forum: Success Takes Time!! Looking at success/relapse rates from opiate addiction after a one-month period, or a three-month period, or even a six-month period of treatment with buprenorphine with subsequent discontinuation of the drug (with OR without counselling) is bound to have a poor outcome.....because (in my opinion) that is NOT enough time for the necessary changes to take place in the addict to have a snowball's chance in hell of staying 'clean!'
Another thing I noticed in the study was that a large number of the participants had other underlying substance abuse issues. I think it was 60% or so of participants had a history of alcohol abuse, nearly half were marijauna users, and another 30%ish had a history of cocaine use. It seems logical to me that a history of or active use/abuse of other mind/mood-altering substances plays a pretty big role in recovery from opiate addiction also. And that is, after all, real-world stuff....many opiate addicts do have long standing histories of polysubstance abuse. But what about those of us who do not? Does that impact the relapse rate? And what about the time span of the drug abuse/addiction? Or the age at the onset of drug exposure/abuse/addiction? All these things are of interest to me when considering the numbers when discussing these dismal relapse rates.
What I have noticed in the few members we have here who have tapered, stopped buprenorphine and then followed up with us after several months or more and not relapsed is that they were on bupe for a pretty extended period of time....certainly more than 3-6 months! As best I recall, most of those few had, in fact, participated in some form of 'therapy' whether individual, group meetings, or a 'religious' practice of some kind to aid in their recovery. Personally, I put a good bit of stock into what I learn from Romeo, Diary of a Quitter and the others who have been kind enough to share their experiences after discontinuing bupe. They're the ones with the "goods!" Scientific studies are great....I learn from those as well. But they come and they go. Sometimes the conclusions that come from them are later proven to have been misleading or incorrect.....as further data and/or subsequent studies come along.
I sincerely hope that more studies like the one we're discussing will be done. We desperately need more information about what really does WORK for opiate addiction! The only conclusions that I, personally, have been able to come to regarding getting out of the cycle of active opiate addiction are that I must either A) plan on being on bupe for the rest of my life or B) plan on being on bupe for an extended period of time (1+ years minimum, in my opinion) and work on every other aspect of my life so that I may learn how to live that life without mind or mood altering substances, and then try recovery without the medication. Those are the only options I, personally, see at this time. I believe that for most of us to have a chance at stopping bupe and staying 'clean,' counselling, therapy and/or meetings will be necessary. That's what I'd like to see studied......but that would require an exceedingly long period of time and would be difficult to set up and follow scientifically. What I'd love to see is sort of a "hindsight" study, in which several hundred opiate addicts were interviewed after one or more years of sobriety from all opiates (including bupe) and asked what measures they have/are using to stay 'clean.' Wouldn't that be awesome?! I don't think that's been done, at least not formally, because it isn't very scientific and these things can't be proven scientifically, etc.... But wouldn't it be interesting?
Back on topic.....Again, I think the point that was made in that study and that Dr. Junig was bringing forth is that over the short-term, counselling does not seem to make a difference in the treatment of opiate addiction with buprenorphine. My own Sub doctor does not require counselling, meetings or anything as an adjunct to my bupe treatment and I think that's fine. I feel it is a purely personal decision whether to employ other therapies with bupe. I agree with Dr. Junig when he talks about how bupe takes away the desperation necessary to fully immerse oneself into the 12-steps or other means of recovery practices. However, I think that if we choose to, we can still (at least to some degree) immerse ourselves into the steps or into therapy or other practices. And I think that most of us will be better for having done so, whether we stay on bupe forever or not. To me, when these other practices become especially critical is when we're talking about trying to stop bupe and go full-out abstinence-based into our recovery. At that point, at least in my mind, we're going to have to have something else in place to keep us 'clean.' I don't want to have to be desperate to do what is necessary to live my life without opiates. And I don't think I'll have to be, in large part, because I've had buprenorphine to aid in my recovery. I can choose to do the work of abstinence-based recovery to whatever extent I feel is necessary and therefore, hope to eventually discontinue bupe and remain 'clean.' I just don't think that can be done without work. Hence, my message to Romeo and others above....there is far more than "luck" involved in that kind of success!
Anyway, that's my take on it. I hope we can continue to discuss it....very interesting.


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Dr. Jeffrey Junig, M.D., Ph.D.

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