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PostPosted: Tue Feb 15, 2011 6:45 am 
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Ok, I'm hoping this isn't in the wrong section for this kind of thing- didn't wanna put it in the "damn doctor/treatment center" spot, as I DO like my doctor, actually; he's an approachable, accommodating, yet by all means professional sort except for maaaybe this one niggling thing; so I'm just wondering if his...what I'll call "prescription-centric"approach is acceptable for a healthy recovery and successful rehabilitation? Am also looking for advice as to how I should deal with the situation...

See, I'm at a point in my treatment where I'm starting to realize just how different (read: distorted) the world really looks when you're a long-term opiate addict; now that I'm a little more than 3 weeks into my suboxone treatment, my vision has cleared up a bit. It's been difficult to adjust. For multiple reasons- namely, that I really, really want this to work, as well as having learned all I have from you guys- I'd like to at least try counseling.

My sub-doc is, of course, one of a select number of such in my area. So I consider myself lucky to have a place on that roster. However, again, after having read here what I have so far, I find it kind of odd that he barely even mentioned the therapy/counseling aspect of recovery. I'm one of only a handful of suboxone patients he has so far, the vast majority of his patients being part of a methadone program instead. The center at which he works has only very recently begun prescribing suboxone- initially and for quite awhile, they dealt solely with methadone patients.

So maybe that has something to do with it, but having worked in addiction treatment sector of medicine for so long, shouldn't he know the significance of having some sort of behavioral therapy/personal counseling along with medicinal treatment? From what I've found online, that's pretty important, but you wouldn't know it at this clinic.

On my very first visit, he gave me the number to the "here to help" hotline- provided solely by the makers of Suboxone, and including only /8/ phone calls (typically over a period of 8 weeks), and that specifically states is NOT a replacement for actual counseling. I did set myself up with a "care coach", but it's not enough. It's only from 9am to 9pm, and they can't speak on a wide range of issues, generally only being there to help you as you ease into your 'induction'.

It's really not enough for me at this point, so when I saw him today, I asked him about available counseling services through the center. Now, at this point I'm paying hundreds of dollars for treatment at this center, and that is NOT including the price of filling each script (which, as you know, is significant!). So I assumed these optional (the doctor was very clear about such services being /optional/) counseling services were included in the cost of treatment.

So I was disappointed to say the least when he referred me again to that same hotline. -.- I told him that it was not a 24 hour services (something that he and certainly the nurse did not seem to be aware of), and that it specifically stated that it was not to be substituted for actual counseling or therapy. This, apparently, was news to him.

Long story short, they said I could come in and do some 'counseling' with the nurse, or even with himself.

But can one even ACHIEVE truly effective/thorough counseling through their prescribing physician?? o_O I have experienced certain thoughts, issues etc. which I have shared with my 'care coach' that, for multiple reasons, I would not feel comfortable sharing with him. As far as 'counseling' with the nurse, while she is a perfectly lovely and presumably competent woman, I can't help but notice the last-minute tacked-on nature of that particular option/suggestion.

Should I be concerned about the fact that I am investing so much into a treatment center that apparently has little to no focus on the counseling aspect of rehab/recovery? =/ And, seeing as how they did not even suggest let alone refer me to any outside resources, should I go seeking counseling on my own? If so, how would I go about doing in this? Keep in mind, with all the money I've invested (and am still investing- every 2 weeks! >.<) into THIS particular treatment center, any other services would have to be more-or-less free at this point... =/


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PostPosted: Tue Feb 15, 2011 8:52 am 
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Hmmm...that sounds really iffy to me...Your doc should have a list of resources for you and a nurse is an ok source IF she is also a therapist/psychologist and knows about counseling...

What you can do is look in Psychology Today...many times there are ads for theapists in local areas....also American Counseling Association will have lists...what I think you should do is google your area and look for therapists who specialize in addiction treatment (not going to a treatment facility necessarily, but a private therapist) and then ask them what they know about Sub....test them first! And sometimes it takes going to a couple of people until you find the right fit for you....
Ask people about their theoretical perspective and have them define that for you....that way you can see if they might be helpful...for instance some people don't care about going back and looking at their childhood issues (which is called psychodynamic in a quick and simple explanation here), childhood trauma's, attachment issues etc....some patients just want to get straight to how do I live life now? So, think about how you want your therapy...but maybe you don't know that quite yet...I guess I'm saying that educating yourself and not going to just anyone will be very important....Your recovery deserves the best chance and I believe a good therapist can do quite a lot of good...It's a lot of work and I applaud your courage for seeking help.

PM me if you like and tell me where you live, I might be able to help you find someone.


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PostPosted: Fri Feb 18, 2011 3:28 pm 
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I'm in the same boat, except I've been on Sub for 1 year and 4 mos. My doc is also a psychiatrist and is exactly what you said, prescription-centric. In fact he is actually a psychopharmacologist. At the beginning I asked about therapy, support groups, etc. (because I assumed it was part of being on Sub), and he responede that going to meetings was probably a "good idea". As to counseling he said, "is there something you want to talk about?" as if he were willing to talk to me, but he didn't sound particularly interested.

I knew this wasn't right so I went about looking for other Sub doc in my area. There were exactly 3 that I could reasonably get to. One was cash only, even though I have insurance. One had some pretty scary reviews from several people, and the third was with a regular family practice - so I made an appointment with them. They DID require counseling, UA's a treatment plan (and meetings I think), all outlined in a contract. The problem was, it was a huge practice, where I waited in a waiting room, then got moved to a 2nd waiting room, then waited in a room for the doc. just so I could talk to him about the program. I was there over 2 hours (this was not an induction or anything). I left with a very bad feeling, and then they proceeded to bill me for a full Sub visit complete w/UA (which I didn't have) and I got the sense that 1) I was just a number and 2) they wanted to keep the Sub patients away from all the nice family practice patients.

Needless to say, I stayed with my current doc. My dose has been all over the board, I relapsed a couple of times, I went off Sub once, and the doc pretty much just writes me a script once a month after speaking to me for about 2-3 minutes. I admit I'm culpable in this, because it's easy to just take the path of least resistance. But I spend a lot of time on this forum and I know that my recovery is lacking.

My doc last week announced that "the government is on his back" about providing treatment. So he's going to start a Sub group therapy meeting once a week. I think attending a Sub group is a great idea, and I wish everyone had this option. It just seems that the docs motives are in the wrong place.

I will attend the group, but I know I would benefit from individual counseling. Because I have insurance I can seek it out on my own, I'm just loathe to actually deal with my issues.

I know this is a long-winded reply. But, yes, you should be concerned if your doc only writes scripts. You have to decide if you want to stay with the doc for the medication, and attend meetings or seek treatment on your own, or if you want to find a new doctor. When I first researched Sub, I was led to believe that providers who took the course and were liscenced to prescribe it were required to offer a comprehensive treatment plan including therapy. But the more time I spend on the forum the more I learn that many (or most) do not. So if you do look for another doctor be sure and ask a lot of specific questions about what they offer and require.
Best of luck to you, and keep posting,
Lilly


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PostPosted: Sat Feb 19, 2011 9:26 am 
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That does sound pretty sketchy to say the least. Chinagirl's suggestion is a good one. In fact, I found my therapist on Psychologytoday.com and I've now been with him for 4 years.


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PostPosted: Sat Mar 12, 2011 2:49 am 
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Thanks everyone, sorry for the delay in responding- I've gone a bit "off the rails" and have been for the last couple of weeks, since encountering some friction in my family (that, though I'm still living with them, has devolved into my mother giving me the silent treatment...).

I'm pretty sure that, in some aspects at least, I've become hooked on adderal; at this point I'm not sure if I should just go ahead and get my own script of it and try to use it as a positive tool or try kicking it again (which didn't go so well...).

Anyway I never did get that counseling- turns out my religulous (lol) parents are opposed to counseling, psychotherapy and, well, modern "soft sciences" in general. They belittled me for considering it and basically accused me of navel-gazing, determining counseling to be "self-indulgent, obsessive, etc.". Somehow, though I didn't think their opinion would matter (we differ on quite a bit philosophically), somehow that really impaired my motivation to seek counseling on my own.

My doctor has yet to autonomously suggest it, but when I pressed him about it he told me he could "talk to me" himself or I could do some counseling with the head nurse. When later I told him I was encouraged to ask about her credentials- whether or not she was actually a /counselor/, he told me she is in the process of "working towards that", which I assume means she is earning her certification.

I don't know how I feel about this. She's a very nice woman, very warm, very encouraging- but I don't feel comfortable talking to the head nurse about my issues concerning this new substance in my life. =/ I know I shouldn't be keeping secrets but... I just don't know. She says it would be confidential but I'm just not comfortable with revealing everything the way I'd like to.

Also, I don't know if close to- or "working towards"- are sufficient credentials... =/ what do you think??


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 Post subject: sub docs as counselors
PostPosted: Sat Mar 12, 2011 11:44 am 
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Hi,

I know a lot of sub docs who are only prescribers. Even my old sub dr who is a psychiatrist....he's not an internist or family doc who decided to take the course in order to be able to rx Sub didn't do any therapy. Altho he gave me a full 30 min. for m $125.00....better than many who say they get 3 minutes with their sub dr.

my new Sub dr is also a psychiatrist and charged me $130.00 for a full 30 min. of time. He also told me he was available to do psychotherapy if I wanted, which if I could afford it I would. He is "out of network" for all his services, not just Sub.

Wth the Sub dr that i know who do not do therapy themselves about 80% all push therapy or meetings or some added help besides just Sub. Some doctors try this, which I think is good because it doesn't scare off clients: they do not push or require therapy...they get patients in, stabilize them on sub and if they relapse or abuse their sub then the require therapy and do ask for accountability with that therapy. I think this is a good idea because he allows people to come in and meets them where they are at so to speak....helps them...and when they struggle then says hey, look, you need more help and in order for me to continue to prescribe for you, I want you to do your part.

So, the fact your dr doesn't push therapy I don't think means anything much. But if you do want therapy call around, look for therapists who have addiction training, who get it and who also understand Sub. It's amazing but many therapist who are also addictions therapist have NO idea about sub or methadone. It's tricky...and I know as a patient I'm sick of educating my doctors...and that it can be hard to find a really good therapist who gets it.

Keep looking....I believe you can get what you need but it may take persistence. Good for you for wanting to go the extra mile. It's courageous...looking at ourselves is very difficult. Well, for me it has been!


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PostPosted: Sat Mar 12, 2011 3:52 pm 
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Not all sub doctors recommend or require counseling. I believe it really just depends on the individual as to if they will benefit from any kind of therapy - addiction or not. Personally I value it very much, but I don't see an addiction counselor. I just see an individual therapist who I was seeing before my addiction. Do you have insurance? If you do, it might be covered - at least partially. If not, when you call around, as about sliding scale fees. It sounds, based on reading your post alone, that you probably would benefit from it, but I could be wrong. You obviously know yourself better than I. But when it comes to opiate addiction, it's not necessarily going to affect your success when it comes to relapse - not if you stay on suboxone. If, however, you plan to go off suboxone in the future, you'll benefit by learning coping skills, identifying triggers, etc. Personally I think everyone needs to have healthy coping skills, again, regardless of whether they have an addiction problem or not. Good luck and I hope if you decide to seek out a therapist that you find one that is the right fit for you. Sometimes you have to try more than one.

You mentioned a problem with the Adderall. I don't know if you want to talk about it, but if you do, just let us know. Until then, I'll just leave it at that. Take care.

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PostPosted: Mon Mar 14, 2011 2:09 pm 
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I think it is a very good sign in your recovery process especially so early into it that you are so concerned with therapy, and i also whole heartedly agree with you, that i feel therapy and counceling is a huge and vital part of the recovery process. I am very sorry that you are having problems with your family, and that they are not being supportive about you seeking counceling, religious beliefs or not i cant imagine not supporting a loved one whos taking such amzing steps like you are to overcome thier disease and thier own obsticles in thier own lives. Whether or not you personally believe in therapy if a loved one is hurting and is adimently seeking treatment to help themselves .they should do everything and anything in thier power to be as loving and supportive of that incredibly difficult process as possible. But the worst part is esp because your living with them right now that this is causing tension and stress for you while you seem to be fighting tooth and nail with all you've got to beat his addiction and recover gracefully. I have to encourage you to do anything in your power to continue your search for either an NA meeting or a therapist who can do one on one counceling and maybe just not mention the counceling to your parents if it is causing this much tension. But I feel your concerns about talking to your doctor or "not even certified yet nurse" are completely justified. Listen to your gut. If you have an uneasy feeling about something that is your "gut" telling you somethings not right. just learn to trust your own instincts. Id say if put in the same situation and faced with the same options i dont think id feel like the doctor really had any time to "really councel" me either vs. just trying to "appease' me, and you are too importand as is your recovery to trust your secrets and feelings with a nurse whos "working towards accredidation" sorry but that just doesnt cut it for me either. I think your gut was telling you the right thing, that "these werent the right people to talk to" Your time is too prescious to have some doc rush you through 55mins of counceling so he can just shut you up. You can find a wonderful addiction councelor who specializes in your specific needs and problems and who will put your mind at ease and give you the time and attention you require and deserve for your recovery. Post that your looking for a therapist and post your area and our friends on this site will find you someone wonderful in your area the people on this blog are incredible and compassionate! Good Luck Sweetheart :wink:

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PostPosted: Thu Mar 17, 2011 12:00 am 
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Everyone has different needs and desires for counseling. The rules for prescribing include the ability to send a patient for counseling, or do counseling, if it is indicated. So doctors prescribing buprenorphine should at minimum have a person to refer you to, should you need or desire counseling. Of course, in most cases that person will expect to be paid for doing that counseling.

A couple comments. First, 'counseling' is a word that can apply to so many things. I see patients for a minimum of 30 minutes per visit, and I consider that to be 'counseling'-- as the time is spent discussing powerlessness, relapse prevention, living life on life's terms, finding positive things to replace addiction with, etc-- the type of things that a typical AODA counselor would handle. Some people want 'counseling' to involve dealing with self esteem issues, grief work, anger issues, etc-- which in some cases would be beyond the training of a typical AODA counselor, and better done by a psychotherapist-- either a PhD psychologist or and MD Psychiatrist who as training in psychotherapy (some psychiatrists do very little psychotherapy, and frankly are not very effective at it). When a person writes here about 'counseling', it may help understand your needs and the perceived problems with your situation by describing what you believe 'counseling' should consist of, and be directed toward. Would you be willing to pay for therapy, if the charge was the usual $140 per hour minimum rate?

I've heard stories of docs who put all of their patients in a group that meets several times per week. Patients must belong to the group, must attend the group, and must pay $40-$60 per group meeting-- up to a couple hundred bucks per week. I've heard of docs who have patients all talk to a nurse for an hour, before the doc walks in with script in hand.

Be careful what you wish for. The biggest complaint that I hear are from patients who are doing great, who want to stay on buprenorphine, but who cannot find a doc to prescribe at a reasonable interval. If they move and need a new doc, even if they have been doing great for three years, the new doc wants them to go through 'intensive outpatient' or do a year of weekly group. THAT, in my opinion, is shameful. Yes, addiction is a tough disease. But like patients with any illness, addicts deserve to have treatment that is individualized for their specific needs. Too many docs see 'addict' and automatically assign group, NA, art therapy, etc-- depending, oddly, on the exact type of therapists who have empty slots in their practice in the clinic.

I think the 'ala carte' approach works best--- that way you only pay for what you truly need. People who are on buprenorphine and doing well should not be required to go through counseling--- period. If they are not doing well, fine-- require just what is necessary. But docs should not use buprenorphine to keep a captive audience for whatever counseling that the doc happens to believe in.

Finally, studies that look at the impact of counseling on success with buprenorphine are NOT all that impressive. I have yet to see a study that shows SIGNIFICANT (statistically) effects on sobriety. If you have them, send them please-- I have not seen that, but I have seen studies showing NO benefit from counseling-- and traditionally, counseling has a poor success rate with opioid dependence.


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