I think that the counseling aspect of many methadone clinics falls short. In order for these patients to begin to put their lives back together, some type of counseling needs to be put in place. These patients are often in a very precarious situation, and counseling is the only chance to reach them. Many patients do not want to meet with a counselor, but they do because they have to in order to not go back to using on the street.
When I entered methadone treatment, I did not want to go see my counselor, and I dreaded every part of that. I was still shrouded in denial, and I feared being lectured for my bad behavior. But, I went to the clinic’s counselors in order to get the medication. If either of the first two clinics I attended had half the counseling staff of the third clinic I went to did, I may have gained a little more insight into staying clean many years sooner.
When someone first gets on methadone, they are in a delicate position. Their lives have been out of control, and they finally came somewhere to get help. Most people are desperate, tired, and sometimes on the verge of a breakdown when they first get on methadone. I think a compassionate and knowledgeable counselor can really make an impact on the patient’s life, if the delivery of the message is well received.
The key at this early stage, when most addicts are not really ready to completely quit, is to present the message in a way that it will be received and absorbed, rather than merely deflected or ignored. Counselors may be frustrated with these patients in early recovery who have numerous slips and who are not ready to get clean, but if they can reach these patients at least some of the message will be absorbed.
I was handed the tools for recovery, a little at a time, for many years in various rooms and offices. I slowly absorbed pieces of recovery, but it took years for these building blocks to finally give me a solid foundation to stand on. I began to use these various and spotty tools when I was ready to get clean, as I delved into my recovery and also myself.
The last clinic I attended had a really great counseling staff, and very few of their patients testing positive for elicit drugs. I did often test positive for various other drugs, and each time I did my counseling appointments increased. I was also required to attend group meetings more frequently.
I enjoyed the group meeting here, and I often engaged in the conversation. I always got something out of the conversation. I left there, feeling like I was not quite so alone. I left there feeling like I could change this situation if I wanted.
These counselors were also always available. If your counselor was busy or unavailable at the moment, one of the other counselors would be happy to see you. All the counselors I spoke with there were kind, compassionate, and also informative. The head of the clinic, who was also a counselor and a recovered opiate addict himself, took a real interest in all his patients, often clearing his schedule if one needed to talk. He spoke with me on various occasions, and I always left his office feeling a little more hopeful.
My counselor at the first methadone clinic I attended was very different. She was often militant, harsh and disapproving. I dreaded going in to talk to Cindy. She looked down at me, disapprovingly over her glasses, shaking her head at me like my mother did when I had been a naughty child. She kept a big file, and she liked to lecture. I did not get much out of our meetings because when she looked down at me over those glasses my mind raced with defensiveness and shame. It is hard to be honest with someone when his reaction to the truth creates such shame.
The counseling at the place I did my second stint with methadone in the heart of New Orleans was the worst. I also want to add that when I was on methadone here, I was not trying to get clean. I just wanted to stay off of heroin, but I did not think I needed counseling and I truly thought I would just be on methadone for the rest of my life. I was still working in the strip club, and I still drank and did various drugs on a daily basis. I thought I was content to remain on methadone forever, and I really did not think I needed a counselor. Looking back on my counseling experience at this time in my life, I will admit that my blasé attitude about the counseling sessions may have played a small role in my memory of this counselor.
At the same time, this particular counselor I was assigned was really awful. This particular clinic was not like the one in Rhode Island where the owner worked there and took a vested interest in each of his patients. This particular clinic was a dosing factory, where they cranked patients in and out of the long and narrow dosing area as fast as they could. The clinic was open in mornings and also in the afternoon, and it was often crowded with clients.
This clinic was not like the only methadone clinic in a small, quaint town in Rhode Island, but instead this clinic sits in the heart of New Orleans where the heroin problem is enormous. In a big city with a heroin problem, the methadone clinics do succeed in cutting down on heroin related crime and also diseases that are spread through IV drug use. The methadone clinics in these big cities do not aim to rid these patients of the addiction, because that order is just too big in place like New Orleans. But these clinics can help social problems that come with heroin addiction, by reducing the number of addicts using on the streets.
The counseling at some of these clinics is shabby, at best. They may have twelve different nurses to work the dosing area, with six different dosing windows, but there were only a handful of counselors. And my counselor must have been the worst of them all.
I really did not mind her, though, because she could care less and always had me in and out of there. I just thought the whole thing was a waste of my time. She was obviously not interested in anything I said, and she always cut the meeting short after just asking a few simple questions.
I will never forget one day, she thumbed through a stack of CDs when I was in her office, during my scheduled and required monthly counseling session. She seemed to be organizing the CDs, and every now and then she would write on one of them with a Sharpie.
She also ran the Saturday group. The Saturday group was for those of us who had tested dirty within that two-week period. I always tested dirty, and I was in the Saturday group at least twice a month. There was rarely any topic, and she would usually give us a worksheet, say a few words, or write a sentence or two on the board. Then, she just sat back and let the room full of anxious addicts take over the conversation.
The room was always anxious because you were not allowed to dose until after the group. Everyone in the room seemed on edge, as you always did awaiting your dose. It was like the minute I rounded the corner to the clinic in the mornings, I could almost taste the orange, chalky Kool-Aid and my sweet relief. My nose started to run sometimes, just seeing the methadone clinic’s building and my insides started to jump around.
We all sat in that room, deep in the belly of the methadone clinic, deep in the belly of the beast of our addictions, bitching for an hour about how much everything sucked. The conversation always drifted to the fact that none of us could wait to get dosed. We all watched the clock vigilantly, and the minute our time was up we all raced down to the dosing windows, flooding the nurses with the Saturday group’s fuck ups.
Counseling is a key piece of the theory behind methadone. And counseling is one of the places I think a lot of clinics fall short. To be fair about this argument, I think it is also one of the places that addicts also fall short.
Counseling must be a two way street to really work, and the patient needs to be ready to do the work involved through counseling, especially to delve into something like addiction. The street is often more one way in a methadone clinic. But, that doesn’t mean that the patient of the clinic will not get anything out of counseling, because I think so much can be gained from counseling here. It just takes a little different approach. I think counselors need to understand that most of these patients resist the counseling, at least in their heads, and they do what they have to get take homes. But, they will listen to the message, if it is presented the right way. Over time, the message may sink in with tiny bits and pieces.
In order to improve the lives of these addicts, the counseling needs to be in place. The counselors need to try to reach their patients in this volatile time. I think counselors who have been through addiction often times have a better chance of reaching a patient who does not really want to go to counseling, as they probably recognize this shared experience. No addict is gung ho about getting better in the beginning; instead they are often forced there by extenuating circumstances. Counseling and groups for the patients who keep testing dirty needs to be even stronger, as they try to give these addicts the tools they need to stay clean.