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Heroin Counseling

Heroin counseling is generally done with a licensed therapist who holds regular sessions with a recovering user. The idea is that users can achieve abstinence and begin recovery based on the discussions and the techniques used during counseling.
The two most common forms of therapy for heroin addiction are contingency management and cognitive behavioral therapy. Both therapeutic approaches may be applied on an individual or group basis and in an inpatient or outpatient setting.
Counseling may also be combined with other treatment interventions and therapeutic services such as medication, employment assistance, and 12-step programs.

What Is Drug Counseling?

Drug counseling, or therapy, is when someone speaks with a trained professional in a confidential environment where thoughts, feelings, and behaviors can be explored and processed.1

Therapy can take place individually or in a group. During individual therapy, the patient meets one-on-one with the provider to focus on their issues and work toward their personal goals. In group therapy, the patient may meet with several other individuals plus the provider. Group therapy may be used in combination with individual therapy to help the person build their support system.2

Doctor with patient discussing treatment options

Whether it takes place in a group or individual format, therapy is a core component of all inpatient and outpatient rehab programs. Inpatient rehabilitation programs are conducted in hospitals or other residential settings and are able to offer more intensive, comprehensive care than outpatient rehab. People who attend outpatient therapy are likely to meet less often and spend less time in sessions than those enrolled in an inpatient or residential program.2

Additionally, counseling may take place over different time frames. For example, some people may only need to meet with a therapist on a regular basis for a few months, while others may need to engage in therapy for several years.

The type of therapy, setting, and amount of time in therapy will depend on what issues are being treated and what goals the patient is working toward. Goals are determined at the beginning of the therapy process and may focus on numerous concerns, such as substance use, maintaining a recovery plan, building skills, and improving social, family, professional, and educational life.2

Heroin Counseling and Drug Interventions

Behavioral therapies are often used to treat heroin addiction. Two therapies found to be effective are cognitive behavioral therapy (CBT) and contingency management (CM).

  • CBT focuses on modifying thoughts and behaviors that can lead to drug use, as well as exploring the effects of continued drug use, recognizing situations that could cause cravings, and finding ways to avoid or cope with those situations.3
  • CM is a technique that includes giving patients rewards, such as food items, movie passes, and other goods and services to reinforce healthy and positive actions, including maintaining sobriety.4

Motivational interviewing and family therapy are also sometimes used as heroin counseling methods.

  • Motivational interviewing involves accepting the point the person is at in their recovery and helping them resolve their ambivalence about quitting drugs or alcohol by working with a therapist who is empathetic and supportive.5
  • Family therapy includes the patient and one significant other—or a parent, in the case of adolescents—meeting with a therapist to learn strategies to improve their home life and reduce substance abuse. Patients develop goals and choose their own interventions, which may involve a contingency management system of rewards.6

Some therapy techniques are especially helpful for young adults. These include the Adolescent Community Reinforcement Approach (A-CRA). This approach takes place in outpatient settings and uses cognitive behavioral techniques to help teens deal with environments and triggers that foster drug use. It teaches and encourages new social skills that support recovery and sobriety, rather than those that led to substance use.7

It’s important to find a therapist you feel comfortable working with so you can build trust. The bond with your therapist will allow you to open up, explore concerns, and work toward positive changes in a safe environment. Also look for someone who’s licensed and specializes in addiction, and who has experience working with people addicted to heroin or other opioids.

Supplemental Recovery Services

Counseling is an essential component of heroin addiction treatment and recovery, but it’s not the only piece of the puzzle. People who are recovering from addiction often need other services in treatment, such as medical care and medication. They also need continuing support after treatment to help them get back on their feet, stay clean, and feel connected to the recovery community.

A comprehensive treatment plan will therefore often include other supportive services, which may include the following:

  • Medication-assisted treatment. The medications that are FDA-approved to treat opioid dependence include methadone, buprenorphine, and naltrexone. These medications are prescribed to manage withdrawal symptoms and reduce cravings to better prevent relapse and stabilize someone in recovery. Research shows that heroin counseling is most effective when combined with medication.8
  • 12-step programs. Programs such as Narcotics Anonymous (NA) include informal meetings with others who have experienced struggles with addiction. These groups allow the user to hear and share experiences on heroin and other substance use, build an understanding support system, and connect with others who may have had similar experiences. Further, such groups allow the user to connect with a sponsor who can provide recovery wisdom to help with maintaining sobriety, especially during difficult times.
  • Employment and education supports. Employment counselors can assess job interests and strengths, assist with a job search and interviews, and explore possible accommodations that might be helpful in school or in the workplace. Employment is essential for livelihood, and it can also be a welcome distraction for someone who is working to avoid relapse.
  • Parenting education. Parents can engage in sessions with therapists, take classes, and attend trainings where they learn how to cope with their child having mental health and/or substance use struggles, deal with their own substance abuse, and learn how to support their children through recovery.
  • Treatment of physical health problems. Many heroin users have medical issues that need to be treated once they’re in recovery. Heroin-related conditions to be aware of include hepatitis C, HIV, lung complications, and cardiovascular issues such as blood vessel inflammation and heart valve infections.97
  • Treatment of mental illness. Some heroin users also struggle with mental health issues, and it’s important to treat any co-occurring conditions to help maintain long-term abstinence. Heroin counseling can address any mental health disorders, but it’s essential to be honest with a therapist about your mental health history since untreated mental illness may increase the risk of relapse.
  • Sober living. Sober living environments provide a substance-free residence. They can be especially helpful for those who are at the beginning of their recovery journey, have recently stopped using, and may be vulnerable to relapse. In such environments, the user is surrounded by others who are also sober and who can offer support as the person looks for a job or works on their education.

If you or someone you know is struggling with heroin addiction, please know that many treatment options are available to you. Finding the treatment approach that best fits your needs can set you up for making positive changes, maintaining sobriety, and living a much healthier and happier lifestyle.

Sources

  1. National Alliance on Mental Illness. Psychotherapy.
  2. Substance Abuse and Mental Health Services Administration. (2018). Treatments for Substance Use Disorders.
  3. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine).
  4. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine).
  5. Substance Abuse and Mental Health Services Administration. (1999). Treatment Improvement Protocol Series, No. 35: Chapter 3 – Motivational Interviewing as a Counseling Style.
  6. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Family Behavior Therapy.
  7. Substance Abuse and Mental Health Services Administration. (2016). Adolescent Community Reinforcement Approach (A-CRA)/Assertive Continuing Care (ACC) (A-CRA/ACC).
  8. National Institute on Drug Abuse. (2018). What are the treatments for heroin use disorder?
  9. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

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