Counselling and other supports
Combining counselling with opioid agonist therapy (OAT) is highly recommended for all OAT clients. Addiction is often a consequence of unresolved emotional issues that cannot be addressed by OAT. It is generally accepted that OAT with counselling is far more effective than OAT alone.
The level of counselling services that are available through OAT providers varies widely. Some doctors provide counselling along with medical care, some clinics have counsellors on staff who offer individual and/or group counselling, and some OAT providers offer no counselling support at all, leaving it up to the client to seek out counselling services elsewhere.
If the level of counselling support offered by your OAT provider does not meet your needs, consider seeking out a psychological assessment to help identify and address issues that may be affecting your emotional health. A history of neglect, abuse and other kinds of trauma is common among people with addiction. Dealing with an addiction often requires dealing with these issues as well.
Counselling services can be provided by a drug treatment counsellor or a social worker, or by your doctor. The level of training and experience of counsellors can vary widely, from those who can tell you where to find food banks and hostels, to those who are able to treat complex psychological problems. Be aware also that counsellors vary in their approach to substance use issues. Some are abstinence based, and may require that you stop all drug use before accepting you as a client. Others are more interested in harm reduction, and are willing to work with you “where you are at.” Make sure you are comfortable with the counsellor’s approach, and that you feel respected, understood and supported. It can be a challenge to find a counsellor who is a good match for you, but it can be well worth the effort.
If you are considering an intensive “rehab” experience, note that many residential treatment centres and therapeutic communities are abstinence based. Some accept residents in OAT, but some don’t because they don’t have a pharmacy on-site or the staff to monitor trips to the pharmacy.
Get started by discussing your counselling needs with your treatment provider to see if you need a referral to outside services. You can also call the ConnexOntario Mental Health (1 866 531-2600) or Drug and Alcohol (1 800 565-8603) helplines to connect you with the counselling services you need. Be prepared that it could take a while to get an appointment with a counsellor; waiting lists are common.
Prior to counselling I didn’t realize why I got into this mess. There are diverse reasons why people do drugs. I took drugs as a way of getting away from things, but it made it much worse. Counselling helps you to deal with the issues and to move in a positive direction.
Shaun, 36 | Methadone, 4 years
It’s accepted wisdom that talking out your problems with someone you trust can help to make things clearer, simpler and easier to solve.
Most often the person you trust is a friend or family member. This is the person you call when you want help or advice. This is the person who listens. If you have someone like this in your life, someone who can offer you support, you may be more fortunate than you know. Strong personal relationships give emotional strength, and you need that strength to learn to live without drugs.
Even if you have a good friend, it is still a good idea to seek out the services of a qualified counsellor. Your friend may be wise in many ways, but he or she may not know how to help you in your struggle with drugs. Sometimes your friend may be too close and too involved to be able to provide the support you need. Find a counsellor with experience in helping people in your situation.
Having the services of a good counsellor can also help to ensure that you keep your good friend. If you’re trying to get through a difficult time in your life, you may be looking to your friend for help a little too often. You may not be able to offer much in return. You can avoid stressing your relationship by laying the heavy stuff on your counsellor. Your counsellor’s job is to listen, to understand and to help you solve your problems for yourself.
You have to work at your recovery; it’s more than just going and getting methadone everyday.
Gemma, 31 | Methadone and
buprenorphine, 4 years
You may find it difficult to open up and trust your counsellor at first. He or she understands that and is willing to help you at whatever level you need. People starting OAT may need help to find a better place to live, to get a job or get into school, to heal relationships, to get through court or to get their kids back. When you’re ready, you’ll be encouraged to talk about your drug use.
As you progress in counselling, you should find it easier to relax and open up. Your counsellor is not going to judge you for what you have or haven’t done. Your counsellor’s job is to understand and, more importantly, to help you understand why you use drugs. You’ll talk about the people, places and things that make you vulnerable to using, your past attempts to change your use, and the challenges you are currently experiencing with changing your use. You’ll talk about what will happen if you continue to use, and what will happen if you stop. Your counsellor will work with you to set goals, and then provide the support you need to work toward those goals.
Counselling may be optional, but the success of your treatment may depend on it.
Counselling has been very important. I may not be ready to discuss something, but my counsellor brings it up and we talk about it a little bit, and the next time a little more, so you get into it, and she doesn’t force it.
Ruth, 64 | Methadone, 22 years
Counselling has been an integral part of my learning to understand the process of addiction, the situation and feelings that created a desire for escape. It has provided me with validation for my feelings and put issues into proper perspective.
Courtney, 39 | Buprenorphine, 1 year
Engaging in trauma therapy has been absolutely critical to my recovery. I was not aware of how desperate I was to numb my feelings.
Jessica, 36 | Methadone and
buprenorphine, 3 years
To succeed you can’t just take it and not follow up with counselling. Anyone on methadone needs to sit down with a counsellor minimum once a month.
Chantale, 35 | Methadone, 6 years
In addition to individual counselling, you may be encouraged to participate in group therapy. Group therapy can provide an opportunity to connect with others who have had experiences that are similar to yours. It can be helpful to realize that you are not alone, and the exchange of strategies and feedback with others can be therapeutic and rewarding. Consider seeking out group therapy through your OAT provider.
My last big rehab was group therapy based and it was crucial for me—I called it my lottery win. My take on addiction—you’re doing that to yourself for some reason—and to stop it, you need to find out what the issues are, and to deal with those issues. I did that through a combination of group therapy and one-on-one with professional people.
Glen, 59 | Methadone, 15 years
Family therapy provides a safe space for family members to communicate openly and effectively. People often hide their drug use from their family. Families may be unaware of what is happening until the situation becomes a crisis. Families need to understand why their family member uses drugs and what they can do to help. Family therapy also helps the person who uses drugs to understand how it affects other members of the family and what support their family members can offer.
Family members and friends may also wish to seek out the support of other families who are experiencing similar challenges. To find family support in your community, contact ConnexOntario’s Drug and Alcohol Helpline at 1 800 565-8603.
When people think of support for people with addictions, they often think of 12-step mutual support groups such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). These groups can be helpful, but they don’t suit everyone. One issue is that AA and NA discourage all substance use and may consider OAT to be a form of substance use. This can vary though, depending on the group. Another issue is that NA groups may introduce you to people who are losing the struggle to stay away from drugs and who may not be the best company for you at a vulnerable time.
On the other hand, some people say these groups provide exactly the support they need. It’s a personal choice. If you think you’d like to try an AA or NA group in your community, you may want to check first to see if they welcome OAT clients.
I have participated in these groups and have mixed feelings. The groups can be catty but the principles are something to ponder. They can be helpful. Take from it what you want.
Randall, 29 | Methadone, 7 months
My exposure to NA has been mostly negative. I don’t see the merit in constantly reinforcing your addiction by using the mantra “I’m Ben and I’m an addict.”
Ben, 27 | Methadone, 8 years
NA is good support. You get people’s numbers. If you get that urge you can call someone. You can go to meetings 24/7. Groups are very helpful.
Brett, 50 | Methadone, 1 year
Some communities also offer groups that are not based on the 12-steps. SMART Recovery groups are becoming more available in Canada. These groups focus on increasing motivation to quit, handling urges, developing new ways of coping and creating a healthy, positive lifestyle. Another option is Women for Sobriety, which has an aim to empower women to handle life situations without resorting to alcohol or drugs. Both offer online support as well as meetings. To find out more about mutual help groups, see the “Websites” section.
Another form of help that may be available in your community is peer support. Peer supporters are generally well educated and trained in supporting people with addiction. Check with you local community health agency (see “Community Health Centres in Ontario” for links to agencies in Ontario), or ask your OAT provider about peer support.
If you cannot find the right support for you in your community, or you are at a point in your recovery where you feel you can offer support to others who might benefit from your experience, consider forming a group or becoming a peer support worker yourself.
Few people can stop using drugs overnight just because they decide they want to quit. You may have to learn a whole new way of living. For most, it is an ongoing process that takes time, patience and determination. Make your decision and follow through. Don’t be afraid to ask for help when you need it. You may even be able to offer help to others. It will get easier.
I changed my whole life. I knew too many people. People don’t care if you’re trying to get help, they’re still going to offer you to get high; it’s just the way it is. You gotta find other things to do.
Paul, 57 | Methadone, 4 years
What’ll I do if I don’t do drugs?
Doing drugs can fill up your day. It’s a busy life: getting the cash, finding your dealer and getting high. Drugs can be a reason to get up and go out. They can offer an identity, a lifestyle, a career. Drugs can block out the past and stand in the way of planning for what’s ahead. When you go on OAT and you stop using drugs, the days will open up. You’ll be able to choose from a variety of possibilities of what you might do with your time. Drugs won’t decide it for you.
The surprising thing is, this newfound freedom can be hard to adjust to. For some, the time is easily filled and welcome. This may be the chance to get back to school or to get ahead in your work. If you have small children, your days can fly by taking care of them. Others may need to search harder to fill the gap that drugs have left. If boredom sets in, it can make you vulnerable to relapse. You need to find new ways to spend your day.
Having things you want to do with your time, that you enjoy, that you take pride in and that make you feel good about yourself can be a great motivator to staying off drugs. Getting out to get your dose takes up a chunk of the day, but it still gives you plenty of time to do other things. If it seems like everyone else is busy and you’re left with nothing to do, take that time to work out what you want to do. Talk it over with your family, your friends, your counsellor. Think about what you used to do before drugs took away your time. Renew those interests and activities, or find new interests. Use the time to make your life your own.
. . . learning to manage, or control, or simply live with an opioid addiction is not really about stopping the use of narcotic drugs. It’s more about learning how to find satisfaction and meaning through your interactions with the world and the people around you.
Sean W., 36 | Methadone, 15 years