Methadone with and without counseling

Drug and Alcohol Findings reviews research on the impact of counseling for methadone patients.

While across the board there was significant improvement, being assigned to standard/enhanced versus interim (no counseling) programmes did not further improve retention, illicit drug use and related problems, or make much difference to criminal activity. There was no evidence that interim patients has been substantially disadvantaged by the four-month period during which only emergency counselling was available and during which they could not ‘earn’ take-home doses by providing ‘clean’ urine tests.

The findings are consistent with other studies at typical US methadone clinics. They strongly suggest that rather than making such services obligatory, opioid agonist treatment regulations should allow for additional services where these are both helpful to and wanted by patients. As well as increasing costs by imposing services that may or may not be needed, mandating these services has the unintended consequence of denying access to more basic treatment which is demonstrably of value to patients and to society. The findings also raise questions over discharging patients simply because they have not attended the required number of counselling sessions.

Some of the obvious possible explanations are:

Counseling is not effective or necessary with opiate addicts. [But, we know it’s effective with doctors.]
Methadone interferes with counseling, possibly leaving patients unavailable for counseling. [There’s some evidence for this with MAT. Here, here, here, here, here and here.]
That the dose of counseling methadone patients receive is ineffective. [It seems pretty intuitive that once-a-month counseling is likely to be a sub-therapeutic dose.]