The Methadone and Family Therapy Clinic for Adolescents
Providemethadone maintenance treatment (MMT) and concurrent family oriented psychotherapy services and psychoeducation to adolescents with DSM-IV-TR diagnosed heroin abuse/dependence Yes, you read correctly…adolescents.
Provide early, comprehensive treatment toheroin dependent/abusing adolescents in aneffort to cease future heroin usage as well asreduce the likelihood of complicationsassociated with heroin use. Focus is placedupon the family unit.
Stanton, et al. (1978), proposed that the heroin’s chronic relapse nature is explainable from the viewpoint of family system’s theory Estimated yearly cost of untreated addiction of opiates – 20 billion (2) Estimated 1 million persons for opiate addiction (including heroin) (2) Provide early methadone treatment for adolescents with heroin abuse/dependence to aid these persons in ceasing heroin usage Provide psychotherapy services to adolescents “…families of young adult heroin addicts tend to differ from normal families or other dysfunctional families in a number of ways” (10) There is a relationship between family functioning and drug abuse (11) Research indicates family dysfunction after substance abuse treatment completion can lead to relapse (11)
Methadone treatment is beneficial, however, many individuals do not remain in active methadone treatment for the minimum period of one year – most of these individuals will replapse (2) It is not uncommon for individuals to continue using upon treatment admission to methadone maintenance programs (2) Financially, untreated opiate addicts rack up about $20 billion (2) Methadone maintenance is a valid treatment approach (2) Estimated cost of methadone treatment per day is $13 (5) Single doses of methadone can last up to 36 hours depending on dose of course – significantly longer time period than heroin (7) There is also possibility for addiction to methadone, which psychotherapy will help to address this potential issue Methadone is low cost compared to other potential drug treatments (8) Methadone considered to be choice treatment for opiate addiction (9) Detoxification from methadone relapse rates are quite high ranging anywhere from 50-90% one year after treatment – hence inclusion of mandatory psychotherapy (9) OVERALL: methadone will stabilize the client for psychotherapy
Minimum duration of treatment as indicated by studies is 12 months continuous use (2) Average daily dosage range 60 to 120 mg (2) Noteworthy potential benefits are not just beneficial to society but also the individual (2) Reduction/ceasation of injectable drug use Common diseases acquired through injected drugs include: HIV, STDs, hepatitis C/B, bacterial infections, etc (2) Reduction in overdose risk Reduction in mortality risk Family stability improvements Possible reduction in criminal activity
Outpatient Treatment Program 1 Year minimum treatment duration Treatment must be concurrent: psychotherapy in conjunction with methadone maintenance Services provided by substance abuse experts as well as family therapy trained psychotherapists Weekly drug test screenings
The treatment program will be broken down into 3 phases (adapted in part from source 3) Phase 1: Stabilization Consists of recognition of need for drug abstinence, initial administration of methadone, struggles with continued heroin use, psychotherapy to address struggles, etc. Minimum duration of 8 weeks Phase 2: Transition Targeted at learning about and the management of addiction process (including withdrawal), motivation development, increased focus on family infrastructure and client’s role in family Phase 3: Community Focus upon development of prosocial community and family connections
Methadone Maintenance treatment Mandatory weekly physician appointment Methadone to be administered on a daily in- person basis by a licensed medical professional with the proper credentials Substance abuse/dependence group therapy, minimum of 1 hour per week Therapy Services Individual therapy, minimum of 1 hour per week Family therapy, minimum of 1 hour per week Psychoeducation, minimum of 1 hour per week
Topicsinclude, but are not limited to methadone treatment, substance abuse, role of the family, etc. Specific topic examples can be (partially adapted from source 3): Treatment regulations for methadone Problem solving Relapse prevention The addiction cycle Owning one’s addiction Blood born pathogens Stress management Relationship boundaries
Potential clients can be referred via parent(s), physician, agency, or self-referred providing parental consent is acquired Potential clients will complete a diagnostic evaluation Family involvement/caregiver involvement, at least one family member/caregiver must be actively engaged in the treatment process with the adolescent
Family therapy model Focus primarily – Brief Strategic Family Therapy Robbins, et al. (2011), found when compared to treatment as usual community based programs that this brief approach yields higher retainment of adolescents and improved family functioning according to parents Is an effective model for adolescent substance abuse (12) Primary aim is to “reduce adolescent behavior problems by improving within-family relationships between family members and other important systems that influence the youth’s behavior…” (12) Support exists for effectiveness in minority families as well (12)
Parental consent/child assent Adolescents ages 14 to 19 Failure to attend 2 consecutive psychotherapy sessions (whether family, individual, or psychoeducational) will result in temporary cessation of methadone administration, after one week of continuous attendance for psychotherapy, methadone treatment will resume.
Automatic termination upon age of 19 (referred/transferred to another program) Failure to sufficiently attend psychotherapy Misuse of methadone (sharing, selling, etc) Complete lack of caregiver/family involvement – treatment process targets family involvement, therefore, at least one member must be actively engaged in the treatment process with the adolescent
Methadone maintenance is effective to a degree, however, it is not a comprehensive treatment approach by itself. It may help wean the person off of heroin, however, there is the potential for long term use. Methadone maintenance is a temporary bridge to psychotherapeutic treatment. Family based therapy will aid in repairing dysfunctions in the family with emphasis on the client.
(2) Center for Disease Control. (2002). Methadone maintenance treatment. http://www.cdc.gov/idu/facts/MethadoneFin.pdf (9) Craig, R.J. & Olson, R.E. (2004). Predicting methadone maintenance treatment outcomes using the addiction severity index and the mmpi-2 content scales (negative treatment indicators and cynism scales). The American Journal of Drug and Alcohol Abuse, 30, 823-839. (8) Eder, H., & et al. (2005). Comparative study of the effectiveness of slow-release morphine and methadone for opioid maintenance therapy. Society for the Study of Addiction, 100, 1101-1109. (5) Methadoneclinic.com. (unknown). Methadone treatment approaches. http://www.methadone- clinic.com/treatments.php (3) New Brunswick Addiction Services. (2009). Methadone maintenance treatment policies and procedures. http://www.gnb.ca/0378/pdf/methadone_policies-e.pdf (12) Robbins, M.S., & et al., 2011). Brief strategic family therapy versus treatment as usual: results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology, 6, 713-727. (11) Rowe, C.L. (2012). Family therapy for drug abuse: review and updates 2003-2010. Journal of Marital and Family Therapy, 38, 59-81. (1) Stanton, M.D., et al. (1978). Heroin addiction as a family phenomenon: a new conceptual model. American Journal of Drug and Alcohol Abuse, 5, 125-150. (7) University of Maryland. (2005). Methadone. http://www.cesar.umd.edu/cesar/drugs/methadone.asp (10) Volk, R.J., Edwards, D.W., Lewis, R.A., & Sprenkle, D.H. (1989). Family systems of adolescent substance abusers. Family Relations, 38, 266-272.