ENTRY: MAT Protocol in Need of Empathy–NOT Sympathy

As a person facing true substance use disorder, you do in fact have many options when it comes to attaining sobriety, and in turn a life built around everlasting recovery.  Inpatient rehabs are widely considered the gold-standard when it comes to initial sobriety.  I say ‘initial’ since, just as with any option for treatment, getting clean and staying clean are concepts drastically independent of each other.  I don’t intend to stress anyone out about this either, but you can also go with a sort of combo of treatment selections.  For example, you could opt for weekly attendance at AA or NA meetings in addition to medication-assisted treatment, like Suboxone or methadone therapy.

A patient taking her daily dose of methadone, or “dosing” to which it is colloquially referred. 

Moreover, just as with every treatment option that involves you seeking assistance of someone other than yourself, there are certain strict standards that must be met on a consistent basis in order for the modality to remain licensed.  Thankfully, Americans reside in a nation that, even in the scathing face of an unhinged opioid crisis, every legitimate service out there appears to be held to accountability.  This is strictly for our benefit.  Personally, it was just over five years ago when I decided to check into a local methadone clinic.  Honestly, even though the term “methadone clinic” has become laden with tremendous stigma, no matter what it’s called, it truly changed my life for the better.  Admittedly, I had to do most of the tough work myself, but finding out what these clinics were all about has positively served me in ways I would have never envisioned.

To elaborate on that last thought; I grew to love going to my counseling appointments and chatting with the nurses everyday.  Furthermore, I became fascinated and quite curious about how these facilities functioned on every single level — theoretically, medically, ethically, financially, legally, scientifically, statistically, etc.  I wanted to find out as much as I could because, hey- you have to admit, MAT clinics are extremely unique places.  If you’re not familiar with them, let me set the scene.  It’s morning time.  You have patients steadfastly approaching some blank, warehouse-style building in their half-awake, stoic fashion.  Upon entering, patients check in with a desk clerk, guard, or they merely scan a key fob.  After patients pass through into the “dosing area,” the only sound emanating from here is the faint, obligatory clamor between nurse and patient (always just prior to the nurse dispensing the medicine).  And that’s just about it.  Wash, rinse, repeat, no joke.  It seems monotonous and droning, but there actually is more going on behind-the-scenes than you’d think, and patients are federally-mandated to complete their respective counseling duties on their own time, during business hours of course.

Standard dosing window, where patients typically receive methadone.

And this is what leads me to the main idea of today’s post.  Basically, no matter which “phase” of treatment you’re in at the clinic, you’ll always have to complete at least one group counseling session per month.  It’s really not much at all, and there are plenty of patients who actually allow themselves to get three, four, sometimes five months behind on their groups, unfortunately.  This is a state requirement (Maine), but federal laws denote similar requirements, unless one’s respective state requires more counseling time.

For roughly six months now, I have been co-facilitating one of these required “groups” offered to patients at my original methadone clinic.  I do this on a voluntary basis, and it was my idea; I just love it.  At this particular facility, patients have a whole calendar’s worth of groups that they can pick from every month when it comes to selecting which group to go to.  This particular place, in my opinion, does a very solid job at trying to make these groups fun.  However, this system has its flaws.  Hey, I understand that by imposing this requirement, part of the reasoning behind it is so that the patients don’t perceive their recovery as being limited to a fixed dose of diluted medicine.  (Lest we forget?  It was this “take-a-pill” mindset that really poisoned many addicts’ minds  before they even became addicts!)  Nevertheless, some of these patients have been attending this type of facility for more than 10 years.  It’s like this in every country that permits methadone treatment.  We even have patients that have been going in excess of 20 years.

I’ve been a methadone patient, so I’m not going to be like everyone else and just assume that those patients don’t need methadone at this point, and they probably could have simply “stopped taking it” after six or nine months.  I think it’s absolutely amazing and beautiful if they’re still there at 20 years.  Look at it this way, they’re most likely not dishin’ out massive amounts of drugs from the back of their cars after two decades of the usually controversial opioid replacement!

group-therapy-1The group over which I reside is called, yup — you guessed it!  It’s the Calling All Addicts group, as it is oh-so suitably titled.  Plus, it is basically an audio version of this blog.  It’s laid back; even though I preside over the crowd each time, I only steer our open-ended conversation.  Patients are allowed to introduce their own topics, as long as they relate to addiction & recovery.  Honestly, it’s not rocket science.  My initial intention with the group was to hone in on the infinite civic and societal effects of drug addiction in Maine and the United States today.  So far, CAA has been extremely successful.  Alas, when I actually discovered that patients (whom I didn’t even know) had been locking horns trying to get into an open seat in the group, I felt humbled.  This was a wonderfully gratifying feeling.
groupsessiontalkThe fact of the matter is, veteran patients will undoubtedly grow tired, maybe even disenchanted by the same ole thing every month.  That is, if they haven’t already, and they probably have, after so many years.  And no, I’m not saying it’s the clinic’s fault, their hands are basically tied from a legal and procedural standpoint.  However, the facility where I hold the CAA group deems me a patient.  Even though a counselor must be present in the room when I have the group, she never says anything (truth is, I talk more than enough for the both of us!).  Alas, the policies are there and do in fact exist for patients to invent their own groups.  This brings me to my point.  It is my strong opinion that MAT centers should start requiring patients to work with each other every month.  To facilitate two individuals connecting over a mutual hardship, like addiction, is a beautiful and truly inspiring concept.  And proof that I know I’m not the only patient that feels this way lies in the basic notion that my group has been full and completely booked to capacity for the last two months, straight.  (With a doubt, this made me feel really good when I found out!)

In the same fashion that support groups exist as social strongholds for groups of people brought together by their mutual undertakings, so do these groups.  Even though they are a necessary part of one’s treatment in an MAT program, they don’t have to be dull and unrelatable.  They shouldn’t be.  Empathy is an effective bonding agent.  So, in the end, it’s really no surprise that a patient-led group is popular and enjoyable… to other patients.  Who would’ve guessed it!?