Question

1)You are a counselor - a client you are seeing has a heroin addiction for the past 10 years. He injects (IV) the drug 4-5 times a day. He has had multiple detoxes, rehabs, and attendance at recovery groups but just can't get sober. He really doesn't want to stop using the drug but recognizes the attendant problems, such as risk for HIV & hep C, with using IV drugs. what modality of treatment would you recommend and why?

Answer 1

As the client is a chronic addict of heroin and had many session of deaddiction for him a multi factorial approach is needed.The specific kinds of treatment used usually depend on:

• the individual
• the substance being used
• any coexisting medical conditions

A variety of effective treatments are available for heroin use disorder, including both behavioral and pharmacological (medications). Both approaches help to restore a degree of normalcy to brain function and behavior, resulting in increased employment rates and lower risk of HIV and other diseases and criminal behavior. Although behavioral and pharmacologic treatments can be extremely useful when utilized alone, integrating both types of treatments is the most effective approach.

Pharmacological Treatment

Detoxification is a useful first step when it is followed by some form of evidence-based treatment. Effective medications include:Methadone, Buprenorphine,Naltrexone .

Going through detox from heroin can be painful and uncomfortable, on top of intense cravings for the drug. People sometimes use heroin to stop the pain from withdrawal and detox itself.Detoxing from the drug is the first step in most treatments. If detox is physically impossible to endure, further treatment will be less effective. To enhance the safety of detox, it’s best the person is medically supervised. Hospitalization will be a better choice for him.

Behavioral treatment

Behavioral treatment can be done in either outpatient or inpatient treatment settings. It can include:

• individual therapy
• group therapy
• contingency management

For him group therapy will be more effective because it involves group mixing, discussions , sharing of feelings, so that he may develop a feeling of togetherness which will enhance his recovery.Cognitive-behavioral therapy have been shown to effectively treat heroin use disorder, especially when applied in concert with medications.It also help him to identify triggers of drug use,build coping skills when faced with cravings,develop ways to deal with relapse, identify and cope with any issues that might be causing emotional discomfort.

Techniques of cognitive therapy include

1. Cognitive restructuring or reframing. ...
2. Guided discovery. ...
3. Exposure therapy. ...
4. Journaling and thought records. ...
5. Activity scheduling and behavior activation. ...
6. Behavioral experiments. ...
7. Relaxation and stress reduction techniques. ...
8. Role playing.

For this client pharmacological and cognitve bahavioural group therapy is advisable