Three consecutive, professionally led (as opposed to self-help) groups following the 12-step program (TSP) were integrated into a methadone maintenance treatment (MMT) program that included 32 heroin-addicted individuals in recovery. This report describes our experience in meeting the challenges that arose and our conclusions regarding the therapeutic potential of this integration. A professional therapeutic staff guided the groups. In-depth interviews of 10 participants and the reflections of the group leaders provided data for learning about the groups' experience. Initially the participants rejected the concepts of Step 1, powerlessness and unmanageability of life. The assimilation of Step 4 (defining character defect) also aroused some resistance. The participants eventually adopted the pragmatic aspects of TSP, including its terminology. The establishment of a common language of recovery helped to create group coherence and a sense of belonging, and helped to meet the needs of those who felt stigmatized by both the nonaddicted and addicted population undergoing nonmethadone recovery. TSP could be adapted to various aspects of daily life, produced a sense of self-efficacy, and stimulated motivation for change. Therapeutic implications are discussed.
We studied stability of sense of coherence (SOC) over time and in relation to the outcomes of former heroin addicts in MMT. Between September of 2003 and April of 2006, all 90 newly admitted patients to a MMT clinic in Tel Aviv were studied and followed up for one year. A SOC (inner resources) questionnaire was done at baseline and after one year. Use of opiates, cocaine, benzodiazepines, cannabis and amphetamines in the 13 months after admission was recorded, and defined as positive if at least one urine test for any drug was positive. After one year, 77 (85.6%) stayed in treatment. SOC scores were similar at baseline and after one year, but were lower among 42 patients who still abused any drugs (118.8 + 27.4), compared with the 35 patients who did not (128.5 + 26.5, Repeated measures, Groups p = 0.003, Time effect p = 0.5, Time*Group p = 0.003). Cumulative retention revealed that 30 patients with SOC scores greater than 130 had longer retention (3.5 years, 95% CI 3.2-3.9) as compared with 60 patients with SOC scores of 130 or less (2.9 years, 95% CI 2.5-3.3). SOC is a stable parameter that can serve as a predictor for success in MMT, both as retention in treatment and drug abstinence.
Many studies have been published on various types of psychoeducational group therapy in methadone maintenance treatment (MMT), but none has ever addressed the issue of group therapy for new beginners, despite the fact that the initial period following the cessation of drug abuse holds promise for many significant changes in an individual's lifestyle and behavior. This article presents an integrative group model for patients newly enrolled in MMT based on a psychoanalytic conceptualization of Hartman's 285 286 D. Potik et al.ideas on adaptation and on Winnicott's contributions about transitional phenomena. The adaptation group includes 10 sessions that relate to significant issues in patients' lives during the recovery process, among them medical information about methadone and addiction-related diseases, prevention of relapse, and anger management. The special characteristics of this group are discussed in the context of specific issues concerning the treatment of MMT patients.
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