The interaction between counseling and methadone in the treatment of narcotic addicts: the challenge of the counseling relationship.

Despite the real and symbolic inportance of methadone to the drug addict, the counseling relationship is still central to the rehabilitative process. This paper discusses the unique aspects of counseling relationships in methadone programs due to the interaction of the physiological and counseling components of treatment. A point of view is presented which emphasizes the need for an open and honest discussion of the worker's role and the expectations of the program early in the treatment process as a means of establishing a therapeutic contract. Affirmation of the authority inherent in the worker's role, and in the structure of the program, lends structure to the counseling relationship and facilitates the rehabilitative process. The contract will also help the patient clarify his personal goals of treatment. It has been noted that methadone can speed up the rehabilitative process because it allows the addict to shift his attention away from the craving for drugs. While counseling staff view methadone as a tool to help patients achieve physiological stability so that psychosocial rehabilitation can occur, patients often view methadone as the primary component of treatment. This differing view of the role of methadone in treatment can lead to conflicts between patients and counselors. The skill of the counselor lies in helping the patients move away from a singular concentration on the drug (methadone), by encouraging a longer point of view and the first steps in the process of personal and social rehabilitation.