Weiner H, Schut J
Int J Clin Pharmacol Biopharm. 1975 Jun;11(4):292-8.
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.
尽管美沙酮对吸毒者具有实际和象征意义，但咨询关系仍是康复过程的核心。本文探讨了美沙酮项目中咨询关系的独特方面，这是由于治疗的生理和咨询成分相互作用所致。文中提出了一种观点，强调在治疗过程早期就对工作人员的角色和项目期望进行开放和诚实的讨论，以此作为建立治疗契约的一种方式。肯定工作人员角色和项目结构中固有的权威性，可为咨询关系提供架构，并促进康复过程。该契约也将帮助患者明确其个人治疗目标。有人指出，美沙酮可加速康复过程，因为它能让吸毒者将注意力从对毒品的渴望上转移开。虽然咨询人员将美沙酮视为帮助患者实现生理稳定从而进行心理社会康复的工具，但患者往往将美沙酮视为治疗的主要成分。这种对美沙酮在治疗中作用的不同看法可能导致患者与咨询师之间产生冲突。咨询师的技巧在于通过鼓励从更长远的角度看待问题以及个人和社会康复过程的第一步，帮助患者摆脱对药物（美沙酮）的单一关注。
