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Is Counseling Really Necessary with Buprenorphine Treatment? Ideally, Buprenorphine care includes medication, doctor visits and counseling. Studies such as those done by A. T. McClellan1 and David Fiellin, MD2, have shown that people with opioid addiction do better with counseling and agonist therapy than those who receive medication alone. One barrier often identified by prescribing physicians in the primary care setting is the inability to meet the counseling needs of the patient. There are no clear guidelines as to type or amount of counseling needed. The work being done at Yale will ultimately provide a reproducible manual for counseling using the Cognitive Behavioral 12-step informed counseling approach to treatment which can be used by nurses who are already accustomed to patient education. The cost of seeing a psychologist or psychiatrist may be out of reach for many, yet no counseling is less than optimum when new behaviors and relapse prevention are crucial to maintaining abstinence. When available, individual counseling sessions and group sessions with drug counselors are always a viable option.

Michael Pantalon, PhD, and David Fiellin, MD, at Yale University developed the medically focused Cognitive Behavioral 12-step informed counseling approach to treatment. Pantalon describes it as “An approach to daily life as an addicted person, based on now strategies for abstinence. The patient and nurse counselor work collaboratively to identify triggers and alternative responses to establish abstinence based lifestyle.”

Although not a panacea for treatment, especially for the dually diagnosed, patients who object to counseling in general may find this method compatible because it doesn’t probe emotional traumas. The focus is on the patient’s strongest motivators not on a higher power. This alternative is empowering for those who find NA’s format of publicly confessing personal character flaws to be self defeating. Pantalon says, “Patients need to remember that counseling is not a forever commitment. The patient who doesn’t plan for abstinence is in effect planning to relapse. People need to know there are options outside of NA, AA and psychotherapy. As prolonged abstinence is achieved, visits usually decrease over time.” – Kathleen Gargano, RN

1 McLellan, A.T., I.O. Arndt, et al. (1993). The effects of psychosocial services in substance abuse treatment. JAMA 269 (15): 1953-1959
2 Pantalon, M.V.; Fiellin, D.A.; O’Connor. P.G.; Charwarski, M.C.; Pakes, J.R., and Schottenfeld, R.S. Counseling requirements for Buprenorphine Maintenance in Primary Care: Lessons Learned from a Preliminary Study in a Methadone Maintenance Program. Addictive Disorders and their Treatment 2004; 3: 71-76.

The NAABT discussion board has evolved into an adjunct to traditional counseling and support groups. Besides 24/7 access and the world wide potential for people with similar experiences, it offers something new, “Anonymous Group Therapy” many of the benefits of a group while maintaining anonymity. It’s also serves as a nonintimidating first step toward recovery. It allows someone exposure to many view points and often sparks passionate debates. Ultimately it has the ability to inspire people to better educate themselves about their treatment, which leads to realistic patient expectations and thus better outcomes.

Mike, a member of the NAABT discussion board, took his topic “Counseling with Buprenorphine Treatment” and synthesized it into an article for us. The full topic and ensuing discussion can be found by following this link:

Buprenorphine Treatment Counseling. When I first started counseling I viewed it as a penance, a necessary inconvenience that I needed to get through, as punishment for my addiction. I sat through it and got very little out of it, due to this attitude. It wasn’t until I started looking at it as a way to make my life better, and began to proactively manage and direct my treatment, that I started to make progress. This required an increase in my self esteem.

I didn’t have cravings, or triggers, so there was no motivation to dwell on that then, I needed to rebuild my self esteem, to allow me to repair the rest of my life. Employment counseling, financial counseling, family counseling, general life planning, and doing “non-addict” things is what helped me. I wanted to act and do things like a “normal person” with an illness and not be labeled a “recovering addict”. Whenever I talked with someone I didn’t say “I am a recovering addict”, I said my “addiction is in remission” if I was pressed to answer at all. It’s a little thing, but it reminded me that I had a medical condition, and helped me feel better about myself and view my treatment as positive. I saw my medication as a tool, not a crutch.

In my opinion, counseling needs are different with Buprenorphine Treatment (BT). With most addiction counseling, cravings, relapse, and dealing with triggers, are the main issues. With BT those things virtually vanished almost immediately for me. I could start to work on the other things, the main issues, the original issues, right away. Then when tapering off, developing tools to deal with cravings and triggers became useful.

Sarah, another member offered this view:

Should I stay with the same counselor long term? When I met my first addiction counselor I was at my lowest point. First impressions must account for something even with experienced counselors. As the next couple of months went by, with the help of the counselor and my treatment I got back to normal. For me, drugs were a brief detour in my life and now that I was back to normal I felt much better. It might be just my imagination but I felt my counselor saw me as that person who first entered treatment and all of my improvement, was a direct result of the counseling, instead of a return to normal. I think my counselor felt I had tendency to revert back to that low state, since she saw that as my “normal” when in reality my “normal” was drug free and the drug use was only a temporary deviation. It’s hard to put my finger on it but a slight condescending tone and the focus on consequences of drug use, makes me think she saw my normal state as the one she met that first day of treatment, and that really isn’t who I am.

I decided to get a new counselor whose first impression of me was more accurate, who understood that my drug use was only a temporary detour. That worked wonderfully, I was able to focus on my current issues and felt I had the respect of my counselor who seemed to know and understand me better. I have since ended counseling, but if I have the need in the future I will have no problem seeking it again.

I don’t know if my reasoning was correct, but if anyone finds they are hitting-the-wall with counseling, it may not be the counseling, but the match between you and your counselor may no longer be the best match. Please don’t give up on counseling, but try to find another counselor that better understands and respects you.

what's new at

For updates on the 30 limit restriction see:

4,442 physicians on the SAMHSA
physician locator nationwide.
(Ability to treat 133,260 of the
4,500,000 estimated in need.)

If you are a certified physician please be sure your information is correct on the locator. Please check for spelling and correct phone number. If you know of a colleague who is on the list but should not be due to no longer practicing, please advise. 1-866-287-2728

Sahmsa is now an official buprenorphine training program that satisfies the SAMHSA training requirement for a DATA 2000 physician waiver. Physicians can take the 12 courses on to qualify for their waiver to prescribe buprenorphine. ASAM DATA-2000 Qualifying Training Program Earn – up to 8 hours AMA PRA Category I Credit.

AATOD National Conference

PCSS releases clinical guidelines for buprenorphine treatment concerning, Acute pain, liver function testing, Billing, Pregnancy, and Management of psychiatric medications. See: PCSS Resources at

in the coming months

In addition to Connecticut, the Patient- Physician Matching System is now available in Maryland, Washington DC, and the greater Atlanta and Pittsburgh areas.

Patients in these locations now have an additional way to connect with a certified physician. Click Patient/Doctor Connection at

• Patient expectations
• Damage due to stigma

The Physician Locator (Doctor/Patient button) sorts physicians by distance in geographic proximity, regardless of city, town, county, or state borders.

Click here to try it for yourself.

Current Newsletters are available at the homepage. Past editions are available as PDF files on our Literature page, under Other Literature.


Disclosure: NAABT, Inc. has accepted funding from Reckitt Benckiser (Richmond, VA, pharmaceutical company that manufactures buprenorphine products) in the form of an“Unrestricted Educational Grant.” The grant is “unrestricted” so that there are no “strings” attached. NAABT, Inc. has complete control over how the funds are used, there are no restrictions on the content or mission of this site, and Reckitt has no control over the content of the site or NAABT’s activities. Reckitt is currently the only FDA approved maker of a buprenorphine based product for addiction. NAABT, Inc. is not affiliated with Reckitt Benckiser.

Click here to learn more about NAABT.

The National Alliance of Advocates for Buprenorphine Treatment is a non-profit organization formed to help people, in need of treatment, find treatment providers who are willing and able to treat opioid dependency in the privacy of a doctor’s office. Our website offers answers to frequently asked questions, a glossary, actual patient experiences, a discussion board, information on the history and treatments of opioid addiction, current news on the subject and more.

This newsletter is provided to keep you informed on matters relating to Buprenorphine Treatment. Please feel free to contact us at with feedback, suggestions, or perhaps you would like to contribute a story. Also feel free to photocopy or print as many as these newsletters as you wish for distribution.

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The National Alliance of Advocates for Buprenorphine Treatment NAABT, Inc. • P.O. Box 333 • Farmington, CT 06034 Tel: 860.269.4390 • Fax: 860.269.4391 • email: