Methadone is a drug that is used medically to suppress the withdrawal syndrome of opioids. The class of the drug is known to be seriously addictive for users. Surprisingly, even the medical health care workers are prone to abused of options drugs found in hospitals. Such drugs include morphine’s codeine, methadone and buprenorphine. Those who are admitted with dependence to opioids are mostly abusers of heroin and cocaine. The addition result to disorientation and patients gives much prevalence to the drugs over other needs. They have been described as drug-thinkers. This is because their lifecycle involves using drug, recovering from drug or acquiring drug(s) (Prescott et al, 2003).
Addiction is believed to result from multifarious interaction of factors. This problem cannot be attributed to personal decision or willingness. However, a number of factors determine the rate at which the addiction set in among drug users. These contributing factors include genetic composition of an individual, stress, dosage, age and co-morbidity.
The prevalence of opioid abuse has been on the rise in different countries since 1980s. In Britain, government established that over 150,000 people were abusing opioids in 2008. However, in 2011 the number had shrunk to between 130, 000. The most affected group is the adolescence and the young adult. These two groups consist about 66 percent of the drug abusers in the world. The prevalence of cocaine abuse in Latin America is estimated to be 0.9 percent in 2009. This is much higher than the world prevalence of 0.5 percent. A report produced by the NACADA shows that Colombia is one of the largest world producers of cocaine. The prevalence of this drug in Colombia was 0.7 percent (Gannon et al, 2010).
The problem of dependences has lead to lost safety and broken relationship. The countries are also investing heavily in the health sector with the aim of reducing the complications of these drugs. The use of methadone has been proofed to reduce consequences of dependence by cubing the symptoms. However, means to supplement this method should be devised. The goals of using methadone in opioid dependency person can be divided into; stabilizing individuals with opioid dependence, detoxification of the metabolites and preventing relapse.
The dependence and withdrawal syndromes caused by opioids are believed to have an effect on an individual. They lead to a state where the drug gets the first priority in case such a person has money. Other responsibilities, such as family matters, are neglected. The effects of this condition include; inability to regulate opioids abuse, where the person cannot decide on when to stop, or what level he should take. Secondly, abuse of opioids causes a physiological withdrawal state, where the body graves for the opioids and cannot perform its normal physiologic functions without the dose. This condition leads tolerance intoxication, where the culprit tends to increase the dose of the drug to achieve the level of satisfaction in the body. The individuals persistently use the drug even with knowledge of harmful consequences. Opioid abuses are believed to cause malnutrition, abscesses, deep venous thrombosis and heart complications (Prescott et al, 2003).
The use of opioids as mentioned earlier causes addiction, intoxication and withdrawal symptoms. These conditions further lead to physical illnesses due to inability to control health behaviors. The means of administration of drugs used by the individual contribute substantially to the causes of illness observed in these people. Most of them do share the instrument used for administration of the drugs. Family breakup is another eminent consequence of opioid addiction. This occurs when the addict is the family breadwinner. The family resources are directed to drug abuse, neglecting other family responsibilities. There are also cases of economic hardship among the family members and friends. Moreover, the condition is associated with increased cases of law breaking in the society (Ahmad, Mufti &Farooq, 2005).
When methadone became widely used in treatment of opioid addiction, several professional publications documented its efficacy in support of it use. Methadone treatment has been studied widely, and its effectiveness demonstrated in a replicable and consistent manner. The basic goal of methadone treatment is the cessation of abuse drug use, and this is the basis for psychosocial rehabilitation. (Chang et al, 2002). A treatment improvement protocol published by the federal government states that treatment of drug abuse can be achieved by supplementing methadone with additional counseling. The California legislature passed an assembly bill, which stipulated that every patient on methadone treatment was to receive a minimum of fifty minutes counseling session per month.
Methadone prevalence has been associated positively in overcoming opioid dependence. Thomas (2005) expressed the financial benefits of using methadone. The expenses of buying abusive drug can be reduced by using the drug in the maintenance phase. The drug has also been shown to prevent physical diseases observed among the drug abusers. This is achieved through secondary disease prevention approach.
The literature on counseling and psychotherapeutic approach demonstrates that counseling can be remarkably effective adjunct for patients undergoing methadone treatment to curb drug addiction. Woody studied the effects of individual counseling for diagnosed methadone patients. In a study conducted by Chang, the participants who received supportive psychotherapy and counseling exhibited significantly less opioid use than the participants who did not receive counseling (Chang et al, 2002).
Rosenblum (2007) examined the effect of treatment intensity on opioid abuse in the form of behavioral-cognitive counseling sessions which were combined with pharmacologic approach. In the study, the counseling five sessions per week (either individual or group), and the researchers reported that patients who visited the biggest number of sessions per week demonstrated the greatest reduction in opioid use at follow-up (Marsden, Stewart & Rolfe, 2000).
This led to Rosenbaum team suggesting that the opioid-dependent patients in most psychosocial trials benefit significantly from counseling approaches. They also suggested that non-specific effects of counseling and psychotherapy (for example, education and support) may be effective for patients on methadone treatment to curb opioid abuse. These results are reflected in the field of counseling in regard to nonspecific factors of treatment.
A research conducted by Conchrange and colleagues, which used extremely stringent inclusion criteria, concluded that patients who received counseling during methadone treatment demonstrated a significant improvement in comparison to those who never received counseling. This was further emphasized by Department of Health Evidence Based Practice Guideline (2001), which concluded that there is evidence of effectiveness of counseling in anxiety and depression associated with methadone treatment (Ahmad, Mufti &Farooq, 2005).
Studies reflecting the counseling approach show that counseling for patients on methadone treatment can be effective. However, these studies do not give a rigid conclusion that there is a difference in efficacy between counseling and other approaches. On the same vein, there have been difficulties in establishing the superiority of any counseling model. For any form of counseling to be effective, the clients should be motivated to take part in it.
Apparently, no research has been conducted on the effects of counseling on patients undergoing methadone treatment to reduce the effects of addictive drugs like opioids. It is in this respect that the current study intends to investigate the effects of counseling on patients who are receiving methadone treatment to curb unwanted opioid and other illicit drugs’ effects (Seivewright, 2008).
Stigma associated with drug abuse in the society is a considerable hindrance to treatment seeking behaviors. Many people who are victims of drug addiction are viewed as lawbreakers in the society. The societies tend to inflict a feeling of outcast to these patients. Consequently, the patients end up in severity of the conditions in fear of being eliminated in the society (Chang et al, 2002). The health care providers are not exempted in this, since they also contribute to the negative attitude in health seeking behaviors. However, people should be made aware that methadone is not used to treat drug abuse effects alone, but also approved drug dependence.
The duration of treatment using methadone can be either short-term or long-term interventions. Many patients tend to resume drug use once they stop using methadone. Almost 83% under short-term medication of methadone will resume their prior drug abuse. This is caused by the tendency of the body to crave for the chemical component of the drug. Seivewright (2008) explained the need to implement the long term approach. This mode will help the patient’s body to adapt to nondrug use state.
Moreover, the incorporation of counseling was supported through a study conducted by Gossop, Stewart, and Marsden (2006). The study revealed that patients who underwent psychotherapy were less prone to resuming to drugs than those who missed this session. These patients understood the complications and severity of resuming to drug more properly, than those on methadone without counseling. Many patients who benefited from the therapy were on treatment for a period of not less than four years. Defaulting from the treatment program was also attributed to be a cause of resuming to the drug abuse state.
2.5. Concurrent Disorders
The health care providers are advised to take proper caution when assessing patients with drug dependence. According to the research conducted by Center for Addition and Mental Health (2008), chances of dual diagnosis is common among addicts. The problem caused by the drugs may exacerbate other silent mental ailment. Therefore, the initiated treatment regime may fail to be efficient. Mental assessment during the treatment period should be conducted to evaluate the existence of other complications, signs and symptoms that are not related to addiction. The vitality to incorporate treatment program for co-morbidities will help in improving the effectiveness of methadone treatment. This determining the co-morbidity in patients will help to establish the counseling message shared and the possible drug interaction (Ahmad, Mufti & Farooq, 2005).
The compulsion to undertake this study is derived from the fact that understanding the treatment programs helps an individual to comply with the therapy. Moreover, this condition requires not only medication to fight withdrawal syndrome, but also in-depth psychotherapy (Seivewright, 2008). This will help the person to change the behavior towards abuse of the drug. The individuals need moral support and continuous advice on how to avoid reentry into abuse, despite their body desires. The addicts continue to use the drug not for euphoric reasons, but to overcome the withdrawal symptoms. Physiological and physical dependence leads to diverse withdrawal symptoms. Unless these symptoms are relieved, the patient will be in a stressful situation. The life of these people is full of disgrace and stress. Unless supportive measures to help them cope with the stress are implemented, there would be little achievement with medication only. Therefore, the study will be much benched on the contribution of counseling to the treatment therapy.
a). The dependent variable will be counseling. For each participant in the study, the attendance at the counseling session is evaluated. This will be used to draw deductions on the influence of counseling on methadone therapy patients.
b). Independent variables will include; relapse, rate of recovery, behavior change, and defaulting. The rate at which the individuals resume to the addition state will be considered as a factor contributed by counseling. The same conclusion will be attributed to the other independent variables.
c). Possible confounding variables include; age, level of education, economic status, severity. The group peaked should be evaluated to be of similar characters as possible. This will help to minimize the effect of confounding variables to study.
This involves how the interface of the variables in the research will interact. The testing before the study will help to determine the probable confounding variables that may influence the validity and reliability. The independent variable will be counseling session attendance, which will be used to deduce the consequences on the dependent variables. The rate of the recovery from the intolerance in respect to counseling will help to deduce the importance of counseling on compliance. Cases of relapse or re-entry will be crucial in measuring the psychological improvement.
The counseling sessions are believed to influence the behavior positively, while failure to attend the counseling session may not achieve a lot in behavior modification. It is necessary to help individuals to cope with criminal actions evidence among drug users. Moreover, despite methadone administration, patients may decide to quit therapy. Therefore, initiation of counseling to instill the personal drive in treatment will be evaluated as a vital measure to determine the effect of counseling.
The research questions to be evaluated during the study include;
I. Does the intervention of counseling service benefit the recovery process of methadone treatment patients?
II. Does the use of counseling services sustain recovery from opioids addition and decrease relapse/re-entry to treatment?
This section will delineate the methods and the procedures of the study in a detailed manner. The study will be a quasi- experiment study. It will involve evaluating two groups of individuals undergoing the methadone treatment. One of the groups will consist of patients who attend the counseling session, while the other group will involve those who do not attend counseling sessions. Therefore, nonequivalent group design will be the quasi-experiment employed in this study.
The participants of this study will include opioid abusers who are under methadone treatment. The study area is a methadone clinic, where these patients are under rehabilitation.
During the selection of individuals who will be participating in the study, the record book of the patient will be used. The first 64 patients in the record of those who attend the counseling session will qualify for the first group of the participant. The other group will be selected from the record of those who do not go for the counseling session. Using the record of those who do not avail for group counseling, the first 64 persons in the record will be picked.
The study proposal will be submitted to the necessary authorities for approval. The authorities will then grant permission for the study to continue in the methadone clinic indentified. Once accepted in the clinic by the administration, consent from the patient will be sought after explaining the significance of the study. The participants will be brief on their part in the study. The participants will be explained the ethics of the study. This will include maintaining the information confidential level, observing participants integrity and privacy.
Data obtained will be projected into graphs, histograms and pie charts for comparisons to be drawn. Where computation is needed, SPSS will be used to analyze the data and information collected. For interpretation of the results obtained, line graphs will be drawn to compare the pretest and posttest results.
The study will use instruments such as observation, one-on-one interviews, and review from the records. After the study is over, questionnaires will be administered to evaluate the level of effectiveness of the methadone therapy. The researcher will closely monitor the progress of the intervention. Though this method is prone to bias, thus, threat to internal validity, the method is vital in drawing conclusion regarding behavior changes. One-on-one interviews will be beneficial in determining the possible confounding modifies that may influence the deductions arrived at in the study. A review through the records will help to determine the historical events, such as jail term and pre-therapy, among the individuals. This will be crucial in determining the possible cases of selection history threats to validity. The study will involve pre-testing the data obtained at the beginning of the study from comparison with the one to be obtained after the study is over. This data will be useful in deriving conclusion of the study.
One of the weaknesses of this study design is that it lacks randomization. The study may then lead to selection of individuals with similar characteristics, which will affect the results obtained. For this reason, the study will be prone to the threat to validity. The threat must be indentified and measures taken to reduce the effect; otherwise, the study will not measure what it is expected to measure.
The possible threats include selection bias, selection history and selection maturity. The selection will be done using a record book to minimize the selection bias. This will ensure that the researcher will not be influenced by his perception in selecting the participants. The study will be conducted in location where the participants are exposed to similar historical events. This will ensure that the selection history threat is catered for. The study will be time framed. This will ensure that the threat to maturity will not affect.