Dr. Kevin Moore Addresses NJ-ACT Members on
Assessment and Treatment of Opioid Abuse

Part 2 – Psychotherapy for Opioid Abusers

By Lynn Mollick

Dr. Moore emphasized that the most important issue for opioid abusers is not their physical addiction to opioids; it is their psychological addiction to them. Since opioid abuse is a chronic relapsing condition, most abusers undergo various treatments during their lifetimes.

There is no single path from a life of abuse to a life of non-abuse. Dr. Moore asserted that all psychotherapy for opioid abusers should include:

1. Screening and overdose prevention – Ask every patient these 4 questions:
a) Are there any opioids where you live?
b) Do you know the symptoms of opioid overdose? (dizziness, confusion, blue lips or nails, difficulty staying awake, inability to be aroused from sleep, breathing that is slow or weak, choking, gurgling or snoring sounds)
c) Do you have Narcan where you live?
d) Do you know that Narcan saves lives and is easily available?

2. Treatment of co-morbid psychological disorders – Because most opioid abusers have comorbid psychological disorders, Dr. Moore believes that they require long term psychotherapy and that most psychotherapists have the clinical skills needed to treat them.

CBT provides a large armamentarium of empirically-supported techniques and treatment modules. Some address the thoughts and behaviors of abuse, while others ameliorate anxiety, depression, and trauma. Motivational Interviewing helps with treatment adherence. At the beginning of treatment Dr. Moore emphasizes responsibility and effort. He uses phrases like:

“Your suffering is so intense. Do you know that you don’t have to suffer?”
“Your situation isn’t your fault. But it is your responsibility to do everything you can to get better. I can help.”

Patients often use the term “getting clean,” but this implies they were dirty and unclean. Dr. Moore suggested that clinicians use the term “sobriety” because it is more descriptive and non-pejorative.

This is descriptive and non-pejorative. Dr. Moore urged NJ-ACT members to remain flexible about the goals of therapy – not to insist that patients choose abstinence, harm reduction, or decreased or occasional use. The best therapy goal is the one the patient chooses. Treating co-morbid anxiety and depression can help patients reduce reliance on opioids.

3. Coordination with medical interventions – Therapists should be familiar with all medical treatments for opioid abuse. Clinicians should be able to refer patients for treatment at an Opioid Treatment Center (for methadone) or at an Office-Based Addiction Treatment Center or “Suboxone clinic” in their area.

4. Know how to recognize an overdose and have Narcan on hand to reverse it. Therapists should also be able to inform others of where to get Narcan and how to use it. Good Samaritan laws protect anyone who administers the drug.