Important Factors for Successful Opioid Treatment Centers: Staff Experience

As discussed in my last blog entry, some opioid treatment centers (previously called methadone clinics) are better than others. Last time I blogged about the importance of communication between staff members. This blog is about the importance of hiring experienced, competent staff.

For an opioid treatment center, the worst counselor to hire is one who doesn’t believe in methadone. This should go without saying, but sometimes clinics hire people who are conflicted about methadone (or Suboxone), and either verbally or non-verbally communicate their uncertainty or negative attitudes about methadone. The effects on patients can be devastating. Fortunately most of these employees don’t remain at opioid treatment programs, either because they must be terminated for the welfare of patients, or because they quit on their own.

Some patients say they’d rather have a counselor who has personal experience with addiction and recovery, because he understands addiction at a deep level. Such a counselor can be valuable, but it’s not enough. A counselor also needs knowledge of counseling techniques and the skill to apply them appropriately. If recovery from addiction is the only attribute of your counselor, why pay for treatment? You can get the same thing for free at any 12-step meeting.

The factor most correlated with patient success in counseling is the relationship with their counselor. A warm and accepting, non-judgmental attitude is most successful. In short, compassion is important. While it’s true that another recovering addict can understand the pain of still-suffering addicts, non-addicts can be just as compassionate, and may have fewer preconceptions about what recovery must be.

The Substance Abuse and Mental Health Services Administration, often called SAMHSA (SAM-sah) for short, produces many publications to serve as guidelines for substance abuse and mental health treatment facilities. They’ve published “Technical Assistance Publication Series, Number 21: Addiction Counseling Competencies.” This document outlines all the necessary skills and knowledge that an addictions counselor should have to work in any drug addiction treatment program.

Counselors must understand addiction. They need to have education about drugs of abuse and how they affect the body and how withdrawal from various drugs affects the body. Counselors should know about all forms of drug addiction treatment, and know which treatment is most appropriate for their client. They should be able to apply helping strategies to best meet the needs of their clients.

Counselors need to be professionals, and conduct themselves in a capable and courteous way. One of my peeves is to hear clinic personnel refer to a urine drug screen positive for drugs as a “dirty” screen. Language matters. Counselors need to have a certain level of self-awareness with good boundaries. This prevents them from being too involved with their clients, or too distant from their clients. They need to follow the profession’s ethical standards. They need to be aware of the need for continued education and be open-minded to new information. This is a rapidly changing field, and counselors shouldn’t continue to work with dated knowledge from the 1980’s.

Once a clinic gets good counselors, they need to keep them. Patients get discouraged when they’re assigned a new counselor every few months. At one clinic where I worked several years ago, a patient told me he’d had six counselors over fifteen months. That’s not OK. Patients get tired of discussing their issues with one person and form a counseling relationship, only to have to start anew a few months later. Staff turnover discourages patients.

Of course, some turnover can’t be avoided in our mobile society, where people switch jobs frequently. But clinic owners need to try to keep good counselors (and nurses and doctors) and retain them to benefit the patients. Clinic owners should be willing to pay staff well, and provide adequate benefits.

Opioid treatment programs need to hire good nurses and doctors, too, with experience and training treating patients with addiction. Doctors should be certified in Addiction Medicine either through the American Board of Addiction Medicine, or through the American Academy of Addiction Psychiatry. And they need to go to continuing education meetings to stay current, since the field of Addiction Medicine changes so rapidly with new research and results.

When I started work at my first methadone clinic, I didn’t know much more than to start the dose low and increase slowly. In retrospect, I should have had more training. If a new doctor has no prior experience working in opioid treatment programs, I’d favor a training course similar to the  course available for doctors who want to prescribe Suboxone.

I love my present opioid treatment program, Stepping Stone of Boone. We’re a new clinic, and relatively small at around 130 patients. We opened in April of 2010, and have had no staff turnover. That’s right – none. All the staff that pioneered the clinic is still there, and all of the new people hired over the last 18 months have stayed. That’s a sign of a good clinic.

It’s a fun place to work because each of us loves what we do, and we believe in what we do. We enjoy not only our patients but also the other staff members. We feel like we are helping people.

My next blog entry will be about the importance of evidence-based dosing of methadone.

7 responses to this post.

  1. […] Important Factors for Successful Opioid Treatment Centers: Staff … Share/Bookmark ← Anti-Addictive Drugs for Drug Addiction Treatment | Christian … […]


  2. Posted by Marie on November 23, 2011 at 2:06 am

    This is a great article. I had been going to a Dr. for Suboxone the first 6 months of being clean. I would be a nervous wreck the night before. I was on probation for smoking 2 buildings down from the office. Yep,I said,probation. If I did it again I would be discharged.The girls that worked there were down right mean.If you needed any help with anything you were told to go to the ER. The office hours started at 5:00am and you didn’t get out till noon.It was awful.The Dr. never listened to anything I had to say.He kept putting me on meds I could not take.I had just had major surgery for a ulcer and part of my stomach removed& he insisted on putting me on meds with anti-inflammorties in them. I could go on and on. We should never be a wreck before we go to see our Dr.The Dr. I have now is all about taking care of all my health issues.Suboxone is only a part of it.If I need anything the nurses call me back within a few hours.
    Unless,you have fought a addiction then no one knows the pain we go thru and to have to deal with the Dr. staff and there craziness is just wrong.
    I so enjoy reading all the stories on this forum.

    Happy Thanksgiving To All.

    I’m so thankful to have found a Dr. that cares.



  3. I believe this web site has some very fantastic info for everyone 😀


  4. Posted by anonymous on November 27, 2011 at 5:34 am

    I took methadone for close to 4 years. I am female, 5’4″ and weighed no more than 140 and was dosing at more than 100mg. I was also asked continuously if I wanted to increase that dose. The clinic was in fact a national for profit chain. The stories I have going to 3 separate clinics during those 4 years would boggle some minds. Your very knowledgeable and I respect your points of view. I’m glad to have found this blog.


  5. Posted by robert on February 19, 2016 at 3:41 am

    i found this information interesting and informative…i am currently employed as a chef in a MICA facility…i do have an opiate addiction as well as moderate to severe pain in my ankle from osteomilitis(excuse the spelling) please HELP!!!


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