Chapter 3 - Logistics of the Model

The optimal frequency for counseling sessions is twice a week, at least initially. More than twice a week may be a burden for the patient who is functioning well enough to be employed and have a family or other social supports. Less than twice a week can be too infrequent to create a strong sense of connection and support and provide the monitoring that is helpful for the person who is struggling with recovery. The necessary frequency depends largely on the amount of structure and support that already exist in the patient's life and how able the patient is to create structure and engage in healthy activities.

When the IDC model was developed for research, the counseling sessions took place twice a week from the first week through the twelfth week and then decreased to once a week from the thirteenth week through the twenty-fourth week of treatment. Following completion of the active treatment phase at 24 weeks, less frequent booster sessions were provided. Booster sessions usually help patients to retain the gains they have made longer. Even infrequent check-in sessions, perhaps once a month, tend to remind patients of the goal and help them feel supported and monitored.

In the IDC model, each session should be approximately 45 minutes, unless the patient arrives late, thus causing the session to be curtailed. The counselor is responsible for scheduling sessions and for dealing with any missed appointments by promptly contacting the patient and rescheduling. If the patient cancels a session, the counselor should offer another appointment as soon as possible. The counselor should always be prompt and keep in mind that the counseling relationship is a professional one and that the patient deserves to be treated with respect.

This model is intended to be time limited, with 36 sessions planned to occur over 6 months. It is difficult to determine what is the optimal amount of addiction counseling, or of any therapy for that matter, because so much depends upon the motivation and progress of the patient. Six months is a fairly generous time allotment, longer than some programs, however shorter than is probably standard in a private practice model of treatment. There is a benefit to offering a time-limited treatment as it can help the patient to structure his or her recovery knowing that there are only so many sessions. In time-limited therapy, the counselor should highlight the length of the treatment in the introductory sessions, and the patient and therapist should complete treatment plans and review goals with this time frame in mind. Also, when the patient nears the time of termination, the counselor should remind the patient of the limit. In the terminating process, the counselor and patient should establish plans or goals, so that the patient is left with a clear idea of where to go after treatment ends.

IDC has been developed for adult male and female outpatient cocaine addicts. Individuals can be abusing or addicted to other drugs in addition to cocaine, with the exception of opiates if methadone maintenance is to be used. Similar counseling would be appropriate for methadone-maintained, cocaine-addicted patients, with modifications recognizing the issue of being in drug maintenance therapy. Also, while this particular approach specifically addresses cocaine addiction in describing postacute withdrawal symptoms and so forth, all of the general themes (everything excluding specific information about cocaine) are appropriate for use in treating other drug addictions as well.

Some individuals need more than IDC or other addiction-focused treatment. For example, dually diagnosed individuals with significant psychopathology often require more attention to their psychopathology than this approach provides. However, the approach can be used in combination with pharmacotherapy for other psychiatric problems or sometimes is employed as part of a package in which a counselor focuses on the addiction and another clinician, usually a psychologist or psychiatrist provides psychotherapy and/or pharmacotherapy to address other psychiatric problems.

This model was developed for use as part of an outpatient addiction treatment program and could be used easily in a private practice setting. It also could be adapted for use in an inpatient program or intensive day treatment program. To do so would involve retaining the structure and content of the sessions but modifying their frequency and the overall length of the treatment. IDC is planned to span 6 months and offer 36 sessions during the active treatment phase and then provide once-a-month followup sessions for 3 months. Usually inpatient and intensive day treatments are briefer, but there is opportunity for counseling to be provided more frequently.

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