What counseling involves
Counseling in this program means individual sessions with a counselor, usually weekly at the start and less often as you stabilize. Sessions are private and typically run 45 to 60 minutes. The approaches used are the ones with the best evidence in addiction care:
- Motivational work in the early weeks, when part of you wants to stop and part of you does not. The counselor helps you sort out your own reasons rather than handing you theirs.
- Cognitive behavioral approaches, which look at the thoughts and situations that lead to using, and practice different responses to them.
- Relapse prevention planning: identifying your specific triggers (pain flare-ups, certain people, paydays, Friday nights) and writing down, in advance, what you will do when they show up.
How it is arranged
We are a medical practice, not a large therapy program, and we are straightforward about that. Counseling is coordinated rather than delivered by a big in-house team. Sessions happen in one of three ways:
- In the clinic, arranged around your medical visits so that you are not making extra trips.
- With partner counselors in Broward and Palm Beach counties whom we know and refer to regularly, and who send updates back to Dr. Escarria with your permission.
- By telehealth, which many working patients prefer.
Our front desk sets up the first appointment and checks that the counselor is in your network. If you already have a therapist you trust, we are glad to coordinate with them instead.
Why medication and counseling together
The research is consistent: people who take buprenorphine or naltrexone and attend counseling stay in treatment longer and relapse less than people who do either alone. Medication makes counseling possible by taking away the withdrawal and craving that make it hard to think about anything else. Counseling makes medication last by dealing with the reasons the substance was there in the first place, so that when you eventually taper, there is something underneath.
Does insurance cover it? Counseling is a covered benefit under Medicare, Aetna, Blue Cross Blue Shield and Cigna, usually under mental health or behavioral health benefits, which can carry a separate copay from your medical visits. Some plans limit the number of sessions or require the counselor to be in network, and our front desk checks this before your first session. Self-pay is available through our partner counselors. Read more about insurance and self-pay.
How it fits the visit schedule
- First medical visit: counseling is discussed and the referral is started.
- Month one: weekly medical visits and weekly counseling, ideally on the same day when it is in the clinic.
- Months two and three: medical visits stretch to every two weeks and then monthly; counseling frequency is set with your counselor.
- Ongoing: counseling notes, with your consent, inform the medical plan, including when it is time to think about tapering.
Is counseling required to get medication?
We do not withhold buprenorphine or naltrexone from someone who is not ready to start counseling, because the medication is what keeps people alive and in treatment. We do keep raising it, because the outcomes are better with both, and some insurers ask for it before approving Brixadi or Vivitrol.
Is it group therapy?
No. What we coordinate is individual counseling. If you want a peer group as well, such as a 12-step or SMART Recovery meeting, your counselor or Dr. Escarria can point you to ones nearby.
Which clinic offers counseling?
Both Davie and Boynton Beach, plus telehealth from home. In-clinic sessions are matched to the days your medical visits fall on wherever possible.
Is what I say in counseling confidential?
Yes. Counseling records are protected by 42 CFR Part 2 and HIPAA. Your counselor shares progress with Dr. Escarria only with your written consent.