Research: Relapse prevention in opiate/opioid addiction using integrative psychotherapy.

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Thank you for participating in this research. By filling in this survey you'll contribute to the research about relapse prevention in opiate/opioid addiction. The purpose of this study is to investigate the effectiveness of integrative psychotherapy in relapse prevention and recovery, and to identify the factors that contribute to relapse prevention.

Opiate addiction is labeled as a chronic condition, that affects millions of people worldwide. Despite the various treatments available, the number of individuals who achieve long-term recovery is very low. Less than 1.1% reach long-term recovery (abstinent for >5 years), less than 3% stay clean for >1 year.

This study aims to contribute to the development and optimization of client-based treatment for opiate addicts, by identifying the gaps in current relapse prevention within regular addiction care and exploring the potential of integrative psychotherapy as an effective treatment method.

The questions in the survey are designed to gain insight into your experience with relapse prevention in opiate addiction, and to identify the factors that contribute to successful relapse prevention.

Completing this survey will take approx 15 minutes. You can fill in your e-mail address below, so you'll receive a copy after you have completed the survey. All data is treated confidentially and the results will be processed anonymously.

Requirements to participate in this study:

Opiates/opioids are or have been your drug of choice.
You have received in- or outpatient treatment that included relapse prevention
Clean time is not required, you can still participate if you're currently using.
You can also participate if you're currently on suboxone / methadone.

By participating in this study, you will be making a valuable contribution to the field of addiction research and helping to improve the lives of individuals struggling with opiate addiction.

Thank you in advance for your participation.

Sincerely,

Valerie de Ruiter, Natasha-Rachel Numan.

Demographic

First Name *

Gender *

Male

Female

Other:

Required

Age *

Country *

Date *

YYYY

History in opiate/opioid use and treatment

We're opiates/opioids your Drug Of Choice? *

Yes

Required

Which opiates/opioids we're/are you addicted to? *

Heroin

Oxycodone

Oxycontin

Oxymorphone

Fentanyl

Morphine

Hydrocodone

Hydromorphone

Codeïne

Tramadol

Methadone

Buprenorphine

Other:

Required

Have you received treatment before, that included relapse prevention? *

Common components of relapse prevention include a relapse prevention plan, recognizing triggers, learning to cope with cravings, and cognitive behavioral therapy (helpful thoughts, learning new behavior).

Yes

Required

What kind of treatment did you had?

For example: detox, inpatient, outpatient, group therapy, etc.

According to the DSM-5, the official term for opiate addiction is "opioid use disorder". There's a difference between opioids and opiates, but to avoid confusion and keep it simple, the term 'opiates' is being used in this survey.

According to the DSM-V, below you will see a list of criteria describing 'opioid use disorder'. Please indicate how many of these criteria apply/were applicable to you.

(if you are now in recovery, refer to when you were still in active addiction).

DSM-5 criteria: Opioid Use Disorder
Tick the boxes that apply or have applied to you. *

Opioids are often taken in larger amounts or over a longer period of time than intended.

There is a persistent desire or unsuccessful efforts to cut down or control opioid use.

A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.

Craving, or a strong desire to use opioids.

Recurrent opioid use resulting in failure to fulfill major role obligations at work, school or home.

Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.

Important social, occupational or recreational activities are given up or reduced because of opioid use.

Recurrent opioid use in situations in which it is physically hazardous.

Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids.

*Tolerance, as defined by either of the following: (a) a need for markedly increased amounts of opioids to achieve intoxication or desired effect. (b) markedly diminished effect with continued use of the same amount of an opioid.

*Withdrawal, as manifested by either of the following: (a) the characteristic opioid withdrawal syndrome. (b) the same (or a closely related) substance are taken to relieve or avoid withdrawal symptoms

Required

Were you addicted to other substances besides opioids? *

Yes

I have used other substances but didn't became addicted to it

Other:

Required

If answered 'Yes', what other substances were/are you addicted to? *

For how long have you been using opioids? *

Clean time

What's your current clean time? The days/months/years you're being abstinent without relapsing.
(*) Being on MAT like methadone/suboxone is still considered abstinent, if it's taken as prescribed.

What's your current clean time? *

I'm currently using.

Less than 6 months

6 months or more

1 year or more

2 years or more

3 years or more

5 years or more

Other:

Required

If you have experienced a relapse before, how much clean time did you have before you're last relapse? *

Relapse

If you 're currently using: How much clean time did you have before you relapsed?

If you're currently in recovery: Have you experienced a relapse in opioid use before?

Yes

Not with opioids, but with other substances

If answered 'Yes': How many times after your last treatment have you relapsed? *

Which of the following reasons have contributed to your past relapses? Please select up to four answers. *

Thinking about using

Negative thoughts

Not knowing how to cope with difficult emotions

(chronic) pain

Cravings

Old behaviors

Difficult circumstances

Conflict with relatives

Being confronted with your DOC ( = drug of choice)

Not having fate in the future

Feeling depressed

(long lasting) withdrawal symptoms

Physical illness

Loss of a loved one

Overconfidence

Required

In your opinion, what is the primary cause of relapse for individuals with a history of opiate addiction? *

Triggers

During the early stages of your recovery from opiate addiction, what challenges or obstacles did you find most difficult to overcome? Please describe up to three challenges below. *

For example: Not knowing how to cope with emotions, cravings, difficult circumstances, physical discomfort or pain, withdrawal symptoms, etc.

Medication-Assisted Treatment (MAT)

Are you currently being prescribed methadone / suboxone / subutex? *

Such as methadone / suboxone / subutex

Yes

Not anymore

Required

If answered "Not anymore": Which type of medication (MAT) were you on?

If answered "Not anymore": How did you got off of MAT?

For instance: tapered, cold turkey, clinical detox.

If answered "Not anymore": Have you experienced a relapse back into opiate use since discontinuing MAT?

Yes

Haven't relapsed on opioids, have relapsed with other substances.

If answered "Yes": Which type of MAT are you currently being prescribed, and for how long?

If answered 'Yes": How do you benefit from MAT?

For instance: to ease withdrawal, pain management, it helps me feel 'normal', to be stable enough to work on recovery, etc.

If answered 'Yes': Have you experienced relapse while being on MAT?

Yes

Haven't relapsed on opioids, have relapsed with other substances.

Relapse prevention

Below is a summary of common components included in relapse prevention, as this is usually provided within regular addiction treatment.

Use the scale to indicate the extent to which you found these factors to be important and beneficial. And the extent to which these factors actually helped to prevent you from relapsing.

Mark '0' if the mentioned component has NOT been a part of your previous treatment.

0 = Not included in treatment

1 = Not effective at all

2 = Not effective

3 = Neutral

4 = Effective

5 = Very effective

Receiving psychoeducation about addiction *

Not effective at all

Very effective

Receiving education about triggers that can lead to relapse *

Not effective at all

Very effective

Receiving education about opioids/opiates, including the risks and effects *

Not effective at all

Very effective

Learning to recognize and identify personal triggers that could lead to substance use. *

Not effective at all

Very effective

Learning new coping mechanisms for triggers *

Not effective at all

Very effective

Learn about the different phases that could lead to relapse *

Not effective at all

Very effective

Developing a relapse prevention plan *

Not effective at all

Very effective

Identify the pros and cons of using *

Not effective at all

Very effective

Increase awareness of the adverse effects associated with opioid use *

Not effective at all

Very effective

Identify people, places, and things that may trigger a relapse or increase the risk of substance use *

Not effective at all

Very effective

Learning strategies to regulate emotions without turning to substance use *

Not effective at all

Very effective

Develop a plan to manage or avoid high-risk situations that may trigger a relapse *

Not effective at all

Very effective

Learn to recognize cravings and label them as such *

Not effective at all

Very effective

increase self-confidence in sobriety *

Not effective at all

Very effective

Attend meetings such as Narcotics Anonymous (NA) or Alcoholics Anonymous (AA). *

Not effective at all

Very effective

Participating in a 12 Step program *

Not effective at all

Very effective

Cognitive Behavioral Therapy *

Not effective at all

Very effective

To what extent did the treatment meet your actual needs?

Not at all

Completely

Which 'dimension' received the most attention during your treatment in regular addiction care?
Select up to 2 answers.

Cognitive (e.g., mindset, cognitive behavioral therapy, changing thoughts about substance use)

Behavioral (e.g., cognitive behavioral therapy, learning new behaviors)

Emotional (e.g., trauma processing, emotional healing, addressing negative emotions such as anxiety or sadness, emotional regulation)

Social (e.g., restoring relationships with loved ones, reintegrating into society, building social connections)

Physical (e.g., addressing physical symptoms, reducing withdrawal symptoms, reducing cravings)

Spiritual (e.g., exploring your purpose in life "who am I?" "what do I want?", understanding "what it's all for", feeling connected).

Required

If you could create your ideal treatment: which dimensions did you feel the most need to work on?
Select up to 2 answers.

Cognitive (e.g., mindset, cognitive behavioral therapy, changing thoughts about substance use)

Behavioral (e.g., cognitive behavioral therapy, learning new behaviors)

Emotional (e.g., trauma processing, emotional healing, addressing negative emotions such as anxiety or sadness, emotional regulation)

Social (e.g., restoring relationships with loved ones, reintegrating into society, building social connections)

Physical (e.g., addressing physical symptoms, reducing withdrawal symptoms, reducing cravings)

Spiritual (e.g., exploring your purpose in life "who am I?" "what do I want?", understanding "what it's all for", feeling connected).

Required

Integrative Counseling and Psychotherapy

Integrative psychotherapy is a treatment approach that involves combining various techniques from different therapeutic orientations to address an individual's specific needs. Unlike single-school approaches, integrative therapy is not limited to a particular methodology or school of thought, allowing therapists to draw on different techniques as needed to improve the efficacy and efficiency of treatment.

Essential components of the integrative approach are:

Client-based: tailoring the therapy to the individual's unique physical and emotional needs, rather than following standard procedures.
The approach is also based on the principle that the mind and body are connected, and both conventional and complementary health care interventions are used based on the individual's needs. For example, hypnotherapy can help to resolve blockages and deeply-rooted issues, while also accessing answers and solutions available to the subconscious mind.
Integrative therapy assumes that individuals possess the ability to develop and heal themselves and focuses on activating inner resources and removing blockages to maximize these self-healing abilities. Additionally, integrative treatment emphasizes identifying and eliminating the root cause of the issue, rather than solely focusing on behavioral change.

Integrative approach

The following is a list of key components of the integrative approach. The questions below are designed to get a better idea of:

What the actual needs are.
What (former) opiate addicts can benefit from to prevent relapse.
Which components would be beneficial.

Please rate on a scale of 0 to 5, based on how much need you have (or would have had) for the mentioned component, and how important you would consider this component to be in relapse prevention.

The therapist / practitioner

Please rate the following factors on a scale of 1 to 5, based on how important they are to you in terms of contact with the therapist/practitioner and how much they could contribute to relapse prevention.

Expertise: A counselor or therapist with expertise, experience, and skills whom you trust can help you. *

Not important at all

Very important

Emotional relationship: You experience a therapeutic connection with the practitioner and feel heard, seen, and understood by them. *

Not important at all

Very important

Personal experience: The therapist/practitioner has had personal experience with addiction and recovery *

Not important at all

Very important

The therapist takes your perspective on the underlying causes of your addiction seriously, and works with you to develop a personalized understanding of your unique situation
*

Not important at all

Very important

The practitioner/therapist meets your needs by jointly drawing up a plan of action.

Rather than the practitioner imposing their own plan or approach, they work together with the client to create a personalized plan that takes into account the client's unique situation, goals, and preferences.
*

Not important at all

Very important

Client-based: The method and treatment are personalized to meet your unique needs as an individual, rather than following standardized procedures. *

Not important at all

Very important

The therapy / treatment

Please rate to what extent you consider the following aspects to be as important in treatment, and to what extent these factors may contribute to relapse prevention according to your experience

Gaining Control: You feel empowered to overcome addiction and have confidence in your ability to recover
*

Not important at all

Very important

Gaining control over your thoughts, feelings, and actions
*

Not important at all

Very important

Developing your skills and abilities, and enhancing personal growth.
*

Not important at all

Very import

Resolve underlying issues and blockages

Meaning: addressing the root causes of addiction and related issues, rather than just treating the symptoms.

Not important at all

Very important

Resolve inner conflict: Addressing and resolving conflicting thoughts, emotions, and beliefs.

Example:

"On one hand i really don't want to use anymore. But on the other hand i don't want to quit completely".

Not important at all

Very important

6 different dimensions

The integrative approach in psychotherapy does not solely focus on cognitive and behavioral dimensions. It addresses all 6 dimensions of the human experience, which are: cognitive, emotional, physical, behavioral, social, and spiritual.

These dimensions are interconnected, and both the issues and solutions can be found in any of these dimensions.

Behavior

Get a clear understanding of where your behavior comes from: why do you do what you do? *

Not important at all

Very important

Learning new behavior and coping skills *

Not important at all

Very important

Recognize the difference between healthy and unhealthy coping strategies.

Not important at all

Very important

Cognitive

Change your perception of substance use.

For instance: Shift your perspective from 'I cannot use' to 'I no longer want to use'.

Not important at all

Very important

Building self esteem by changing negative thoughts about yourself. *

Not important at all

Very important

No longer suffer from anxious thoughts *

Not important at all

Very important

Experience peace of mind *

Not important at all

Very important

Stop your mind from worrying *

Not important at all

Very important

Distinguish 'helpful' thoughts from 'harmful' thoughts.

Not important at all

Very important

Emotional

Reduce feelings of stress *

Not important at all

Very important

Reduce feelings of anxiety *

Not important at all

Very important

Reduce feelings of sadness *

Not important at all

Very important

Reduce feelings of anger *

Not important at all

Very important

Reduce feelings of grief and loss *

Not important at all

Very important

Feeling safe within yourself *

Not important at all

Very important

Heal unprocessed emotions

Get rid of emotional bagage

Not important at all

Very important

Healing from trauma *

Not important at all

Very important

Building self-confidence *

Not important at all

Very important

Feeling connected to yourself and others *

Not important at all

Very important

Experience positive emotions without needing any substances *

Not important at all

Very important

Experience peace and relaxation *

Not important at all

Very important

Having faith in the future *

Not important at all

Very important

Physical

Reduce cravings *

Not important at all

Very important

Reduce (chronic) pain and physical discomfort *

Not important at all

Very important

Experience physical relaxation *

Not important at all

Very important

Improve physical health *

Not important at all

Very important

Feeling fit and energized *

Not important at all

Very important

Social

Learn healthy ways to process stimuli *

Not important at all

Very important

Learn ways to cope better with external stimuli *

Not important at all

Very important

Restoring relationships with loved ones *

Not important at all

Very important

Feeling confident in interacting with others *

Not important at all

Very important

Getting in touch with like-minded people / fellows *

Not important at all

Very important

Establishing healthy (new) relationships *

Not important at all

Very important

Understanding the impact your behavior has on others *

Not important at all

Very important

Setting boundaries without feeling guilty or burdened by them *

Not important at all

Very important

Spiritual

Discover who you really are (apart from your addiction) *

Not important at all

Very important

Sense of meaning; seeing life as meaningful *

Not important at all

Very important

Sense of purpose; having clear goals in life *

Not important at all

Very important

Feeling spiritually connected to a higher power *

Not important at all

Very important

Experiencing faith: being able to trust that everything is working out for you. *

Not important at all

Very important

Resolving and clearing subconscious blockages *

Not important at all

Very important

Identifying and eliminating the root cause of your addiction, rather than focusing on the symptoms. *

Not important at all

Very important

Experience self-love *

Not important at all

Very important

You're almost there! Only 3 more questions and you're finished.

What do you think that is currently missing in most regular addiction treatments? Please share your thoughts and write down 3-4 elements. *

What do you think would be the most beneficial to you, to prevent you from relapsing?

If you are currently in recovery for more than 12 months: What was your biggest reason or motivation to really make it work this time? What helped you to stay clean and sober during these past months/years?

Please clarify your previous answer: What did [previous answer] helped you with? Or what have you achieved with the help of [previous answer]?

- For instance, if you've answered "suboxone", what did/does suboxone help(ed) you with? (for example; "it makes me feel emotionally stable, it reduces cravings and helps me to feel normal")

Thank you for your participation and for investing your time and effort!

*Important: press the 'send' button to save your final answers and to complete the survey*

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