CAT Group for Individuals Receiving Medications for Substance Use Disorders

To provide counseling assistance to people taking medications that help protect them from problematic substance use, we offer a counseling-assisted treatment group – a CAT* group.

The CAT group offers instruction and practice in skills that support medication adherence and compliance, retention in treatment, and abstinence from banned and/or illegal substances.

Finding a safe, supportive place to address the challenges of taking – and continuing to take – medications for substance use disorder, mental illnesses, and/or physical pain in rural Southwest Virginia, U.S.A., can be a challenge in itself. I am here to help.

CAT group meets on Mondays from 5:30 – 6:30 PM in the Blacksburg, Virginia office.  (Directions)

I also offer a skills-focused, substance use disorder treatment group that meets on Sundays from 3:00 – 4:30 PM that may also be of assistance.

Counseling-Assisted Treatment (CAT) for SUDMedical providers’ requirements for frequency and type of counseling vary. Please share this page with your provider and gain approval prior to registering as a new client.


  • Group membership is limited to 7 individuals.
  • You are invited to attend each week. You must attend a minimum of two sessions per month to retain membership in the group. Clients need to book the sessions they will attend at the beginning of each month.
  • The fee is $50 per group session.
  • A 75-minute, one-time intake appointment is required prior to placement in group. The fee for the intake is $175. (If I have worked with you in other contexts, an initial session may not be needed. Please contact me to discuss.)
  • Please read carefully about my fees, noting that insurance is not accepted, and no-shows are billed at the full rate. (If interested, you can read more about my business model in the FAQs.)
  • While my approach to counseling for SUDs is based in research, I value kindness, acceptance, and realism. If I err, I will say so and apologize.

*Since medical care, including medications, is the first line of care for the medical illness of substance use disorder, the term “medication-assisted treatment (MAT)” is misleading. Counseling assists with medication, not the other way around.

If this is a fit for you, I would be delighted to help.

To request an appointment for an intake appointment prior to enrollment in the CAT group, please read about appointments and fees, then register as a new client.

Context for clients and providers

Mandated counseling by federal laws, state laws, medical boards, insurance companies, and the criminal justice system creates ethical dilemmas for clients/patients, medical providers, and counseling providers.

The Comprehensive Addiction and Recovery Act (CARA) requires that prescribers of buprenorphine be able to provide or refer patients to counseling. Virginia Medicaid patients are required to receive SUD counseling in order to receive either methadone or buprenorphine.

However,  according to this 2017 report from Harvard Medical School, and additional research, “[N]o rigorous study has ever been able to show that the addition of psychosocial services to opioid agonist therapy alone improves outcomes in the treatment of opioid use disorder.”

In sum, by law and policy, people receiving medication for opioid use disorder are required to attend counseling, and medical professionals are required to require counseling, but research reports that counseling for most people with opioid use disorder, most of the time, doesn’t improve outcomes.

Improved outcomes are imperative, however.

  • Patients prescribed medications for substance use disorders and mental illnesses need to keep taking them unless medical providers say otherwise. In particular, buprenorphine is one of the top two medications for opioid use disorder, but 50% of patients stop taking it after 6 months. Because of the nature of opioid use disorder, buprenorphine or methadone are required long-term, perhaps life-long. People who drop out of medication programs are at high risk of return to use, overdose, and premature death.
  • Patients risk losing their prescriptions if they are unable to abstain from illegal or banned substances. Providers are mandated to do drug testing to measure for therapeutic levels of medications and to screen for possibly fatal drug interactions, but also to catch use of illegal substances and low levels of medication that might indicate diversion. Providers risk investigation by the DEA and losing their licenses if they continue to prescribe to patients using illegal or banned substances or not taking medications as prescribed.

Welcome to Counseling-Assisted Treatment (CAT) for SUDEnter the 2016 Surgeon General’s Report: “Unfortunately, despite decades of research, it cannot be concluded that general group counseling is reliably effective in reducing substance use or related problems.”

In the midst of all this contradiction and complexity, our counseling-assisted treatment (CAT) group focuses on these specific areas:

  • Counseling assistance in support of the primary, evidence-informed goal of substance use disorder treatment: To assist individuals in living healthy, functional lives, in connection with others, such that substance use does not result in negative consequences for themselves, others, or society.
  • Instruction and practice in specific skills that, according to research, help with medication adherence and compliance.
  • Instruction and practice in specific skills that, according to research, help people abstain from banned or illegal substances, including alcohol and marijuana.
  • Contingency management, a research-backed protocol supportive of medical treatment for opioid use disorder, an area in which Warren Bickel, Ph.D., at our own Virginia Tech-Carilion Research Institute, is a leading researcher.
  • A letter documenting attendance handed directly to the client at the end of each session.

Research is clear on the therapeutic modalities, in tandem with medical care, that assist people with substance use disorders.

When I tweeted the leading addiction journalist, Maia Szalavitz, this question: “What fights addiction?”, she tweeted in reply, “Love, evidence & respect.”

I so look forward to working with you in loving, evidence-based, respectful ways.

To request an appointment for individual or group counseling, please learn more about appointments and fees, then register as a new client.

Providers, for more information, please contact me.

Last revised 10/30/18