Treatment is one light at the end of the very dark tunnel of opioid addiction. Treatment does work, and it is a wise investment. Every dollar spent on treatment saves up to seven dollars in health, social, and criminal justice costs. Addiction to heroin and prescription pain killers (as well as alcohol and other drugs) can be and has been successfully treated, sometimes by working with an individual therapist, but more often through a variety of comprehensive treatment options. These include intensive inpatient (residential) and outpatient programs; a pharmacological component may or may not be a part of each option. Many experts (including the Hazelden Betty Ford Foundation) now believe that combining behavioral therapy with anti-addiction or maintenance medications presents the best chance for successful recovery from opioid use disorder. Effective treatment addresses medical, psychological, legal, social, and vocational issues. As is true for the treatment of other substance use disorders, opioid addiction treatment works best when followed by mutual-support group participation (such as Narcotics Anonymous or Alcoholics Anonymous) and a sober living environment. Here are the four components critical to recovery:
- detox (getting off the drug)
- treatment (learning to live without drugs)
- continuing care (supported sober living)
Intervention can be an effective means for getting someone to accept treatment, but it is unwise to attempt a formal intervention on your own without a qualified professional assisting you and while the user is under the influence of drugs or alcohol. The most successful interventions are conducted with the help of addiction experts and when users are coming down from a high.
During an intervention, close friends and family members go around the room telling their loved one how their drug use has affected them personally, and the person is presented with the opportunity to seek treatment.
Residential and Outpatient Therapy
Before entering a treatment program, most clients go through a detox process under the care of medical and mental health professionals. While any remaining drugs or alcohol are leaving the body, clients undergo additional assessments for physical and mental health conditions so that treatment can be tailored to their needs. Residential treatment programs last from a few days to many months. Longer programs may include a halfway-house program that helps the person in recovery gradually reintegrate into society. Outpatient programs offer many of the same features as residential treatment but only occur for a few hours each day or a few days a week. During this time, the patient can continue to work and return home each night. In general, residential treatment is suited for those who are more prone to relapse, those who have fewer social supports, and those who have a co-occurring psychiatric condition. Outpatient treatment is suitable for people with more supports, less complicated life conditions, and a less severe addiction. It is also less expensive than inpatient treatment. Most residential and outpatient treatment programs use a team consisting of medical staff, substance use disorder counselors, perhaps clergy, mental health professionals, and others, including volunteer recovering addicts.
Twelve Step Programs
Before the development of treatment programs, the only option available to a person with an addiction was hospitalization or a Twelve Step group, such as Alcoholics Anonymous or Narcotics Anonymous. These groups are still an important component of recovery for people who have been through treatment, and working the first five Steps is often part of treatment in residential and outpatient programs. People have also found and maintained lifelong recovery by relying solely on a Twelve Step program. With the wide availability today, it’s a good idea to seek out treatment, but participation in a recovery group, like a Twelve Step group, is also a significant factor in avoiding relapse and enjoying a healthy life after treatment. Twelve Step groups meet at locations all over the world. Membership is free to attend and meetings are often held in donated spaces, such as churches and community centers. The groups emphasize mutual help, which occurs as members share stories, help each other with recovery issues, and support each other in avoiding relapse, both during and outside of meeting times. The Twelve Steps involve internal, reflective examination of the self, as well as external actions, such as making amends and reaching out to other addicts. The process of “working the Steps” is continuous, not a one-time event. People tend to say they are “in recovery” from addiction, not “recovered” from it. This helps remind them that it is easy to slip back into old behaviors.
Co-occurring disorders, or dual diagnosis, refers to having a simultaneous mental health disorder and substance use disorder. It is common for people with addictions to also suffer from depression, anxiety, or more severe mental illnesses such as schizophrenia or bipolar disorder. Research shows that people who use alcohol or other drugs early in life are more likely to have mental or emotional problems. It’s also true that many people with mental illnesses “self-medicate” with alcohol or other drugs to numb emotional pain, relieve anxiety, or quiet their thoughts. In the past, the medical profession treated one disorder first, typically the substance use disorder, before addressing the other. It is now understood that treating both simultaneously leads to better outcomes. Any successful addiction treatment program will include a mental health assessment and treat co-occurring disorders at the same time.
Medication-Assisted Treatment and Maintenance Therapy
Because opioid addictions are so powerful, and because the risk of overdosing after relapse is so high, many in the medical community (including the Hazelden Betty Ford Foundation) are embracing medication-assisted treatment (MAT). Research shows this method to be effective for opioid use disorder. One drug used in MAT is naltrexone. Naltrexone is an opioid receptor blocker that is injected once a month to prevent opioids from producing a high. It has been shown to keep people on track in their treatment and to reduce cravings. Because naltrexone can’t be used to get high, there’s no risk of it being diverted for sale on the street. Another drug being used is Suboxone, which is a formulation of buprenorphine/naloxone. This is a daily medication that helps reduce cravings and relapse and has been shown to improve treatment results. Suboxone may be diverted for sale on the street, but mainly is used to treat withdrawal symptoms. Methadone is often used in what’s called maintenance therapy. A synthetic opioid typically taken as a pill or liquid, methadone blocks other opioids from acting on the opioid receptors in the brain. At the same time, it prevents the difficult withdrawal symptoms that often accompany cessation of the drug. Patients report to a clinic or treatment center for a daily dose of methadone, and the dosage is calibrated to allow them to continue their daily work and life routine without cravings and without get- ting high. Methadone does have street value, so its access is highly regulated.