Treatment for Opioid Addiction

Psychological and Medical Treatment Options

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People have become addicted to opioids for centuries, however, use of opioids has escalated since 2000 with the development and marketing of powerful painkillers that are highly addictive and carry an enormous risk of overdose. This has become a serious problem, with opioid epidemics occurring in the US and other parts of the world.

Opioid addiction is one of the most challenging addictions to overcome, but there are some great treatment options available that can help with physical, psychological, and social aspects of this distressing condition. Although prescription opioid painkiller addiction has much in common with heroin addiction, there are important social differences that will influence the kind of treatment that will be helpful.

Evidence-Based Addiction Treatment

While there are many people who believe they hold the key to curing addictions, the reality is that it is a complex, long-term problem which develops in vulnerable people. So the treatments required are also complex and multi-faceted.

It is important when considering any treatment that it is evidence-based, which means that the treatment has been studied and shown to be effective for many people with the condition. All of the treatments discussed in this article have good scientific evidence to support their effectiveness, although this doesn't mean they work for everyone, every time, particularly if used in isolation from other, necessary treatments.

It is crucial for treatment to be effective that the person receives adequate treatment for the physical harms, psychological underpinnings, and physical aspects of the addiction, as well as the social causes and consequences of the problem. If any of these three aspects of opioid addiction are not properly treated, the treatment is not likely to be successful, and the person will relapse, feeling even more of a failure than they did before they tried to quit. Therefore, these treatments should be put together into a comprehensive treatment plan that is consistently followed before, during, and after the person quits opioids.

Harm Reduction

Harm reduction is an approach to helping people with opioid use disorder that focuses on reducing the physical and social harms that affect people who use heroin, and sometimes other opioids, rather than on encouraging the person to quit.

Harm reduction is an important part of treatment for people who inject opioids. It includes strategies such as needle exchange programs, safe injection sites, opioid replacement therapies (such as methadone maintenance programs), and naloxone as a tool for overdose reversals. Harm reduction saves the lives of people who would otherwise die of blood-borne infections such as HIV and hepatitis, blood poisoning, and overdose. Harm reduction strategies are often also the first step for a person who uses opioids in getting help, and can lead to additional treatments.

Psychological Treatments for Opioid Addiction

Psychological treatments have become very sophisticated over the past few decades, and focus on every stage of overcoming opioid addiction, from making the decision to change, quitting or reducing opioid use, becoming abstinent, and avoiding relapse. There are several different approaches, that should be tailored to meet the individual needs of the person with opioid use disorder.

Some of the best known psychological treatment are detailed below.

Motivational Interviewing & Motivational Enhancement Therapy

Motivation is the most important psychological predictor of effective treatment for an opioid addiction. If someone doesn't really feel motivated to quit opioids, they have a high risk of relapse, which in turn, can lead to a greater risk of death by overdose. For this reason, motivational interviewing or motivational enhancement therapy is a very important step in helping people who use opioids to get ready to quit before actually attempting it and to guide them through the various stages of change.

Motivational interviewing is usually very well received by people who use opioids because it is a very supportive approach. Although there are some myths about motivational interviewing, the treatment is often effective.

Cognitive Behavioral Therapy (CBT)

Cogntive behavioral therapy, or CBT, is one of the most proven treatments for opioid use disorder. In addition, it is highly effective for treating a range of other psychological problems, such as anxiety disorders, depression, and trauma, that often co-occur with opioid addiction. Therefore, CBT is often a good psychological treatment to start with.

Couples Counseling

Couples counseling or couples therapy, sometimes called marital therapy, has been shown to be very effective in treating substance use problems and addictions, including opioid use disorder. Couples counseling is helpful both for couples who wish to stay together during and after recovery from opioid use disorder and for those who are choosing to separate. Sometimes couples counseling can be used in combination with other treatments.

Family Therapy

Family therapy can help many families where one or more family members has a problem with addiction or substance use, but it is particularly effective for adolescents with substance use disorders. The basic approach focuses on the dynamics of the family as a whole as needing therapeutic attention, and the person or people with substance use problems are considered a symptom of the overall family disease, rather than the cause of the problem.

Family therapy can be very helpful when partners or children are also affected by the behavior of the person who is addicted to opioids. Hearing about their experiences can help to motivate someone with an addiction to change their behavior in order to improve the lives of those they love. The family can also find ways of supporting the person quitting opioids, and become more aware of the ways in which they may have inadvertently contributed to difficulties that occurred in the past.

Family therapy is widely known, and may be available as part of a comprehensive treatment program, and covered by insurance, as well as available privately.

Hypnotherapy

Hypnotherapy is a type of psychological therapy which uses naturally occurring mental states and therapeutic suggestion to help people with addictions to think differently about change. Hypnotherapy uses hypnosis to help people access these mental states in an ethical and responsible way. It is nothing like stage hypnosis, which uses volunteer or accomplices' suggestible mental states to entertain an audience.

Some people find hypnosis to be very effective in breaking through their own psychological barriers to change, and find hypnotherapy to be empowering, as well as relaxing, helping them to feel more control over their own mental state without drugs. However, although hypnotherapy is well known, it is a controversial and often poorly understood therapy. If you decide to try hypnotherapy, make sure you use a therapist who is qualified. Certification requirements vary by jurisdiction and you should expect to pay $100-200 per hour. You will probably need several sessions for hypnotherapy to support you through your recovery.

Neurotherapy

Neurotherapy is a less commonly used treatment for addictions, but it is one that can be highly effective, particularly for people who don't respond well to talk therapy. It was discovered during animal studies that the brain could be trained to produce brainwaves of various frequencies that are associated with healthy psychological states, and that there are brainwave patterns associated with vulnerability to various mental conditions, including addiction.

Neurotherapy involves having electronic sensors painlessly attached to your scalp with a conductive gel, and then relaxing while a computer provides you with feedback on your mental state. This feedback can be in the form of a video of a movie, which appears lighter as your brain produces desirable frequencies and darker as it produces frequencies that are associated with vulnerability to addiction. Alternatively, the video might have color that increases or decreases in intensity as feedback. Music or audio tones can be used to provide you with feedback, which get louder or quieter depending on your mental state, allowing you to retrain your brain as you relax with your eyes closed. If the music chosen is soothing and pleasant, this can be a very relaxing experience, which allows people with addictions to discover their own ability to access pleasurable mental states without drugs.

There are not many practitioners who are able to provide neurotherapy services, as it is not well known in the health professions, and it requires extensive training and costly equipment to provide the service. Those who do provide it, however, are usually highly dedicated, and understand its potential to help people who have not responded well to other treatments. If you are considering neurotherapy, make sure you choose a practitioner who is certified with the Biofeedback Certification International Alliance (BCIA), and expect to pay $100-200 per hour, for several sessions.

Twelve-Step Facilitation

Twelve-step facilitation is a strategy built on the premise that involvement in a mutual support group like Narcotics Anonymous or Alcoholics Anonymous can help individuals to achieve and maintain abstinence. Although there is some evidence that this approach is effective in the treatment of alcohol abuse and dependence, the evidence of efficacy in opioid-dependent individuals is still unclear. Furthermore, as the groups are not a formalized treatment, sometimes abusive people can take advantage of vulnerable participants, and can even use groups to deal drugs.

Many participants in these groups benefit from new friendships and sober activities that may result from mutual support groups like NA or AA. Meetings are free and widely available across the globe. These programs are based upon acceptance of the chronicity of the disease of substance use disorder, surrender to a higher power, and fellowship among abstinent peers.

Contingency Management

Contingency management is sometimes used when individuals with substance use disorders are mandated to treatment by an employer or the court system. In a system of contingency management, failure to comply with treatment results in job loss, imprisonment, and loss of reputation. Contingency management can be coupled with positive or motivational incentives, whereby participants can earn money or vouchers for complying with the program.

Medical Treatments for Opioid Addiction

There are several different options to choose from if you choose medical treatment for addiction.

Buprenorphine

The first line of treatment is office-based pharmacological or medication-based therapy with buprenorphine, a sublingual medication that blocks the opioid receptors in the brain to prevent opioid withdrawal symptoms, without causing the same amount of sedation or euphoria experienced with pure opioid agonists.

Buprenorphine maintenance therapy is administered through a clinic. Patients who are maintained on buprenorphine or methadone are not simply switching to another drug of abuse: they are all on effective treatments prescribed by a qualified physician.

Physicians need a license or DEA waiver to prescribe buprenorphine or Suboxone (buprenorphine plus naloxone, to discourage injection). People who use these treatments are often able to mend relationships, hold jobs, and they are at lower risk of street crime, violence, and HIV. They achieve stability that enables fuller participation in behavioral interventions and other forms of psychological therapy.

Methadone

Methadone is a synthetic opioid that alters the effects of pain on the nervous system, but with a reduction of the euphoria and sedation associated with heroin and opioid drugs. This means that people who are addicted to opioids, such as heroin, can be physically stabilized on methadone, allowing them to put their lives in order, and engage in therapy to treat the underlying causes of their addiction. It is effective for treatment of withdrawal from opioids and is used in medication-assisted treatment of serious opioid addiction. It usually given orally, but can be given by injection, in liquid form, or as a tablet or wafer. It is typically dispensed through a government approved program.

Naltrexone

Naltrexone is an additional pharmacological therapy used less frequently for opioid dependence. It completely blocks opioid receptors and as a result, sometimes people who use opioids don't like the effect, typically only using it when their motivation to quit is very high. The long-acting injection, Vivitrol, is a form of naltrexone that eases compliance, requiring monthly injections.

Choosing a Specialist

If you have problems with opioid use disorder, a referral to a mental health or addiction medicine expert can be helpful to determine next steps. Your chances of success depend a great deal on your motivation to change.

Addiction treatment professionals are typically licensed in some capacity, but state laws vary with respect to the qualifications these individuals must hold for licensure. In some jurisdictions and states, there is very little requirement for education and training in substance use disorder, and there may not even by a requirement for training in appropriate counseling. There are a number of websites that have resources to help you find treatment services, including websites maintained by government agencies like SAMSHA.

It is critical to find a medical professional trained in addiction. This group can include doctors who certify with the American Board of Addiction Medicine, or those who train for years in a general psychiatry residency and have a good understanding of the disease, although a small number of primary care physicians, particularly those who work in communities with high rates of opioid use disorders, are highly knowledgeable and competent in treating opioid use disorder.

It is also important to find an independent professional who will not benefit financially from their recommendation to a specific program or group of programs. It is helpful to consult with a professional who has broad knowledge of all options for treatment, not the owner of a treatment facility.

A thorough assessment by a professional trained in the evaluation of substance use disorders should include exploration of your patterns of use, the quantity of substance used, blackouts, legal or job-related problems, and ancillary data that can include genetic factors, family history, trauma, coping skills, and support systems.

Some addiction professionals ask to talk to family members or close friends, to get a more objective viewpoint of the patient’s usage pattern. There are many factors that can guide a healthcare professional to find the best individual treatment plan. It is important to tailor a plan to the individual’s beliefs and to medical science.

A Word From Verywell

Although it can be a difficult step to seek treatment for opioid use disorder, and it can sometimes take numerous treatments and even relapses to become abstinent, there is no doubt that you will not regret it. There are many inspiring stories of people who have overcome opioid use disorder, and have had a whole new appreciation of life as a result.

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