Learn / How to Approach Healing From Opioid Abuse
It’s all too easy to become addicted to opiates. Once you develop a tolerance for painkillers, it can be difficult to imagine life without them. This is true even for people who started by using opioids under medical supervision. And because they are so commonly prescribed, the misuse of these drugs is extremely prevalent. Because of this, there are many rehab programs for opioid use disorders.
It’s possible to use painkillers appropriately. For some patients, they can even be necessary. However, that’s not true for everyone. Opiate misuse can quickly become a vicious cycle. This is partly because these drugs not only impact brain chemistry; they also have an effect on physiology.
Opioids are narcotics derived from the poppy plant, including heroin, morphine, codeine, fentanyl, methadone, tramadol, and more. Because these drugs can cause breathing difficulties, “opioid overdose1 can lead to death.”
Opioids bind to the opioid receptors, which are located both in the brain and throughout the body. These receptors are involved in the experience of pleasure and pain. When any of these drugs, including illicit and prescription opioids,2 bind to these receptors, “they block pain signals sent from the brain to the body and release large amounts of dopamine throughout the body. This release can strongly reinforce the act of taking the drug, making the user want to repeat the experience.”
Experts are concerned that narcotics are overprescribed3 for any type of acute or chronic physical pain. Because of this, opioids are widely available, even to people without their own prescriptions. And without proper medical supervision, these highly addictive drugs can have seriously harmful effects on a patient’s body, mind, and interpersonal relationships. The misuse of prescription opioids4 can cause “difficulty with memory and in reading certain types of emotions in other people, which they are unaware of.”
In addition, opiate misuse can lower a patient’s acute pain tolerance.5 As you become more sensitive to pain, you may feel stronger urges to misuse painkillers, which results in an even lower tolerance. Although patients’ “tolerance to pain does appear to increase after the completion of treatment” for opiate use disorders, it’s hard to move past this addiction without help. And because of how easy it is to get caught in the cycle, opioid use disorders are so common, they are considered to be a national crisis in the U.S.
Opiate addiction often starts with the intention to treat pain.6 And at one time, prescribing great quantities of narcotics was considered a best practice in the medical field. “During the 1990s, there was a push by public health officials to improve pain treatment in the United States. This led to pain becoming the ‘fifth vital sign.’ Doctors and nurses were given the impression that pain should be totally relieved. Narcotics are excellent pain relievers and too often they became the ‘go to’ treatment for pain. Although the public health effort was well intentioned, the consequences are now very well recognized. Overuse of prescription opioids has been a major contributor to the current ‘opioid epidemic.’”
The statistics of the opiate crisis7 paint a chilling picture. According to the National Center for Drug Abuse Statistics, over 10 million people misuse opiates every year. In that same time frame, nearly 50,000 people die from opiate overdoses. This class of drugs is a factor in 72% of all overdose deaths.
And the numbers are going up. “In 2020, more than 92,000 Americans died from drug overdoses, a nearly 30% increase over 2019.” If you suspect you may have an opiate use disorder,8 you don’t have to be part of that statistic.
Breaking the cycle is hard, but it is absolutely possible. Data suggests that many adults in the U.S. have recovered from opioid use disorders.9 And for many patients, the process of recovery begins with detox.
Detox can be physically dangerous. This is true for any substance, and especially for opiates. Because of this, it’s extremely important to undergo detox with proper medical supervision. Fortunately, doctors have many tools for withdrawal management.10 For example, your symptoms may be monitored using the Short Opiate Withdrawal Scale. This scale ranks patients symptoms, such as gastrointestinal distress, muscle spasms, aches and pains, etc., on a scale of zero to three. The severity of your symptoms will determine your eligibility for certain non-addictive medications.
Many patients benefit from medically-assisted treatment (MAT) for opiate detox and continued recovery. In this protocol, you may be prescribed medications such as clonidine, buprenorphine, or methadone. The latter is an especially common treatment for people in recovery.
Methadone is a synthetic opioid, and commonly used medication for opiate use disorders.11 This drug “eliminates withdrawal symptoms and relieves drug cravings by acting on opioid receptors in the brain—the same receptors that other opioids such as heroin, morphine, and opioid pain medications activate. Although it occupies and activates these opioid receptors, it does so more slowly than other opioids and, in an opioid-dependent person, treatment doses do not produce euphoria. It has been used successfully for more than 40 years to treat opioid use disorder and must be dispensed through specialized opioid treatment programs.”
As effective as it can be for some patients, methadone is not an appropriate treatment for everyone. It may interact with other prescribed medications, causing heart conditions. Furthermore, its active ingredients remain in the body even after its noticeable effects wear off. Because of this, patients may unintentionally overdose if they fail to take methadone12 exactly as prescribed.
When used improperly, methadone can also become addictive. Despite this, it is often an effective treatment. The neurobiology of opioid use13 is extremely complex, and it is absolutely essential for patients in recovery to stay in close communication with a medical team when using any prescribed alternative to narcotics.
Methadone treatment12 can take place in an inpatient or outpatient setting. If you’ve been cleared by a physician, you may even be able to take this drug by yourself, at home. However, this option will only become available after a period of stricter supervision.
Methadone may be prescribed for short-term use, or may help you navigate later stages of healing. Whether or not you plan to use this medication after your initial detox, it’s important to make a long-term plan for recovery.
When you’re planning for life after detox,14 it’s important to consider residential treatment. According to one study, medication and/or inpatient treatment have been “associated with reduced risk of death when compared to no treatment post detox” for people with opioid use disorders.
Various rehab programs offer different types of therapy. You may find that certain types of therapy resonate with you more than others, and this may change over time. Some experts believe that different treatments are appropriate at different stages of recovery from opiate addiction.15 For example, “psychotherapy may help at the pre-contemplation and contemplation stages, while cognitive and behavioral therapies may be more appropriate for the action and maintenance stages.” A few types of therapy can be especially helpful for patients recovering from opiate misuse.
Medication-assisted treatment, or MAT, is a highly effective treatment for this condition. According to the National Institute on Drug Abuse (NIDA), MAT is an extremely important component of treatment for opiate use disorders.16 “Abundant evidence shows that methadone, buprenorphine, and naltrexone all reduce opioid use and opioid use disorder-related symptoms.”
Using prescribed substances to treat the misuse of other substances may seem counterintuitive. However, for these particular patients, psychotherapy and behavioral health treatment may be enough. In fact, research has found that medication can improve the outcomes of opiate use disorder treatment,17 with or without the addition of talk therapy or behavioral therapy.
This data confirms the effectiveness of medical treatment for these patients. Regardless, patients in certain programs in the U.S. may be required to receive at least one form of counseling. According to federal law, patients who receive MAT for opiate use disorders18 in accredited and certified opioid treatment programs (OTPs) “must receive counseling, which may include different forms of behavioral therapy. These services are required along with medical, vocational, educational, and other assessment and treatment services.”
Cognitive behavioral therapy (CBT) is a style of talk therapy in which the patient learns specific, practical skills for navigating difficult thought patterns. CBT is an effective treatment for substance use disorders19 in general, and opiate use disorders in particular.
CBT may be especially helpful for patients recovering from opioid use disorders20 that began with the misuse of prescriptions for chronic pain. This is because CBT “may be used effectively to treat chronic pain, either as a stand-alone treatment or with other nonopioid pharmacological treatments. CBT improves pain-related outcomes along with mobility, quality of life, and disability and mood outcomes.” This data suggests that CBT may be an effective replacement for prescribed narcotics, whether or not the patient has a substance use disorder.
CBT has also been shown to increase the likelihood of long-term drug abstinence21 for certain patients. In one study, “those in the CBT group had more than twice the mean number of weeks of drug abstinence compared with those who received medical management alone.” This treatment was found to be more effective for people who misused prescriptions than for those who used illicit opioids, like heroin.
Contingency management (CM)22 is a type of therapy that works well for patients who have misused any type of opioid. Some versions of CM, like voucher-based reinforcement, work especially well for recovering heroin users.
These programs involve “tangible rewards to reinforce positive behaviors such as abstinence.”22 For example, a patient might receive a voucher every time they test negative for opioid use. These vouchers can then be exchanged for rewards such as food items, movie tickets, or other prizes. Some versions of CM reward patients with actual money.
It is important to combine contingency management with other forms of therapy,23 because “treatment effects often dissipate after contingency management is discontinued.” In order to achieve long-term recovery, patients should consider long-term treatment options such as talk therapy and support groups, such as 12-Step programs.
No single type of treatment is right for everyone. As you consider whether inpatient treatment is right for you, remember that there are many different options available. If you can, it’s best to talk to the admissions teams at a few facilities, and learn which types of therapy they offer.
Recovering from an opiate use disorder is an extremely personal process. And healing isn’t always a straightforward path. But no matter what your experience has been so far, change is always possible.
As you start to plan for recovery, remember that you, too, deserve to heal. You deserve support and care. And with the right resources, you can begin to create a meaningful and sustainable life.
If you’d like to learn more about inpatient treatment, you can browse our list of rehabs for opioid use disorders here.
Reviewed by Rajnandini Rathod
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