Heroin Addiction Treatment
Some people, with extraordinary willpower and social support, can detox and stay sober without professional assistance, but these people are rare and the vast majority of heroin addicts will need professional heroin treatment. For the purposes of this article, only professional treatment options are discussed. There are many self-help groups and programs available for heroin addiction as well.
There are five professional methods of heroin treatment. Heroin addicts may elect to undergo:
- Medically Supervised Detoxification
- Rapid Detoxification
- Residential Rehab Program
- Medically Assisted Treatment
The Five Methods of Heroin Treatment
Each of these methods for heroin treatment has pros and cons. Some treatments may work better for some than others and some of the treatments can be used in combination. For example, an addict may have a medically supervised detoxification followed by a residential rehab program.
Treatment for every addiction should be individualized to meet the needs of the addicted person.
- Some addicts have been able to hold on to jobs and keep their addiction secret. A person in this situation may not want to go to a residential rehab program because people might question where they are and their addiction would come to light.
- Others may have been using heroin for twenty years or more and need more intensive treatment to learn how to live a life without substances.
The next section describes each treatment method in detail so you can decide which treatment would be best for your situation.
1. Medically Supervised Detoxification
Detoxification is simply the process by which the opiates leave your body and the body begins to return to normal working order without opiates.
Detoxification generally takes from three days to a week depending on how much opiates the addict was using. Opiate withdrawal can be extremely painful and could possibly be dangerous if the addicted person has other health problems such as diabetes or heart problems.
Because of the dangers of opiate withdrawal, it is necessary for opiate withdrawal to be medically supervised. This means that any facility that will detox an addicted person from opiates must have medical staff on duty. Generally, a nursing staff will observe the addicted person and report to a doctor who is on call and checks on the patient daily.
Medications can be prescribed by the doctor to make the addicted person more comfortable while undergoing detoxification. Many facilities prescribe medications for nausea, diarrhea, sleep and other symptoms of withdrawal. Whether or not to prescribe medications and what medications are prescribed are at the discretion of the doctor so this will vary from facility to facility.
Staff at some facilities use Suboxone to ease withdrawal symptoms and then they wean the addict off Suboxone over a few days to a week. If you are considering detoxification, you can contact the facility you have chosen and ask them how they usually handle detoxification. They may not be able to give you clear-cut answers because treatment is individualized and you would have to be seen by the doctor but they might tell you if they use Suboxone or not.
While detoxification rids the body of opiates, it does not treat the underlying causes or the psychological aspect of addiction. For this reason, detoxification can be a first step before entering a residential rehab program.
2. Rapid Detoxification
Rapid detoxification is a process where the addict is placed under anesthesia while they are given medications to rid their body of opiates.1 Medications given may be naltrexone, which is an opiate blocker, or clonidine, which is a blood pressure medication. The process takes about one to two hours.
- The idea is that the body is completely rid of opiates while the addict is comfortably asleep throughout the process. This form of treatment can be more dangerous than a slower detoxification process.
- There is some controversy over the effectiveness of this treatment. While it does rid the body of opiates, this treatment on its own does not address the psychological aspects of addiction.
3. A Residential Rehab Program
Residential rehab treatment is inpatient treatment which generally lasts from 30 to 90 days; the addicted person stays at the treatment facility 24 hours a day.
Inpatient treatment facilities vary according to treatment philosophy and psychological techniques used to treat addiction.
Some inpatient facilities are based on the 12 Step model:
- These facilities encourage addicts to attend 12 Step meetings and develop support systems to maintain sobriety. They may have people from Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) come to the facility to talk to you about the program. And many facilities with this philosophy will take you to AA or NA meetings outside of the facility.
Other facilities take a mind, body and spirit approach with treatment techniques that address each of these areas.
- This means the facility would include treatments that address psychological, physical and spiritual needs. Psychological treatments may involve learning about triggers and cravings and developing ways to cope with these as well as building coping skills for life.
- Exercise could be a part of treating the physical part of addiction as well as medications for dual diagnosis addicts. Dual diagnosis means that the addict has mental health issues in addition to addiction.
- Spiritual treatments may involve encouragement to return to the church or religion the addict believes in, discovering spiritual beliefs or exploring how addiction changed their values and spiritual beliefs.
Some inpatient facilities specialize in treating dual diagnosis addicts and alcoholics:
- If you have a mental health diagnosis in addition to addiction, it is important to find a facility that will address both conditions. People who have co-occurring mental health problems cannot ignore the need for mental health treatment since mental health symptoms tend to affect the addiction.
- For example, someone with depression may relapse when they feel depressed or someone with an anxiety disorder may be more prone to using drugs when their anxiety is worse. To not treat the depression or anxiety would be like treating half of the problem.
Regardless of philosophy:
- Most inpatient facilities offer both individual and group therapy
- Psycho-educational groups are also common at inpatient facilities. Psycho-educational groups are groups focused on a particular topic which the group facilitator will educate the group about and then allow the group time to discuss the topic. Some facilities even have classes to teach the addicted person about the disease concept, how drugs affect the brain and other educational topics.
- Some facilities offer free time to engage in recreational activities, read recovery literature or write in a journal.
- Other facilities offer classes in arts and crafts. Some even have pets that the addicted person can interact with because pets can offer great stress relief.
- You may be expected to do chores like cleaning your room and common areas.
- There may be areas and equipment available to engage in sports like volleyball or basketball.
- Some facilities take clients to recreational activities outside the facility. As you can see there are a variety of activities that could be a part of your treatment.
Each facility is different and each will have different activities. You can contact different treatment programs to find out what their program has to offer. Many facilities even have websites and Facebook pages so you can learn about the facility before you go.
4. Medication Assisted Treatment
Medication Assisted Treatment (MAT) is a form of heroin treatment which provides the addict with opioids to replace the heroin or other opiates the addict may be taking. Opioids are synthetic or man-made medications. Opioids keep the addict from having withdrawal symptoms. There is some controversy over the use of MAT as some people believe it is just substituting one drug for another. However, MAT medications have significant advantages over heroin use for the addict.
- One advantage is that MAT medications are longer lasting. MAT medications have a half-life of 24 to 36 hours which means that only half of the medication leaves the body in 24 to 36 hours. The advantage of this is that the addict no longer needs to take drugs every 2 to 4 hours but can take a medication once a day. This helps the addict remove themselves from the lifestyle of addiction.
- Another advantage is that MAT is taken orally and is created so that an addict cannot abuse it intravenously. This keeps the addict from getting the euphoria associated with street drugs and also helps reduce incidents of disease such as HIV and hepatitis.
There are two types of MAT – Methadone and Suboxone
Methadone is an opioid used to treat heroin addiction. Methadone is a partial blocker which means that it partially blocks the effects of other opiates. This is to keep the addict from using other opiates in addition to methadone. Methadone can be prescribed by a doctor for pain but it is generally prescribed and dispensed in methadone clinics. Addicts must go to the clinic daily until they earn the privilege to have take-home bottles. The methadone wafer is dissolved in water and juice is usually added or it can be dispensed in liquid form. Methadone is dispensed by a nurse and must be swallowed in front of the nurse to be sure it is not diverted to sell on the street.
When an addict begins treatment with methadone, the doctor prescribes a low dose based on information gathered during the intake process. The dose is gradually increased until the addict is stabilized. Stabilization means the addict is on a dose that keeps them from having withdrawal but does not intoxicate the addict.
By itself, methadone only keeps the addict from having withdrawal symptoms. However, methadone clinics are required to provide counseling to the addict to treat the psychological aspects of addiction. While in treatment, the addict can learn about the disease of addiction, relapse prevention techniques and develop new social connections with people who don’t use drugs. They can also deal with many of the consequences of their addiction. For example, addicts can begin to face legal problems, health issues, repair family relationships and even go back to school.
Once the addict has stabilized on a dose, learned about addiction and repaired many of the problems in their life, they can gradually decrease their methadone dose until they are drug free. Some addicts choose to remain on methadone and can be on it for the rest of their lives if they choose to do so.
Suboxone is an opioid with a full blocker. Suboxone contains Naloxone which is added to keep addicts from abusing it intravenously. It also keeps addicts from being able to get the euphoric effects of opiates while on Suboxone. As long as the addict takes their medication daily, they cannot get “high” by using opiates. This helps deter the addict from abusing their medication.
Subutex is the same as Suboxone but it does not contain Naloxone. It is meant for pregnant women and others who cannot take Naloxone for health reasons.
Heroin addicts who choose Suboxone treatment are generally given a dose between 8 mg and 16 mg. Much like methadone, the doctor prescribing the Suboxone will prescribe a dose sufficient to keep the addicted person from having withdrawal symptoms. Many Suboxone clinics provide counseling to treat the psychological aspects of addiction. Suboxone can also be prescribed by individual doctors who are certified to prescribe it.
To find a doctor or clinic that prescribes Suboxone or methadone, the Substance Abuse and Mental Health Services Administration (SAMHSA) has a treatment locator on their website. SAMHSA is a government program that provides information on substance abuse and mental health issues.
Naltrexone is a drug marketed under the name Revia, Depade and in extended release, Vivitrol. Naltrexone is an opiate antagonist used to treat heroin addiction. The addicted person must be free of all opiates and not in withdrawal before this medication is given. It works by blocking the euphoric effects of opiates. The addicted person cannot get “high” while taking this medication. It can be given orally but the addicted person has to take the medication daily for it to be effective. If the addicted person stops taking the medication, they can use opiates after the drug is out of their system. This mean that if they have cravings, they can simply stop taking the medication and go back to heroin use. It can also be given in the form of a monthly injection which means the addicted person cannot get “high” for at least a month after getting the injection. It is commonly prescribed after an addicted person has completed another treatment like Suboxone or a residential rehab program.
Any of these types of treatment can work if you can recognize that heroin brought more pain and horrible consequences to your life than fleeting moments of pleasure. However, the best treatment with the highest chance of success is the treatment that you put the most work into. Heroin addiction is never easy to overcome but it can be done when you work hard at your recovery.