Many people can, and do, overcome opioid dependence and end their addictive behavior. It may take courage and commitment to begin a treatment plan (and stick with it) but getting professional support to identify the program that is best for you will increase your chances of success.
Comprehensive treatment plans combine medical care from a doctor (such as a specialist in addiction medicine, psychiatrist, or primary care provider with special interest and training) with support from a professional counselor, therapist, or group program. Support from family and friends can also be really helpful. Various treatment approaches are outlined below; by working with a healthcare professional you can consider the approach that is best for you and your situation.
“There isn’t one way to get clean or overcome an addiction. It’s your recovery. You should have a say in it. Talk to your doctor and set realistic goals but also goals that you know will help you stay away from your addiction.”
When beginning a treatment program, it is important for your healthcare provider to assess your medical needs.
They need to know about your opioid dependence and any other physical and mental health conditions. He or she should also ask about your history of addictive behaviors, social and family situation, financial concerns, and your personal goals. This will help determine the type of medical treatment, as well as what counseling and other support services they recommend.
“Find a doctor you can build trust with, they are there to help you… You should find a doctor that you feel like you can talk to and trust and tell them how you are feeling.”
When you take opioids, they attach to special areas on the brain cells called receptors. Opioid replacement medications act on these receptors instead. The brain thinks it is getting its usual opioid, which means withdrawal symptoms and cravings are controlled. Although the medication may also be a form of opioid, you won’t get the same high as with the opioid you have become dependent on.
Opioid dependence medication will allow you to start to regain a more normal state of mind, free from the highs, lows, preoccupations and obsessions caused by opioids. By allowing a person’s mind to focus on the lifestyle changes that lead back to healthy living, opioid-dependence medication can clear a path towards recovery.
“With the medication, I didn’t have worry about having to frequently dose or having to find drugs to just not feel sick.… I just took it once a day. I no longer felt sick. I could function at a normal level and I didn’t come off as someone who is high. I went back to college. I didn’t feel high or groggy. I was able to go to class and concentrate.”
Some people begin their recovery by using medications over a short period of time, to try to come off opioids quickly, under medical supervision (this is sometimes called detoxification).
Detoxification programs are offered in a variety of settings, including hospitals, rehabilitation facilities, and drug treatment centers. Participants in these programs may find it helpful to be away from the pressures of their usual environment, to focus on their recovery.
Some detoxification programs only last for a few days, with continued counseling and support services to provide help with long-term coping skills. Other residential programs last for longer periods of time, and include supportive counseling and therapy sessions to focus on recovery from addictive behaviors. Participants often continue with support services in the community after completion of these programs.
“When you come back home from your inpatient program, think about going to a support meeting. You may find that if you go right away, it’ll be that much easier to go again.”
Other people take part in outpatient programs, where they receive medication and/or support services in a day-treatment center, or receive care and services to support their recovery while they are still in their day-to-day environment.
People with these treatment plans may appreciate the opportunity to stay at home and carry on with their jobs and other responsibilities while undergoing treatment.
“The daily structure and stability of my outpatient program really helped me stay on track in the beginning and was part of my success in recovery.”
A number of medications may be used for opioid dependence, but the two opioid replacement medications that are most commonly recommended are methadone and buprenorphine (both are taken by mouth).
Methadone has been used as a treatment since the 1960s. It is given only in accredited clinics (both public and private).
You will need to attend the clinic every day, especially for the first few months, where you take the methadone under close supervision.
The staff will check whether the dose you receive is at the right level for you, whether you experience side effects, and how well you do over time. Methadone clinics may require you to attend group counseling sessions, as well as any individual counseling you may be having. Some people find the daily routine, face-to-face support, and contact with other patients at the clinic a helpful part of the process.
“Once I got back on track and in a treatment program, my life started to fall into place. I was able to get an apartment, I got a part-time job. Everything fell into place because I was able to make clearer and better decisions.”
Buprenorphine is a newer opioid-dependence treatment, which can be prescribed by certain doctors with specialized training.
Once your dose is determined, you will be prescribed doses to take at home. This may be an advantage if you find it inconvenient to make daily clinic visits, especially if you work or have other ongoing responsibilities. You may also prefer a more private environment in which to deal with your addiction. Counseling is strongly recommended alongside buprenorphine treatment, and is a requirement in some treatment centers.
NOTE: Many buprenorphine products also contain a chemical called naloxone. Naloxone is included because some people may try to tamper with buprenorphine tablets or films and inject them in the hope of getting high. In this case, the naloxone enters the bloodstream and prevents the high, but it also leads to withdrawal symptoms. As long as the buprenorphine products with naloxone are taken by mouth as prescribed, the naloxone does not have this effect.
“The physical dependency of opioids is a big challenge – it is a huge barrier to overcome in the early stages of recovery. Medications help you avoid the physical sickness and withdrawal. Buprenorphine stopped the withdrawal symptoms and made it possible for me to concentrate on other parts of recovery.”
Your doctor will give you advice about the medication that is best for you.
There will be an initial “induction period” where your treatment will begin, withdrawal symptoms will be monitored, and the care team will work out the right dose for you.
It is very important to ensure that you receive enough medication to help with your cravings and withdrawal symptoms, and don’t risk taking too much medication. You should start to experience the benefits of treatment quite quickly.
“In early recovery – your number one goal is to get through the next 24 hours without using. Keeping the goal as simple as that is important.”
You will then enter the “maintenance” phase, where you will continue to take the medication to control your condition while you are working on managing addictive behaviors and regaining control of the other aspects of your life.
The length of time a person takes maintenance medication varies; some stop after 6–12 months and others will stay on medication for several years or more.
“In the first couple of months, really stay on top of whatever the plan is and to some extent, allow the professionals around you to help make the decisions for you, because it is very easy to say ‘I’ve got this down because I feel better physically’ and then go make some pretty stupid decisions.”
“It’s a little easier now that I’ve been clean for a few years but I know in my head that it takes just 30 seconds to make that bad decision to lead me down the wrong road. I just try to keep myself away from those trigger situations.”
When you are ready to stop medication, this has to be done gradually and under medical supervision (this process is known as tapering).
It is important to recognize that taking opioid-dependence medication is not about swapping one problem drug for another. The medication helps to control your condition in the same way that people with other chronic diseases take long-term medication.
It is also important not to let expectations (either yours or those of friends or family members) determine how long you should be on treatment without proper medical consultation. Finally, if you find that one medication or treatment option is not right for you, you should discuss alternative approaches or treatments with your healthcare provider.
“People need to understand that medication is a treatment. It is not replacing one addiction for another. You’re not getting high, you’re not chasing that high. You’re choosing not to allow yourself to get high. It allows you to deal with the mental baggage that led you to the addiction, all of the emotional baggage, all that you were stuffing down inside with pills or heroin or whatever. It allows you to deal with that while protecting you physically from the withdrawal symptoms and protecting you from relapse.”
Detoxification and maintenance medication don’t address the issues that led you to misuse opioids in the first place, or help you to break habits linked to your addiction.
This is why behavioral therapy and other counseling services are an important part of recovery. You may take part in one-to-one counseling or in a group setting, which may help you focus on:
In addition to counseling, many people benefit from the chance to share their experiences with others facing the same struggle. Support groups may take the form of informal, local gatherings, or can be online chat rooms or forums. There are also structured support programs of various types, some of which use social support at meetings or online communities.
“Treatment can be scary at first – you don’t know what to expect, you fear the withdrawals, you don’t want to open up in group therapy. Being in a support group felt funny in the beginning, I felt very uncomfortable. But once you get comfortable with the people, it becomes second nature. You talk about everything, things that bother you, things that you never thought you would share with other people. You get as much as you give in group. It really helps to know people are there for you.”
“I have been trying on and off for years but this time I’m trying to do everything you are supposed to do instead of the parts that I think will work for me. I think that’s really important. A challenge that I am facing, everyone has their ups and downs. Life does not stop happening just because you are doing well. I’m working on developing tools to cope with daily frustrations and really big life-changing crises without relapsing. This is very important in recovery.”