Heroin Treatment: Detox, Medication, and Therapy – Heroin is a powerful illicit opioid drug that is directly involved in the deaths of thousands of people each year in the United States. Heroin has a high potential for abuse and dependence and usually requires a comprehensive approach to effectively treat the disorder, prevent relapse, and sustain long-term abstinence.
Due to the intensity of withdrawal symptoms, individuals addicted to heroin usually begin treatment by undergoing a medical detox.
Medical Detox and Ultra-Rapid Detox Programs
Heroin withdrawal symptoms typically onset within 12 hours of the last dose, peak in intensity from 2-3 days and last for about one week. While heroin withdrawal symptoms are rarely life-threatening, the detox period can be tremendously challenging to endure.
Medically-supervised opioid detox programs use medications to mitigate the intensity of withdrawal symptoms and monitor patients 24/7 to ensure safety and relative comfort. Many medical detox programs make use of drugs such as Subutex or methadone to help transition patients away from illicit opioids.
In some cases, patients will undergo an ultra-rapid detox, in which they are placed under anesthesia and receive medications that accelerate the withdrawal process. In theory, patients wake up from the anesthesia having passed through the worst of the withdrawal symptoms while unconscious and are ready after a day or two of recovery.
In reality, ultra-rapid detox can be life-threatening, whereas a medical detox is almost never dangerous. It is more expensive than the more-often used medically-supervised withdrawal. Also, ultra-rapid detox is rarely combined with behavioral therapy or continued support, so those who leave detox and reenter the real world are particularly vulnerable to relapse.
Methadone maintenance is a form of opioid substitution therapy and heroin treatment. The patient is switched from heroin, an illicit drug that causes adverse health and behavioral effects, onto methadone, a legal opiate that permits the person to better function in society. However, because the person is not withdrawn off opioids completely, there are few or no withdrawal symptoms.
Taking a proper dosage of methadone once a day prevents drug cravings and withdrawal symptoms, but because taking an excessively high dosage of methadone can lead to a euphoric high, access to the medication is tightly monitored. In any case, methadone replacement therapy permits people to concentrate on re-engaging in their lives, participate in treatment, interact socially and get back on track at work or school.
Some people continue taking methadone indefinitely, others eventually choose to decrease their dosage gradually and ultimately discontinue it entirely. Problematically, although methadone works quite well, it is not an easy medication to quit using. For this reason, many methadone users decide to transition onto buprenorphine, before stopping opioids entirely.
Buprenorphine works similarly to methadone as an opiate substitution medication. Once someone begins taking buprenorphine, he or she should not experience drug cravings or symptoms of withdrawal.
Buprenorphine is approved by the FDA for the treatment of heroin addiction when sold as Suboxone or Subutex. Suboxone contains two active ingredients: buprenorphine and naloxone. The buprenorphine attaches to opiate receptors in the brain and prevents withdrawal symptoms, while the naloxone makes the medication more difficult to abuse and impossible to overdose upon.
Due to Suboxone’s lower potential for abuse, it can be prescribed in 30-day increments, so people taking Suboxone don’t have to travel to a methadone clinic every day like methadone users are required to do.
Also, the eventual withdrawal syndrome of cessation from Suboxone is considered far milder that of Methadone. Unfortunately, some people cannot get full relief from withdrawal symptoms with Suboxone, so people with very severe heroin habits may need to use Methadone to feel maximum relief.
Naltrexone is another medication that can be used for the treatment of opioid addiction. Naltrexone works by attaching to opiate receptors in the brain and blocking them. If someone uses heroin after taking naltrexone, the drug can no longer access the opiate receptors in the brain and, therefore, does not result in an effect.
Naltrexone can help motivated people to stay abstinent. Only oral forms of naltrexone are approved for the treatment of opiate addiction, so if a person in recovery decides to use opiates again, all he or she needs to do is discontinue taking the naltrexone pills.
Vivitrol, on the other hand, is an extended-release formulation of naltrexone that is administered by injection once a month. Vivitrol has the same effect except, once administered, the patient has little choice but to remain abstinent for the period of the medication’s effectiveness.
Psychotherapies, such as cognitive-behavioral therapy or contingency management, have shown efficacy in helping people overcome opiate addiction. For the best chances of success, the National Institute on Drug Addiction (NIDA) recommends combining psychotherapeutic and pharmacological approaches, such as methadone or buprenorphine treatment, into a single comprehensive treatment plan.
Cognitive-behavioral therapy (CBT) is an evidence-based treatment that teaches those in recovery new techniques for achieving and sustaining abstinence. Patients learn which environmental factors put them at risk of relapse and how to avoid these “triggers” when possible. Likewise, patients are taught strategies for overcoming the temptation that will, at some point, unavoidably occur.
Behavioral therapies such as CBT require active participation in the therapeutic process and implementation of the techniques learned. People who are stabilized on medications like buprenorphine find it easier to stay involved in the therapeutic process than people grappling to overcome drug cravings and withdrawal symptoms.
Many of those who are in recovery from heroin addiction find that participation in support groups, such as 12-step programs, can be beneficial. People who attend meetings regularly have access to a drug-free social support system and can make sober friendships and share experiences with others who understand the challenges they are facing.
Some people in recovery find Narcotics Anonymous (NA) helpful, while others prefer Methadone Anonymous (MA) or other support groups. Meetings are free, readily found in most urban areas, and can complement a more comprehensive recovery program.
Heroin Treatment: What is Best for You?
The best form of treatment is, inevitably, one that meets the individual’s needs and is effective. No one method of treatment is best for everyone, but in general, people seem to have the best success when they undergo methadone or suboxone maintenance therapies combined with behavioral therapy and other treatment components, such as participation in support groups.
Other people prefer to break entirely free from opioids, however, and instead choose to undergo a medical detox followed by an integrated program of behavioral therapies, counseling, and other addiction treatments.
Overcoming an addiction to heroin is challenging, but it can be done. Whatever path to sobriety you choose, understand that it will take time and effort – there are no quick and easy fixes. People who stay actively involved in treatment for a year or longer have a much better chance of staying abstinent for good. Receiving a combination of long-term inpatient treatment followed by outpatient treatment, counseling, and aftercare is a great start.
Comprehensive addiction treatment can help you restore your sanity and reclaim your life! Contact us as soon as possible to find out how we can help you begin your path to a full, long-lasting recovery!