People have become addicted to opioids for centuries, however, opioid use has escalated since 2000 with the development and marketing of powerful painkillers that are highly addictive and carry an enormous risk of overdose.
Opioid addiction has become a serious global problem, with opioid epidemics occurring in the United States and other parts of the world.
Prescription opioid painkiller addiction has a lot in common with heroin addiction, but there are important differences that influence the kind of treatment that will be most effective.
Opioid addiction is one of the most challenging addictions to overcome, but there are treatment options available that can help with the physical, psychological, and social aspects of substance use disorders.
Evidence-Based Addiction Treatment
Addiction is a complex, long-term condition that develops in people who are specifically vulnerable to it. Likewise, the treatment necessary for overcoming addictions is also complex and multi-faceted.
When considering addiction treatment, it’s important to establish that it’s evidence-based, which means that the treatment has been studied and shown to be effective for many people with the condition.
The treatments discussed in this article are supported by scientific evidence that demonstrates their effectiveness. However, keep in mind that a particular treatment won’t necessarily work for everyone, every time–particularly when it’s used apart from other necessary treatments.
For a treatment to be effective, a person needs help addressing the physical harms, psychological underpinnings, and physical aspects of addiction, as well as the social causes and consequences of their substance use.
If all of the physical, social, and mental health aspects of opioid addiction are not addressed, the treatment is not likely to be successful and the person may relapse.
Therefore, these treatments should be part of a comprehensive treatment plan that is consistently followed before, during, and after the person quits opioids.
Harm reduction 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.
The harm reduction approach is especially helpful for people who inject opioids. It includes strategies such as needle exchange programs, safe injection sites, opioid replacement therapies (such as Suboxone/Subutex 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 human immunodeficiency virus (HIV), hepatitis and overdose.
Psychological Treatments for Opioid Addiction
In the last few decades, psychological treatments have become more sophisticated. The approaches focus on every stage of overcoming opioid addiction from making the decision to change and quitting or reducing opioid use to becoming abstinent and avoiding relapse.
There are different approaches, but each should be tailored to meet the individual needs of the person with opioid use disorder.
Motivational Interviewing & Motivational Enhancement Therapy
Motivation is the most important psychological predictor of effective treatment for opioid addiction. If someone is not motivated to quit opioids, they are at a high risk of relapse which in turn puts them at greater risk of death by overdose.
For this reason, motivational interviewing or motivational enhancement therapy is an important step in helping people who use opioids prepare to quit before they attempt to do so. The approach guides them through the various stages of change.
While there are some myths about motivational interviewing, the treatment is often effective. Motivational interviewing is often well received by people who use opioids because it is a supportive approach.
Cognitive Behavioral Therapy (CBT)
Cognitive-behavioral therapy (CBT) is one of the most effective treatments for opioid use disorder. It’s also a highly effective treatment for other psychological disorders including anxiety disorders, depression, and trauma—all of which can co-occur with opioid addiction.
If someone has an addiction to opioids as well as a co-occurring mental health condition such as depression and anxiety, CBT is often a good psychological treatment to start with.
Couples counseling (sometimes called couples or marital therapy) can be an important part of a treatment plan for someone with a substance use disorder, including opioid addiction. It is often used with other treatments.
Couples counseling can be helpful for couples who wish to stay together during and after recovery, as well as for those who choose to separate.
Family therapy can help families with a member or members who are dealing with addiction, but it is especially effective for adolescents with substance use disorders.
The basic approach focuses on the dynamics of the family as a whole. Therapeutic attention is not just focused on the person who is using a substance; rather, a family member’s substance use is considered to be the “symptom” of overall “disease” within the family.
When the behavior of a person addicted to opioids starts to affect their partners, children, or parents, family therapy can be helpful. Sometimes, hearing from loved ones about their experiences can motivate a person dealing with substance use to change their behavior.
Family therapy can also help family members support the person who wants to quit opioids, as well as help each member become more aware of how they may have inadvertently contributed to difficulties that occurred in the past.
Family therapy is widely used and part of a comprehensive treatment program. It may be covered by insurance or available privately.
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 mental states in an ethical and responsible way. It’s not like stage hypnosis, which uses a volunteer’s suggestible mental state to entertain an audience.
Some people find hypnosis effective for helping them break through their own psychological barriers to change. Hypnotherapy can be empowering and even relaxing, helping someone feel more in control of their thoughts without drugs.
However, hypnotherapy is a poorly understood therapy and can be controversial. In addition, its research base for efficacy in addictions is much less than for other established treatments. If you want to try the method, find a therapist who is qualified in hypnotherapy. Keep in mind that certification requirements vary by jurisdiction.
Therapists who use hypnotherapy charge, on average, $100 to $200 per hour. You will probably need several sessions to support your recovery.
Neurotherapy is less commonly used, but there is some research on its use in addictions and might be a consideration—particularly for people who haven’t found talk therapy helpful.
The Origins of Neurotherapy
Research performed in animals has found that the brain can be trained to produce brainwaves of various frequencies that are associated with healthy psychological states. The animal studies also found that some brainwave patterns are associated with vulnerability to various mental health conditions, including addiction.
During neurotherapy, electronic sensors are painlessly attached to your scalp with a conductive gel. While you relax, a computer provides you with feedback on your mental state.
The feedback is typically in the form of a video that appears lighter as your brain produces desirable frequencies and darker when it produces frequencies that are associated with vulnerability to addiction.
Alternatively, the video can also have a color that increases or decreases in intensity according to the feedback. Music or audio tones can provide feedback, which gets louder or quieter depending on your mental state.
This allows you to retrain your brain. If the music chosen is soothing and pleasant, it can be a very relaxing experience, and one that helps people dealing with addiction discover their own ability to access pleasurable mental states without drugs.
Currently, there are not many Neurotherapy practitioners, as it is not well known in the health professions and extensive training and costly equipment are required to provide the service.
However, practitioners who do use Neurotherapy are usually highly dedicated and believe in its potential to help people with addiction who have not responded well to other treatments.
If you are considering Neurotherapy, choose a practitioner who is certified with the Biofeedback Certification International Alliance (BCIA). You can expect to pay, on average, $100 to $200 per hour, and you will likely need several sessions.
Twelve-step facilitation is a strategy built on the premise that involvement in a mutual support group like Narcotics Anonymous (NA) or Alcoholics Anonymous (AA) can help individuals to achieve and maintain abstinence.
While there is some evidence that the approach is effective for treating alcohol abuse and dependence, evidence of its efficacy for treating opioid-dependent individuals is limited.
Groups may also pose some risks: because they are not formalized treatment, participants can be especially vulnerable to predatory individuals. These people may try to take advantage of members by selling drugs to the group or using the group to sell drugs.
However, groups can also be supportive, safe spaces for people in recovery. Many members benefit from new friendships and sober activities that take place in mutual support groups.
Two examples are NA and AA, which are programs based on acceptance of the chronicity of a substance use disorder as a disease, surrender to a higher power, and fellowship among abstinent peers. Meetings are free to attend and are held every day in locations all over the world.
Contingency management is sometimes used when individuals with substance use disorders are mandated to get treatment by an employer or the court system.
In this 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
If you choose medical treatment for addiction, you’ll have several options. They may be combined with other forms of treatment or you may need to try more than one to find one that works for you.
The first line of treatment is office-based pharmacological or medication-assisted treatment (MAT) with buprenorphine. The sublingual medication works by blocking opioid receptors in the brain, which prevents 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 or individual clinician. Physicians need a license or DEA waiver to prescribe buprenorphine or Suboxone (buprenorphine plus naloxone) to discourage injection.
Patients who are maintained on buprenorphine or methadone are not switching to another drug of abuse; rather, they are using an effective treatment prescribed by a qualified physician.
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. The medication helps them achieve the stability that enables fuller participation in behavioral interventions and other forms of psychological therapy.
Choosing a Specialist
If you are dealing with opioid use disorder, a mental health or addiction medicine specialist can help you determine the 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 are few (if any) requirements for education and training in treating substance use disorders. Professionals may not be required to receive training for addiction counseling.
Several websites provide resources you can use to find treatment services, including resource lists maintained by government agencies like SAMSHA.
Doctors who certify with the American Board of Addiction Medicine, or those who train for years in a general psychiatry residency, have a good understanding of the disease of addiction.
Additionally, there may be primary care physicians, particularly those who work in communities with high rates of opioid use disorders, who are highly knowledgeable and competent in treating opioid use disorder.
Look for an independent professional who will not benefit financially from making a recommendation to a specific program or group of programs. It is helpful to consult with a professional who has a broad knowledge of all options for treatment rather than 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, the consequences of your use, 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.