Caring for someone with a heroin addiction isn’t easy, but there is a lot families can do to help. They can:
- Learn all they can about how heroin works
- Hold a drug intervention meeting
- Identify inpatient heroin treatment options
- Obtain preauthorization for treatment from insurance companies
- Interview heroin addiction treatment providers
- Transport the person to the treatment facility
- Participate in therapy appointments, as needed
- Identify heroin addiction support group meetings in the community
- Look for signs of heroin addiction relapse
Out of all the illegal drugs that hurt, and even kill, people, heroin is one of the “number one” drugs, says CNN.
The National Institute on Drug Abuse estimated in 2011 that 4.2 million people aged 11 and over had tried heroin, and 23 percent of those people would become addicted to the drug.
Heroin use is on the rise, spiking 250 percent between 2000 and 2014 in Vermont, with more than 681,000 heroin users across the United States in 2013, according to the Substance Abuse and Mental Health Services Administration. Even in the face of such overwhelming numbers, real recovery is very attainable for those who are addicted to heroin. Treatment options for heroin addictions can help individuals to build new, clean lives that are free from all heroin use.
Treating a heroin addiction first requires that users are broken of their physical dependence on the substance. Since heroin has such an immediate neurological and psychological impact, virtually rewriting the brain’s perceptions of pleasure, reward, and the anticipations thereof, individuals have to be gradually and carefully weaned off their dependence. This entails reducing the amount of heroin they consume, while at the same time controlling for the inevitable withdrawal symptoms that come from the body receiving less of the drug to which it has become so accustomed. Withdrawal symptoms include:
- Muscle cramping
- Nausea and vomiting
- Cravings for more heroin
- Suicidal thoughts (in cases of extreme or chronic heroin abuse)
For that reason, being purged of heroin and the desire to retake heroin (detoxification) can be a very delicate and complex process, and one that should never be attempted alone. Speaking to MinnPost, the director of a program at the Hazelden Betty Ford Foundation in Minnesota talks of “severe depression,” and individuals having unshakeable feelings that they will never be free of that state. This, coupled with the other symptoms of withdrawal, make it likely that individuals will relapse if they try to detoxify on their own or could even succumb to the suicidal ideations that arise as part of the process.
Medical detox, however, ensures that trained professionals who know how to ease people through the worst parts of withdrawal always supervise those who are withdrawing. These professionals can ensure that people receive the right medications to be successfully weaned off heroin, taking into account each individual’s medical history, mental health, and susceptibility to other addictive substances.
Another advantage to professional medical detox is that individuals are in a system that gives them the additional needed resources to overcome their heroin addiction. Such resources include counseling and therapy. In the same way that detoxification addresses the physical toll of heroin addiction, the mental toll of the addiction is treated with therapy. Sessions often cover how the person can better cope with the kind of stressors that would have, in the past, triggered heroin use.
Medically Assisted Detoxification
Inpatient therapy allows for this kind of supervision, ensuring that each person’s physical dependence on heroin is broken in as safe and stable a manner as possible. One way of doing this is by administering medications like Suboxone. Suboxone consists of two drugs: buprenorphine, which is an opioid that only partially stimulates the brain’s opioid receptors (as opposed to heroin, which fully stimulates the receptors) to cause reduced euphoria and dependence, but also diminishes the effects of heroin withdrawal; and naloxone, which reverses the effects of opioids by blocking the opioid receptors in the brain.
The combination of raising the threshold of effect (via the buprenorphine) and ensuring that the opioid receptors are not significantly stimulated (naloxone) makes Suboxone a popular choice of medication for use in inpatient treatment programs. The Washington Post called Suboxone “the drug that could combat the heroin epidemic.”
Suboxone carries a risk for causing its own addiction in certain people, which is why the drug should only be taken in an inpatient setting. This will ensure that its administration is only conducted in the presence of healthcare professionals, who can alter doses (and discontinue if necessary) to ensure that the patient does not develop a dependence on Suboxone.
For a long time, methadone (a synthetic opioid) was used to help people break their dependence on heroin, but it is now the “fastest growing cause of narcotic deaths,” according to The New York Times. Methadone’s addictiveness has led to it being connected to twice the number of deaths caused by heroin, and the vice-chair of psychiatry at the University of California San Francisco explained that its “continued provision of an addicting drug” can necessitate patients staying on methadone for years.
For this reason, the Western Journal of Medicine explains that methadone is a Schedule II drug in the United States. There is a legitimate medical use for methadone, but it can cause “severe” physical and psychological dependence, and it has a high potential for abuse. Therefore, only pharmacies, practitioners, and clinics that have been approved by the U.S. Food and Drug Administration can prescribe methadone.
Related: A Guide to Harm Reduction
If addictions are short-term, or not very extensive, people may be referred to outpatient treatment programs; however, this is generally not applicable to heroin addiction. Since heroin addiction is serious and usually severe, outpatient detox is not recommended. Medical detox, in an inpatient setting, is usually required for this addiction.
For those in recovery from heroin addiction, outpatient treatment often follows a stay in an inpatient treatment program. Once individuals have undergone medical detox and “graduated” from a treatment program, aftercare can commence in the form of outpatient care. This may range from a daily treatment program, given on an outpatient basis where the individual returns home each night, to weekly meetings with a therapist.
Even though those in an outpatient program are allowed to go home at the end of the day, a regular visit to a treatment facility can last for hours, requiring tests, observation, and counseling sessions. Such an intense program bestows a sense of responsibility upon participants, compelling and motivating them to maintain their sobriety and meet the standards of outpatient therapy.
Oftentimes, outpatient therapy may occur at different intensity levels as people progress through care. Individuals may begin with daily therapy sessions. As they become more stable in their recovery and more comfortable with their return to daily life in the “real” world, they may progress to semi-weekly or weekly sessions.
Key Benefits of Inpatient Treatment
Inpatient treatment offers a couple key dynamics that outpatient treatment does not. Inpatient care imbues participants with feelings of security and safety, as 24-hour supervision prevents the possibility of relapse.
The sense of protection of inpatient therapy comes from giving clients a place that is free of the stresses and temptations of the outside world. Here, they have distance from the problems that may have lured them to heroin in the first place, and they can focus all their time and energy on healing and restoring themselves. The freedoms offered by outpatient therapy are very attractive, but they are not for everyone – and generally, they are not for those suffering from this serious addiction.
A network of relationships and support can be created in inpatient treatment. Psych Central refers to this as a “therapeutic community,” whereby the participants in an inpatient program form a bond of encouragement and understanding that lasts far beyond the last day of formal treatment. Some of the friendships made in these programs can help those struggling to stay on the wagon when their sobriety is threatened.
Additionally, health insurance plans may offer coverage for inpatient treatment (pursuant to a doctor’s written referral), as long as the treatment costs for inpatient therapy do not exceed the costs that would be incurred by surgical or medical treatment. Rehabilitation centers usually offer a range of payment options, such as sliding scale or monthly payment plans, to help individuals pay for their treatment.
Whether a patient is referred to an inpatient or outpatient program depends on the results of the initial intake process. Most intakes use the criteria set forth by the American Society of Addiction Medicine (ASAM), which examines six dimensions for determining the individual’s position on the addiction spectrum:
- Potential for abuse and/or withdrawal (determining the person’s past history and current status with regards to heroin abuse and severity of withdrawal effects)
- Medical conditions and potential complications (assessing the person’s medical history, family history, and current physical condition)
- Emotional, behavioral, and cognitive conditions (assessing the person’s emotional and mental state of mind)
- Readiness to, and interest in, changing (how determined the person is to overcome addiction)
- Potential of relapse or continued use (assessing the likelihood that the person will relapse or otherwise struggle to maintain sobriety)
- Recovery/living environment (assessing the person’s home environment, including the people, places, and things in that environment
Therapy and Counseling
Regardless of a person’s inpatient or outpatient status, treatment is not complete without therapies to help control behavior and thought processes. The National Institute on Drug Abuse mentions Contingency Management (CM) therapy and Cognitive Behavioral Therapy (CBT) as two examples of mental health interventions that seek to show individuals how they can navigate the outside world and remain sober. In 2009, the Journal of Studies on Alcohol and Drugs published the findings of a study that showed that 79 percent of patients who received CBT as part of their treatment reduced their rates of substance abuse to a greater extent than patients who received substance abuse treatment without CBT.
There is real hope for those addicted to heroin. With research-based, professional treatment, individuals can achieve stable, balanced lives in recovery. While that recovery is not always easy, with comprehensive care and aftercare support, it is within reach.