Hydrocodone (Vicodin, Norco) Addiction and Treatment
Hydrocodone is the most commonly abused prescription opioid. The American Society of Addiction Medicine found that in 2014 alone, 1.9 million Americans ages 12 and up abused prescription pain relievers. The most advisable way to recover from hydrocodone abuse is to seek treatment at a rehab center that is equipped to:
- Discuss the option of medication-assisted treatment (MAT)
- Provide individual and group counseling
- Encourage participation in group recovery meetings (e.g., Narcotics Anonymous)
- Promote wellness through nutritional counseling, acupuncture, massage, yoga, and other holistic options
- Offer healing-oriented programs, such as expressive arts therapy and equine-assisted therapy
- Invite loved ones to participate in family therapy
- Help with the creation of an aftercare program
Recovery from hydrocodone is always possible.
American society is considered worldwide to be a “pill culture.”
The US has received this reputation due in part to the many advancements made in pharmacology here. However, medications that can be therapeutic, such as hydrocodone, can also become drugs of abuse.Hydrocodone is a generic opioid pain reliever that is an active ingredient in numerous branded medications, including but limited to Norco, Lortab, Vicodin, and Lorcet. This narcotic is indicated for the treatment of moderate to severe pain. Hydrocodone is a highly addictive drug. However, individuals who take this drug by prescription as part of a medically supervised pain management plan do not risk addiction if they follow the doctor’s instructions for use.
In order to better take in the extent of the heroin and prescription opioid abuse epidemic currently befalling America, it is helpful to consider some facts and statistics. Based on a large-scale survey, the results of which were published by the American Society of Addiction Medicine, the following were found to be true:
- In 2014, an estimate 21.5 million people in the 12+ age group were experiencing a substance use disorder. Of this group, 1.9 million were abusing prescription pain relievers, including hydrocodone. In 2014, 586,000 were using heroin.
- Of the individuals who were surveyed and using heroin, 94 percent reported that they chose heroin over prescription opioids because it was cheaper and easier to obtain. In other words, these individuals had a preference for prescription opioid pills, such as hydrocodone, but couldn’t afford or find them.
- In 2014, there were 47,055 drug overdoses in the US. Abuse of prescription opioids is driving the current narcotic abuse epidemic. Of these overdoses, 18,893 involved prescription opioid pills and 10,574 involved heroin.
- In 2012, Americans received 259 million prescriptions for opioid pain relievers.
- There is overwhelming migration from prescription opioid abuse to heroin abuse. Among individuals who reported that they were using heroin, four out of five had started out by misusing prescription opioids.
These statistics reflect the magnitude of the prescription drug and opioid epidemic while also highlighting the interrelatedness of prescription opioids and heroin. Individuals who abuse hydrocodone may easily swap out this drug for another opioid, such oxycodone and, in some cases, even heroin. For this reason, it is a good idea to learn about hydrocodone abuse specifically, but also opioid abuse in general.
Hydrocodone AbuseHydrocodone addiction is only one facet of the US prescription painkiller epidemic. There are a variety of opioids on the legitimate and illegal drug market. Some individuals will find hydrocodone to be their primary drug of abuse, even if they are polydrug users. In fact, of all opioid pain relievers, hydrocodone is the most abused. It’s a potentially fast and slippery slope between recreational use of hydrocodone and the development of an opioid use disorder. Individuals who take hydrocodone as part of a pain management treatment plan may develop a physical dependency on hydrocodone, but not progress to addiction.
As the National Institute on Drug Abuse explains, the two main features of physical dependence are tolerance and withdrawal. In short, people who continually abuse hydrocodone will need to take more of this opioid over time in order to experience the desired psychoactive effects, such as a hydrocodone high. After a period of hydrocodone abuse, if a person stops using or significantly reduces the regular level of intake, then withdrawal symptoms will emerge. The following is a sample of some of the possible withdrawal symptoms that may be experienced:
- Mood swings
- Changes to appetite
- Suicidal thoughts
- Flu-like symptoms, such as fever and a runny nose
- Dilated pupils
- Nausea, diarrhea, and vomiting
It is important to understand that hydrocodone, as well as other opioids, can present particularly significant health risks during the withdrawal process. For this reason, there is a general recommendation that individuals who are seeking recovery undergo medical detox or substitution therapy. For instance, during the intake process at a rehab center, when the addiction team members learn that the person has been abusing oxycodone, they may advise that the safest approach is to start the person on narcotic-based medication (substitution therapy). After the recovering individual is safely stabilized on a substitution therapy program, primary addiction treatment will begin.
Medications for Hydrocodone Abuse
For a public that is unfamiliar with opioid addiction treatment, it may seem illogical that narcotic-based medications are used to treat narcotic abuse. However, at present, this approach is the most effective one available. To illustrate, if a person has been abusing hydrocodone and stops, withdrawal symptoms will typically emerge within 30 -72 hours. Individuals with a history of hydrocodone or other opioid abuse report that at some point they want to continue to take these drugs just so they don’t have to go through withdrawal. It is particularly frustrating to consider that individuals may stay addicted to dangerous opioids because they, understandably, do not want to suffer through withdrawal.
Substitution therapy can effectively intervene here. Since substitution therapy medications are narcotic-based, they can act on the brain in a way similar to opioids without producing a high. At the same time, these medications can stop or reduce withdrawal effects. Substitution therapy is also referred to in addiction literature as medication-assisted treatment (MAT).
Substitution medications can be used during the withdrawal process from hydrocodone, and their use can continue indefinitely. Some individuals take these medications for years. Others will eventually use a substitution therapy medication to achieve a full detoxification (i.e., the body system is entirely opioid-free). The following medications can be used for the treatment of hydrocodone abuse:
- Methadone: Use of this manmade synthetic opiate has become a matter of common knowledge because of its pervasiveness. Provided individuals only take their allotted dosage, methadone will effectively suppress withdrawal symptoms and allow a person to function well in daily life. In this way, methadone can help a person to avoid an opioid relapse as well as give them time to develop the skills necessary to build a drug-free life. Note, in order to receive methadone, a person must visit a clinic every 24-36 hours.
- Buprenorphine: This is a generic drug that is the active ingredient in two branded drugs used in substitution therapy treatment: Subutex and Suboxone. During medical detox, the first phase of addiction treatment, a team of addiction professionals may start a person on Subutex (buprenorphine only) or Suboxone (buprenorphine plus naloxone) directly. A person who starts on Subutex usually does so after two days of being off hydrocodone. Subutex comes only in a sublingual tablet format. Shortly after the person is stabilized on Subutex, the treatment team may now transition the recovering individual to Suboxone.
Suboxone has two formats: sublingual tablet and sublingual film. Like Subutex, Suboxone works in the brain by attaching to opioid receptors while at the same time stopping or reducing withdrawal symptoms, including cravings for opioids. The presence of naloxone in Suboxone means that if a person abuses a narcotic, withdrawal symptoms will emerge. Naloxone, therefore, creates a deterrent effect, discouraging the individual from relapsing.
- Naltrexone: This drug can both reduce withdrawal effects during recovery from hydrocodone as well as block the effects of a narcotic if one is taken.
- Naloxone: This is mainly an emergency response medication. If a person is experiencing an opioid overdose, this drug can reverse the deleterious effects. Many states are expanding public access to this lifesaving drug and working to ensure that emergency medical response teams and police stations have it in stock. Naloxone may also be available to the public at pharmacies in some areas. In this way, anyone who is concerned that an opiate or opioid overdose may occur can obtain naloxone in advance.
As the National Institute on Drug Abuse makes clear in their Principles of Effective Treatment statement, medical detox alone is never enough. Looking at addiction treatment broadly, there are two main pillars of care: medications and therapy. The rest of the architecture of addiction treatment, including complementary therapy, can be seen as supporting beams. The phases of treatment — medical detox to primary addiction treatment to aftercare — are like connecting rooms.
Some rehabs are not equipped to offer medical detox onsite, but a rehab that offers a full continuum of care will be able to do so. To understand the full range of treatments available after hydrocodone detox, it is necessary to look at what goes on during primary care for addiction at a rehab center.
Primary Care for Hydrocodone Abuse
The following is a sample of the different types of recovery programs available:
- Detox (residential, outpatient, or hospital-based)
- Residential treatment (also called inpatient treatment; may be short-term or long-term)
- Hospital-based residential treatment
- Partial hospitalization (a step below residential treatment but more intensive than outpatient care)
- Outpatient care (intensive or standard)
- Opioid maintenance (a methadone clinic or ongoing visits to a doctor who is qualified to prescribed Suboxone)
- Extended care
Once an individual has entered a rehab program for the treatment of hydrocodone abuse, the addiction team will create a tailored plan.
A tailored plan does not mean the process is entirely individualized. Rehabs have daily schedules, which everyone follows, but they do still have personalized plans and care.
The following is a sample of the types of rehab programs and services that may be available, depending on the program type:
- Therapy: Available in both individual and group settings, the methods used will depend on the rehab’s overall treatment philosophy as well as the experience and training of the therapists on staff. The approaches that are used in individual sessions may be used in group therapy, which is therapist-led, or group therapy may use a different approach to provide variety. There are many different research-based therapy methodologies that therapists can draw from to help individuals recovering from hydrocodone abuse.
- Group recovery meetings: The model is the same whether it is onsite at a drug rehab center or held elsewhere. Some groups follow the structure of the 12-Step model while others, such as SMART Recovery, do not involve spirituality or faith. These meetings are member-led (i.e., a therapist does not lead or moderate the discussions). Groups are often composed of individuals who experience substance abuse in general, though some groups may be dedicated to recovery from certain drugs of abuse, such as hydrocodone.
- Complementary treatments: Depending on specific programming, rehab centers may offer a host of services that are targeted to wellness, such as nutritional counseling, yoga, acupuncture, massage, fitness classes, and chiropractic care. At a minimum, a rehab will likely have an exercise room or at least dedicate some free time during the daily schedule for individuals to take a walk or exercise.
- Animal-assisted therapy: Some rehabs offer animal-assisted therapy, such as equine-assisted therapy.
- Expressive therapy: Some rehab programs offer classes in the arts to promote working out feelings in creative ways. It is well observed that drug abuse involves emotional causes – more pointedly, the suppression of pain. Art therapy can individuals to learn how to better communicate with themselves and use different media (such as paint or a musical instrument) to articulate their feelings.
The following are some of the most common types of aftercare for a person who has finished hydrocodone abuse treatment at a rehab center:
- Residence in a sober living home
- Ongoing individual therapy
- Group therapy meetings
- Group recovery meetings (such as Narcotics Anonymous)
- If applicable, regularly (can be daily) going to a methadone clinic
- If applicable, regularly visiting a doctor who is prescribing Suboxone
- Getting regular checkups, including drug tests
- Taking care of any legal, family, or other problems related to prior drug use (Living in healthy circumstances with little stress can help to prevent a relapse.)
There are numerous effective, research-based treatments available to help a person end an addiction to hydrocodone.
The range of services and programs available at rehab centers ensures that there are many opportunities for a person to effectively recover from hydrocodone abuse.