How to Approach Healing From Opioid Abuse

Detoxing from Opiates

Detox can be physically dangerous. This is true for any substance, and especially for opiates. Because of this, it’s extremely important to undergo detox with proper medical supervision. Fortunately, doctors have many tools for withdrawal management.¹⁰ For example, your symptoms may be monitored using the Short Opiate Withdrawal Scale. This scale ranks patients symptoms, such as gastrointestinal distress, muscle spasms, aches and pains, etc., on a scale of zero to three. The severity of your symptoms will determine your eligibility for certain non-addictive medications.

Many patients benefit from medically-assisted treatment (MAT) for opiate detox and continued recovery. In this protocol, you may be prescribed medications such as clonidine, buprenorphine, or methadone. The latter is an especially common treatment for people in recovery.

Methadone Treatment for Opiate Use Disorders

Methadone is a synthetic opioid, and commonly used medication for opiate use disorders.¹¹ This drug “eliminates withdrawal symptoms and relieves drug cravings by acting on opioid receptors in the brain—the same receptors that other opioids such as heroin, morphine, and opioid pain medications activate. Although it occupies and activates these opioid receptors, it does so more slowly than other opioids and, in an opioid-dependent person, treatment doses do not produce euphoria. It has been used successfully for more than 40 years to treat opioid use disorder and must be dispensed through specialized opioid treatment programs.”

As effective as it can be for some patients, methadone is not an appropriate treatment for everyone. It may interact with other prescribed medications, causing heart conditions. Furthermore, its active ingredients remain in the body even after its noticeable effects wear off. Because of this, patients may unintentionally overdose if they fail to take methadone¹² exactly as prescribed.

When used improperly, methadone can also become addictive. Despite this, it is often an effective treatment. The neurobiology of opioid use¹³ is extremely complex, and it is absolutely essential for patients in recovery to stay in close communication with a medical team when using any prescribed alternative to narcotics.

Methadone treatment¹² can take place in an inpatient or outpatient setting. If you’ve been cleared by a physician, you may even be able to take this drug by yourself, at home. However, this option will only become available after a period of stricter supervision.

Methadone may be prescribed for short-term use, or may help you navigate later stages of healing. Whether or not you plan to use this medication after your initial detox, it’s important to make a long-term plan for recovery.

Long-Term Treatment for Opioid Addiction

When you’re planning for life after detox,¹⁴ it’s important to consider residential treatment. According to one study, medication and/or inpatient treatment have been “associated with reduced risk of death when compared to no treatment post detox” for people with opioid use disorders.

Various rehab programs offer different types of therapy. You may find that certain types of therapy resonate with you more than others, and this may change over time. Some experts believe that different treatments are appropriate at different stages of recovery from opiate addiction.¹⁵ For example, “psychotherapy may help at the pre-contemplation and contemplation stages, while cognitive and behavioral therapies may be more appropriate for the action and maintenance stages.” A few types of therapy can be especially helpful for patients recovering from opiate misuse.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment, or MAT, is a highly effective treatment for this condition. According to the National Institute on Drug Abuse (NIDA), MAT is an extremely important component of treatment for opiate use disorders.¹⁶ “Abundant evidence shows that methadone, buprenorphine, and naltrexone all reduce opioid use and opioid use disorder-related symptoms.”

Using prescribed substances to treat the misuse of other substances may seem counterintuitive. However, for these particular patients, psychotherapy and behavioral health treatment may be enough. In fact, research has found that medication can improve the outcomes of opiate use disorder treatment,¹⁷ with or without the addition of talk therapy or behavioral therapy.

This data confirms the effectiveness of medical treatment for these patients. Regardless, patients in certain programs in the U.S. may be required to receive at least one form of counseling. According to federal law, patients who receive MAT for opiate use disorders¹⁸ in accredited and certified opioid treatment programs (OTPs) “must receive counseling, which may include different forms of behavioral therapy. These services are required along with medical, vocational, educational, and other assessment and treatment services.”

Cognitive Behavior Therapy

Cognitive behavioral therapy (CBT) is a style of talk therapy in which the patient learns specific, practical skills for navigating difficult thought patterns. CBT is an effective treatment for substance use disorders¹⁹ in general, and opiate use disorders in particular.

CBT may be especially helpful for patients recovering from opioid use disorders²⁰ that began with the misuse of prescriptions for chronic pain. This is because CBT “may be used effectively to treat chronic pain, either as a stand-alone treatment or with other nonopioid pharmacological treatments. CBT improves pain-related outcomes along with mobility, quality of life, and disability and mood outcomes.” This data suggests that CBT may be an effective replacement for prescribed narcotics, whether or not the patient has a substance use disorder.

CBT has also been shown to increase the likelihood of long-term drug abstinence²¹ for certain patients. In one study, “those in the CBT group had more than twice the mean number of weeks of drug abstinence compared with those who received medical management alone.” This treatment was found to be more effective for people who misused prescriptions than for those who used illicit opioids, like heroin.

Contingency Management

Contingency management (CM)²² is a type of therapy that works well for patients who have misused any type of opioid. Some versions of CM, like voucher-based reinforcement, work especially well for recovering heroin users.

These programs involve “tangible rewards to reinforce positive behaviors such as abstinence.”²² For example, a patient might receive a voucher every time they test negative for opioid use. These vouchers can then be exchanged for rewards such as food items, movie tickets, or other prizes. Some versions of CM reward patients with actual money.

It is important to combine contingency management with other forms of therapy,²³ because “treatment effects often dissipate after contingency management is discontinued.” In order to achieve long-term recovery, patients should consider long-term treatment options such as talk therapy and support groups, such as 12-Step programs.

No single type of treatment is right for everyone. As you consider whether inpatient treatment is right for you, remember that there are many different options available. If you can, it’s best to talk to the admissions teams at a few facilities, and learn which types of therapy they offer.

Continued Recovery from Opiate Misuse

Recovering from an opiate use disorder is an extremely personal process. And healing isn’t always a straightforward path. But no matter what your experience has been so far, change is always possible.

As you start to plan for recovery, remember that you, too, deserve to heal. You deserve support and care. And with the right resources, you can begin to create a meaningful and sustainable life.

If you’d like to learn more about inpatient treatment, you can browse our list of rehabs for opioid use disorders here.

Reviewed by Rajnandini Rathod

1. Opioid overdose. (n.d.). Retrieved from https://www.who.int/news-room/fact-sheets/detail/opioid-overdose [↩]
2. Abuse, N. I. on D. (2021, June 1). Prescription opioids drugfacts. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/prescription-opioids [↩]
3. Mann, B. (2020, July 17). Doctors and dentists still flooding u. S. With opioid prescriptions. NPR. https://www.npr.org/2020/07/17/887590699/doctors-and-dentists-still-flooding-u-s-with-opioid-prescriptions [↩]
4. Lost in Translation: Does regular misuse of prescription opioids affect one’s ability to understand others’ emotions? (n.d.). Retrieved March 25, 2022, from https://www.recoveryanswers.org/research-post/lost-in-translation-does-regular-misuse/ [↩]
5. Wachholtz, A., & Gonzalez, G. (2014). Co-morbid pain and opioid addiction: Long term effect of opioid maintenance on acute pain. Drug and Alcohol Dependence, 145, 143–149. https://doi.org/10.1016/j.drugalcdep.2014.10.010 [↩]
6. Treating opiate addiction, Part I: Detoxification and maintenance. (2005, April 1). Harvard Health. https://www.health.harvard.edu/mind-and-mood/treating-opiate-addiction-part-i-detoxification-and-maintenance [↩]
7. Opioid crisis statistics [2022]: Prescription opiod abuse. (n.d.). NCDAS. Retrieved March 25, 2022, from https://drugabusestatistics.org/opioid-epidemic/ [↩]
8. Opioid Use Disorder | psychiatry.org. (n.d.). Retrieved from https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder [↩]
9. Hoffman, L. A., Vilsaint, C., & Kelly, J. F. (2020). Recovery from opioid problems in the us population: Prevalence, pathways, and psychological well-being. Journal of Addiction Medicine, 14(3), 207–216. https://doi.org/10.1097/ADM.0000000000000561 [↩]
10. Information, N. C. for B., Pike, U. S. N. L. of M. 8600 R., MD, B., & Usa, 20894. (2009). Withdrawal management. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK310652/ [↩]
11. Abuse, N. I. on D. (–). How do medications to treat opioid use disorder work? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-do-medications-to-treat-opioid-addiction-work [↩]
12. Methadone. (n.d.). Retrieved March 25, 2022, from https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone [↩] [↩]
13. Kosten, T. R., & George, T. P. (2002). The neurobiology of opioid dependence: Implications for treatment. Science & Practice Perspectives, 1(1), 13–20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/ [↩]
14. Life after detox: Can medication and residential treatment for opioid use disorder reduce risk of death? (n.d.). Recovery Research Institute. Retrieved January 24, 2022, from https://www.recoveryanswers.org/research-post/medication-residential-treatment-opioid-use-disorder-reduce-risk-death/ [↩]
15. Treating opiate addiction, Part II: Alternatives to maintenance. (2005, May 1). Harvard Health. https://www.health.harvard.edu/mind-and-mood/treating-opiate-addiction-part-ii-alternatives-to-maintenance [↩]
16. Abuse, N. I. on D. (–). How effective are medications to treat opioid use disorder? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder [↩]
17. Medications for opioid use disorder improve patient outcomes. (n.d.). Retrieved from https://pew.org/34ixgdT [↩]
18. Mat medications, counseling, and related conditions. (n.d.). Retrieved March 25, 2022, from https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions [↩]
19. McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive-behavioral therapy for substance use disorders. The Psychiatric Clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012 [↩]
20. Psychologists’ role in helping to treat opioid-use disorders and prevent overdoses. (n.d.). Https://Www.Apa.Org. Retrieved March 25, 2022, from https://www.apa.org/monitor/2017/04/ce-corner [↩]
21. Psychologists’ role in helping to treat opioid-use disorders and prevent overdoses. (n.d.). Https://Www.Apa.Org. Retrieved from https://www.apa.org/monitor/2017/04/ce-corner [↩]
22. Abuse, N. I. on D. (–). Contingency management interventions/motivational incentives(Alcohol, stimulants, opioids, marijuana, nicotine). National Institute on Drug Abuse. https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/contingency-management-interventions-motivational-incentives [↩] [↩]
23. Bolívar, H. A., Klemperer, E. M., Coleman, S. R. M., DeSarno, M., Skelly, J. M., & Higgins, S. T. (2021). Contingency management for patients receiving medication for opioid use disorder: A systematic review and meta-analysis. JAMA Psychiatry, 78(10), 1092–1102. https://doi.org/10.1001/jamapsychiatry.2021.1969 [↩]