Opioid abuse is one of the most serious public health crises facing America today, as the dangerous consumption of legal and illegal drugs has crippled towns, neighborhoods, and cities across the country. For as devastating as the epidemic is, recovery is always possible. Rehab for opiate abuse requires a lot of time and sacrifice, from both individuals suffering from addiction and their families, but it has helped countless people get their lives back.
Rehab for Opiate Abuse
Rehabilitation for opioid abuse entails physically, psychologically, and emotionally weaning the client off the need for opioids. This is not an easy process; opiates force the brain into producing neurotransmitters and endorphins that cause powerful sensations of pleasure, comfort, and analgesia (the inability to feel pain), and clients who have physical or mental health issues might come to think of their drugs as the only sources of relief and escape from their distress. The human body produces those same neurotransmitters and endorphins naturally, but the chemical potency of heroin or prescription opioids increases the production a hundredfold.
Over time, those addicted to opiates cannot think of anything but being on the opioid high, and everything in their lives revolves around getting more drugs; whether it is expensive prescription medication or cheap heroin, the addiction does not discriminate.
Discontinuing opiate intake, whether intentionally or otherwise, deprives the body of the chemically augmented neurotransmitters and endorphins that flooded the central nervous system whenever the drug was consumed. The result is that a user feels physically sick and psychologically depressed, and this increases the compulsion to take more drugs – not so much to achieve the blissful euphoric highs, but to avoid the excruciating and distressing symptoms of the body being unable to function without the opiates.
Rehabilitation for opioid abuse entails breaking these physical and psychological connections, but breaking them carefully and methodically.
Medically Assisted Detox
When a client receives medical detox for opiate abuse, there are two components to the process: ridding the body and brain of the desire for more drugs, and enduring the withdrawal symptoms that arise when the drug is withheld. Cravings for more drugs and the physical and psychological stress of withdrawal can threaten the success of the process and increase the chance of relapse, so clients require constant supervision by doctors and other medical staff members. One way that doctors can ease the detox process is by providing medication to ease the withdrawal symptoms.
The purpose of medical detox is to help clients manage their withdrawal systems by way of reducing the severity of the symptoms. Benzodiazepine drugs (sold under names like Xanax, Valium, or Ativan) slow down the central nervous system, which induces a tranquilizing effect that counters the anxiety and depression that arise from withdrawal. Such drugs are also useful for soothing the physical effects of withdrawal, such as muscle pain and cramping. Psychology Today explains that benzodiazepines are administered during detox as anticonvulsants. Similarly, since the high blood pressure brought on by withdrawal can cause extreme sensitivity and pain, blood pressure medication can be given to help individuals relax and rest.
One of the most important drugs used in medically assisted detox is Suboxone, as buprenorphine that is often prescribed for those going through opiate withdrawal. While the use of methadone as a substitution treatment for opiate abuse has proven controversial because of how strong it is, buprenorphine is notably less potent than other opioids and much less likely to become a source of chemical dependence itself. For this reason, Suboxone is commonly prescribed to help clients going through rehab for opiate abuse.
Nonetheless, even medically assisted detox entails giving vulnerable, at-risk clients drugs that are similar in composition to the opioids that started the problem. For this reason, professional supervision is a must, as individuals are very prone to relapse due to the distress of withdrawal.
What about the opioid detox process is so stressful that a person might need even more drugs to get through it? Psych Central notes that opiate abuse damages multiple systems in the brain (many of which deal with neurological communication and hormonal regulation). When the opioids are gone, those systems are thrown into a frenzy, and the signs of this frenzy are the withdrawal symptoms of detoxification:
- Flu-like symptoms
- Anxiety and depression
- Nausea, vomiting, and diarrhea
- Muscle and joint pain
- Chills and cold sweats
In severe cases of opiate abuse, individuals can experience hallucinations or suicidal thoughts as part of the withdrawal process.
Some people attempt to detox by themselves or by giving up opioids abruptly, without any tapering process. This is incredibly dangerous because the severity of the withdrawal symptoms (which can last for up to two weeks in the case of chronic and long-term opiate abuse) makes relapse irresistibly tempting. The doctors in a rehabilitation facility can ensure that no relapse takes place, and they can administer antianxiety medications to the client to reduce cravings. This is why rehab for opiate abuse should always be carried out with medical supervision, whether in an inpatient or an outpatient facility; home detox and cold turkey detox attempts leave too much to risk. Those who relapse during withdrawal are in danger of making their addictions worse because of how physically and emotionally vulnerable they are during the process. A return to opiate abuse during or after withdrawal could even be fatal.
Inpatient rehab is generally recommended for those with severe opiate addictions, either in terms of the length or extent of the abuse. If the person lives in a situation where drug use might be a risk factor, such as an abusive household or a living situation where drugs are easily accessed, then a doctor might advocate for inpatient treatment, to physically remove the person from the unfavorable environment to better ensure that treatment success is not jeopardized by the risk factors.
A stay of more than two consecutive days at a rehab center meets most of insurance, medical, and legal definitions of inpatient treatment.
Inpatient rehab allows for constant monitoring and supervision of the client through the withdrawal process, allowing doctors to intervene when the symptoms are at their worst and providing a layer of security if the client is experiencing suicidal tendencies. In addition to administering medication, doctors and healthcare professionals can also provide emotional support and encouragement to clients experiencing anxiety or depression during withdrawal.
Inpatient rehab is important even after detox. Clients with serious cases of opiate addiction need counseling and therapy to deal with the psychological damage of their behavior, as well as to learn how to cope and survive without the crutch of drugs. Onsite residence allows for regular and frequent attendance at meetings, group therapy sessions, classes, and other forms of therapy that inpatient rehab facilities provide, such as yoga classes; art, music, or dance therapy; wilderness therapy; exercise classes; cooking classes; and other forms of experiential therapy that are intended to expose clients to new and healthy ways of thinking, problem-solving, and regulating their emotions.
On the other hand, for those whose opiate abuse has been relatively short-term and moderate, and who have an acceptably stable and safe home environment to return to, doctors may recommend outpatient rehab. Instead of residential treatment, an outpatient program offers clients more autonomy in their recovery, on the assumption that when they go home, they and their family members are in a position to ensure a healthy living environment, with little to no chance of relapse. An outpatient program for opiate abuse allows clients to maintain school, family, and work obligations; however, they will be required to attend meetings every day, or a few days a week, and regularly report on their progress to a caseworker or doctor.
A doctor will recommend a person for outpatient therapy if the person has a support network to go home to, and the doctor is satisfied that this network will provide encouragement and accountability to ensure the individual’s sobriety and alert the treatment center and emergency services if there is a relapse. For those who have no such safety net, a doctor is more likely to suggest inpatient treatment.
Co-Occurring Disorders and Integrated Treatment
Opiate abuse, or any form of substance abuse, rarely exists in isolation. The relationship between a substance abuse problem and a mental health disorder is a complex one, referred to as co-occurring disorders. Co-occurring disorders are a simultaneous mental health disorder and drug (or alcohol) problem, regardless of which condition developed first. For example, many people who have been diagnosed with post-traumatic stress disorder abuse opiates to help them cope with anxiety, while some people who have clinical depression resort to taking heroin to escape their feelings of sadness, guilt, and despair.
The standard for co-occurring disorders is integrated treatment, a comprehensive program that tackles the medical, psychological, behavioral, and social fronts that exist in a dual substance abuse and mental health problem. When doctors determine that a person has a co-occurring disorder, the first step is to create a unique treatment plan – one that addresses the immediate presentations of the issue as well as the underlying causes, with a structured, realistic goal for long-term improvement and health.
This can involve personal therapy sessions, group meetings, and family therapy, all with the idea of empowering the client to learn from mistakes, learn how to manage their symptoms, and address personal issues that may have contributed to the development of the problem.
An important component of integrated treatment (and, indeed, most forms of opiate addiction therapy) is an aftercare plan, which entails working with a peer group of others in recovery to maintain the skills and philosophies of treatment in the real world. Aftercare programs, like 12-Step groups, allow for recovery to be maintained and sustained even during periods of stress, loneliness, and boredom, and through the temptation to relapse. Being connected to sponsors and friends who have been through the experience helps clients find solidarity and support among likeminded individuals, which makes a huge difference in holding fast to treatment principles when they are challenged.
Opiate abuse is a truly devastating public health problem. In December 2016, the Centers for Disease Control and Prevention noted that the number of fatalities from heroin and prescription opioid overdoses had overtaken fatalities resulting from gun homicide, to say nothing of the many families and communities torn apart by the new black market for narcotics. Treatment is always available, addressing both the psychological and personal reasons behind opiate abuse, allowing clients and their families to find healing and hope for the future.