How to boost your chances in heroin recovery
Today’s coverage of the opioid epidemic centers mainly on the dangers of these drugs:
The devastating consequences of using heroin, the deaths that are plaguing America, and how difficult it can be to quit using once you’ve begun.
In some ways this makes sense. As of 2016, there are about 27,000 lethal opioid overdoses per year, a figure that rivals the AIDS crisis in the 1990s. The current estimate is that 23% of people who use heroin develop a substance use disorder. These facts cannot be ignored.
However, people can —and do— recover from heroin use disorders every day. We believe that more people would be able to move past heroin and embrace a life of sobriety if more information was available about how to approach recovery. In that light, we have compiled the different methods available and the efficacy of each one.
Relapse rates in recovery
It is important to note that addiction is a chronic, relapsing-remitting disease, which means that a good deal of people will not achieve perfect sobriety, even after going through detox and rehabilitation. The relapse rate among people with substance use disorders is 40-60%, which is comparable to the relapse rates of Type I diabetes, hypertension, and asthma; in fact, 50-70% of people living with the latter two diseases tend to relapse.
Because of the nature of substance-use disorders, it is important to remember that a relapse does not indicate failure. Rather, it means that the course of treatment should be adjusted so that you can find something that works for you.
However, there are other facts to keep in mind:
- Less than 50% of people who abstain from substance use for a year will relapse.
- Less than 15% of people who abstain for five years will relapse.
What works for you is more important that what works for most people. Keep that in mind when reviewing the different methods below.
Success rates in recovery
To help deal with the difficulties of detox and its aftermath, many people with heroin use disorders will seek a successful rehabilitation program. There are four main types to choose from —detox-only, outpatient treatment programs, short-term residential treatment, and long-term residential treatment— all of which have their advantages and disadvantages:
Detox-only treatment is as simple as it sounds. People with heroin use disorders are given access to either inpatient or outpatient detox services without follow-up or aftercare. Unsurprisingly, according to the American Society of Addiction Medicine, “detoxification alone” only increases the probability of relapse into active use and overdose deaths. Studies on the outcome of detox-only interventions are not promising with regard to the rates of sustained abstinence and recovery achieved after such services.”
However, if you do choose to go this route, be aware that 51.4% of people complete inpatient detox versus 36.4% of people who complete detox on an outpatient basis. It is also important to understand the relevance of your diet while detoxing. Eating foods like wheat bran, vegetables, whole grains, peas, and beans can make symptoms of heroin detox, such as diarrhea, nausea, and vomiting less severe. This may improve your odds of completing detox.
Outpatient treatment is generally less expensive than residential treatment, which can appeal to heroin users with more limited means. This type of treatment can vary in intensity. Be aware that low-intensity outpatient treatment can be limited to drug education whereas intensive day treatment can be on the same level as a residential program. If you choose to go this route, make sure to research your options thoroughly; your likelihood of succeeding in recovery depends on the contents of the program you choose.
Short-term residential treatment
Short-term residential treatment is intensive, but quick, and is often based on a modified version of 12-step programs. The original model consisted of 3-6 weeks of inpatient treatment, followed by long-term outpatient therapy and participation in a 12-step program. However, since the National Institute on Drug Abuse (NIDA) states “that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment,” this type of treatment might not be the best course of action when trying to quit heroin.
Long-term residential treatment
Long-term residential treatment provides 24/7 support, generally in a therapeutic community (TC). If you choose a TC, you can expect to stay for 6-12 months, which aligns with the NIDA policy that any treatment under 90 days will be of limited efficacy. NIDA also states that methadone maintenance for heroin addiction should continue for at least one year, which also aligns with the TC approach.
Therapeutic communities focus on the idea that substance use disorders consume your life, so any approach to rehab should “resocialize” you as a whole person. TCs aim to use staff, other residents, and social and psychological areas for growth to build responsibility, accountability, and productivity.
In addition, TCs include different types of therapy to rid you of harmful beliefs, ideas about yourself, and behaviors and to replace them with more helpful ways to live your life. TCs also tend to offer employment training and other types of occupational therapy on site and can be modified to address the needs of people with special needs or co-occurring disorders, setting you up for the successful continuation of recovery once you leave.
Therapeutic communities have also been proven to work. One study showed that people who used a TC decreased illegal activity by 50%, and increased full-time employment by 10%. The longer you stay in a TC, the more it helps you, too. Another study followed up with TC residents after five years and found that 16% of people who stayed six months or less had suicidal thoughts or made attempts compared to 4% of those who stayed longer than six months, and 28% of people who stayed six months or less were working full-time compared to 46% of those who stayed longer than six months. Based on the evidence, a long-term stay at a therapeutic community is the best first step for people with heroin use disorders entering rehab.
Worried about how to pay for treatment? The Affordable Care Act counts treatment for substance use disorders as one of ten essential health benefits, meaning that all health insurance sold on the Health Insurance Exchange or provided by Medicaid must include coverage for recovery-related services.
Which medications are most effective?
There are many medications that work to fight heroin use disorders, and each type has its own pros, cons, and success rate.
Methadone blocks the symptoms of heroin withdrawal and the “high” achieved by using heroin. It is available as a pill, liquid, and wafer and can be taken once a day under a doctor’s supervision. It can be addictive, so it is important always to take it as prescribed. Success rates range from 60-90%; the longer you stay sober, the more likely you are to remain sober.
Buprenorphine produces some symptoms of euphoria and respiratory depression, like heroin does; however, the effects of buprenorphine are much lower than the effects of both heroin and methadone. It also has a point at which taking more of it does not increase its effects, lowering the potential for misuse and addiction. It can be taken orally or under the tongue. Success rates have been as high as 40-60% in some studies, as measured by completion of treatment and one year of sobriety.
Naloxone is sometimes added to buprenorphine to decrease the likelihood of abuse. It blocks opioid receptors, reversing the effects of heroin, especially in the case of an overdose. A study of people who took naloxone and buprenorphine showed that 54% were sober by the end of six months.
Naltrexone, unlike methadone and buprenorphine, binds and blocks opioid receptors in the brain to eliminate the euphoria and sedation of heroin and reduce cravings for it. It is available as a daily pill and in a monthly injection. One study found that the pill form had a sobriety rate of 44.4% after six months. Another study found that after 24 weeks, 36% of participants had remained sober while using the injection, and the average participant receiving the injection was sober for 90% of the study period. However, it can be difficult to get people to use naltrexone since it does not produce a high of any kind.
Overall, methadone is the most effective of the medications available, but since it can be addictive in and of itself, consider all options before choosing the best for you.
How effective are behavioral interventions?
The efficacy of behavioral intervention depends on which one you use. There are several types to choose from:
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT), which helps you recognize, avoid, and cope with circumstances under which you might use. A study of people undergoing CBT while taking buprenorphine showed a 75% retention rate in an inpatient addiction clinic. Of the 75% remaining in treatment, 75% of their urine tests were negative for opiates and other drugs.
Contingency management (CM), in which rewards are given in exchange for clean drug tests. Studies have shown that 24% of patients enrolled in both methadone maintenance and a CM program greatly reduced their drug use as compared to 0% of the control group. There was also an average decline of 16% in drug-positive urine tests by patients in a CM program versus a decline of 2% in the control group.
Motivational enhancement therapy
Motivational enhancement therapy (MET), which tries to work quickly to provoke internal motivation to stop using and enter treatment. Research has shown that 50% of people involved in this type of therapy remained abstinent for 30 days versus only 21% of the control group. Individuals involved in MET also used less alcohol and had higher rates of employment during the study period.
Family therapy, which is a type of counseling that helps family members communicate more effectively and resolve interpersonal conflicts. Studies have shown that family therapy can strengthen family bonding, reduce drug use in parents, and improve the efficacy of treatment in married or cohabitating couples when they’re concurrently using methadone. Other studies have shown that behavioral family counseling in conjunction with naltrexone is more effective during treatment and a year afterward than individual therapy.
Which factors work against me?
There are a few factors that tend to predict relapse, including:
- Triggers linked to using heroin, such as people you used with and places where you used or bought it.
- Being in the presence of drugs.
- Mental illness.
- Criminal activity, regardless of whether or not it’s drug related.
One of the most important things to consider when choosing a treatment plan is that, according to recent research, combining medications and therapy is more effective than either one on its own. If multiple methods appeal to you, feel free to mix and match as you like.
In fact, ASAM states that heroin addiction should be managed by following these steps:
- Detox, either on an inpatient or outpatient basis.
- Long-term residential treatment.
- Several weeks of a partial-hospitalization program (a non-residential hospital program similar in intensity to residential treatment, but without 24-hour monitoring).
- 90 days of an intensive outpatient program.
- Six months or more of individual and group therapy, potentially while living in a half-way house and attending a 12-step program.
However, only you can decide which route to success you wish to travel. The only thing that matters is arriving at a future free of heroin.
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